07120119CITY OF CUPERTINO:�T�=aropr.�k��,.ri�"
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BUILDING DIVISION PERMIT
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BUIDING ADDRESS:
19705 STEVENS CREEK BLVD
TBD — TO BE bETERMINED
PERMIT NO.
07120119
W NER'S NAME:
PERMIT ISSUE DATE
DR HONG HE
01/18/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITF.CTIENGINEER:
BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
uon
t 1 accused under previsions of Chapter 9 (commercial
1 hereby affirm Wam
withSmaon7O110)ofDivi6lon3afthe Buvneaaad Nofeukns Cody,aedmyalice—is
T. I. DENTAL OFFICE NON—STRUCTURAL, INCLUDES
in full force and! effect
�'
Lie eaacClw//--..-- Le.0
,ELECTRICAL, MECHANICAL, & PLUMBING.
DauA�Sntrutol"
C DECLAR O
1 unMntanJ ml Plans shell he toted u W bllc rsord.
Leaned Professional
OWNER -BUILDER DECLARATION
I hereby affirm Net I am ucmpt room Ne Contractors License Law for the
following moon. (Section IN 1.5, Business and Prefwinns Cade: Any city or county
which tequlms a permit to comment, alar, imr mm demolish, or repair my structure
prior to its issuance, also requires die applicant (or such permit to Ne a signed sources,
he is licensed to the of toe Contrnelaes U... Law 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions (Chapter
-
xr..110000
(commencing with Sudan 7008) of Division 3 of am Business and Prufwions Code) or
4
this he k ...at therefrom and the buss for the shaped assumption. Any vinlatias of
MI
Occupancy Type
Seems 7031.5 by any applicant fora permit subjects the applicant to .civil penalty ofumber
.atmdrt than five hundred dollars (SM
31620083
0 I,aownerof Jaepmputy.armywpioyeuwithw{esudeeirmicmm melon,
Required Inspections
andthets,Momuom'sLt. aowdolouau(Sec. 7014. BuWrcoa
andoothework
aro PmfwW4N Cam: Tha Contramrs law dao ret apply w owner of
IMviirepressthmeon,wdwhe doessuch tutshimselfedthrmlhh .
ondaam r
ownpropertyon lom s, imPmwmwu am not laume We B.
awn employes, provided ed m
...
ledred
imprmch
year o
year or mproeforn.
—
pupwneo-
builder will have the bttNen of previa{ Nat he did sur Wild m improv far purpose of
Wilms ill aveting eWmprevemmtumlowiiinot
,
❑ 1, as owner of the property, sac exclusively contracting wide licensed come com to
mnstrect the project (Sec. 7014. Business she Prefwlons Cade:) The Contractors U.
cents Law does not apply to an owner of property who Wild, or improves thereon, and
who contracts for such projects with a contraction licensed pursuant to the Contractors
License Law.
El 14m aempt under See ,B k PC for this moon
want Data
.
WORKERS COMPENSATION DECLARATION
1 hereby aElm under penalty of perjury ore of the fallowing deelaratiotts
0 1 have and will maintain a CaNBau of Caruent toself-Ia me fed WorlmesCompm-
wor, at provided for by Section 3700 of the Labm Cade. for the performance of dee
were for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance drum work far which this permit Is Issued.
'
My Wari CompoaNp'Immrana mer and Policy mamba are:
Carla L Polley No.:
•R ATE OF EMPnON FROMW ERS'
COMPENSATION INSURANCE
V
(This section need not he completed If the permit i. Tremae hunmeddollm ($IN)
or loss)
I cerdfy, gut in toe performance of the wars for which this permit 4 istuN, I WWI not
employ anypcason In my mamcr se u la mature subject to tits' Wdrmars' eampmusedon
Laws of Cahmoods. Data
Appilcud
.
NOTICE TO APPLICANT: IL after making this Certificate of Eacmption, you auk
heceme subject to dee Wo u r. Compensation provisions of 0m Labor Cade, you most
forthwith comply with such pmvWons or esu permit.ball he dcancd remitted.
CONSTRUCTION LENDING AGENCY
I hereby Mm that then is a consuuctinn lending amnry for the performance of
the wort for which this permit la issued (Sec 3097, Civ. C.)
Lender's Name
_
Lender, Addrts.
I certify teal I have read this application and mm Wt the show: information is
comet. 1 agree to comply with WI city and county ordinances and sum laws relating to
building construction, and hemby wanxim representatives of Nis city to cater upon the
above-mendoned properly for inspection perpaes.
(We) agree to save, indemnify and keep hamlw the City of Cupertino against
Ilabiliu m, judgments. corm and expenses which may In my ray mome against aid City
in consequence of the granting of this permil,
APPLICANT UNDERSTANDS AND WI OMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R GU NS.
Re -roofs /
!/
Type of Roof
Signawrto APPIiunUCantrretorDate
HAZARDOUS MATERIALS DISCLO RE
Will dee applicant or fuium Wilding occupant store or Moore h oto mauriW
as darted by the Cupenlno Municipal Cade. Chapter 9.13, and the Hulu and Safety
otic, Section 25532(a)7 j
0y. 45rN.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,agree to remove
Will sac applicant dr futu building occupant use cqulpmmt or devices which
.I
emtr ha'raNmu airconuminaa u dall m l by the Bay Arta Air Quality Management
all new materials for inspection.
District?
G Ye. } No
I have mad the haardcvts mo uriats requirements under Chapter 6.95 of tits CWirm,
itis Hulthl:Seciy Cadc.Scctiau2M5.25533an 534.1yptlsrsm duatifthe buil Tal
data t curmnWMa
tooy w a count. this it u my respons 'll u mufy toe memart of the
"q"imm`ntswhi` �i1m"m`poortom 'CcmksmerO""parry'
Signature of Applicant Date
�/�jAll
roof coverings to be Class "B" or better
Owner u authorized agent Data