04040077CITY OF CUPERTINO
t � j�^rxx''"`�/'?
;,CONM1 "C , R I' �FO;I2MATI0_
BUILDING DIVISION PERMIT
-NgA,''
BuaDING ADDRESS:
LING YANG
PERMIT ND04040077
33
R'S NAME:
PERMIT IESUI DATE
LING YANG
E;
SANITARY NO. CONTROLNO.
ARCHITECT/ENGINEER:
- -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
hereby affirm Nal I em licensed under provisions of Chapter 9 (commencing
p
with Section 700u) of Division 3of me Buslnessand Professions Coda, and my licenec is
1. fellfe and coat.
. SFDWL-2 STORY & GUEST UNIT.
Lice Cls Cleo toe. a
Dam Contractor
LIVING 5,159 GARAGE 450.5
ARCHrrECrS DECLARATION
I understood my plans shall heuasd as public =ends
(GUEST UNIT 766.5 INCL)
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from de Contractor's License law for the
following ¢axon. (Section 7001.5, Business and Professions Code: Any city or county
which requires a permit m common. alms, improve, demolish. or repair any surmount
prim in i% issuance, else mquim tie applicam for such permit to file a signed statement
Ft. Floor Area
Valuation
that he us licensed purriam to the provisions of the Conscious license Law (Chapter 9
Sq.
(commencing with Sutton 7000) of Division 3 of me Business and Pmfesaions Code) in
$650000
that he is exempt decrefmm and the buts for toe alleged exemption. Any violation of
APN Number
Occupancy Type
Sudan 7031.5 by my applicant for a permit mbjecs the applicant 10 a civil penalty of
not mom Nan Ow hundred dollars ($500).
❑ i. a owner of ft Wopmy, m my emplayees with wagu u thevwle mmpcmdm.
-
Required Inspections
willdemework.andthewumureismlintendedoroRemdfmsale(Sw.7044,8u wed
and Professions Cade The Gentlemen en Lianas law docs ml apply m an owner of
-
property who build, or hormones Namur,andwhodoessuch work Mmselfor through his
own employees, provided distance imprommenuam notimerWW moRemd forssle. If,
however, the building m improv em, is held within one year ofcompleuon. the owner.
Wilder will have the burden of proving Nat he did nm build in improw fm purpme of
vele,).
t as towner of the property, am excluaiwly convecting with licensed con=lon in
the project (Sec. 7004, Business and Professions Code:) Them U.
come
menton.
anus law Once not apply m an awn. of property, who beide or improve Commas and,
La
whocommentLA.' (m such project, with a coetractor(s) licensed pmuum m de Canuanor's
we Law.
exam Tse P C for Nu euon
' IYn�Y/> /n � 17 �
•
s� /
Dau
Dam
WORK HIS COMPENSATION DECLAR�
I hereby affirm under penalty of perjury arc of the following dulwatinnX
(`
�oOJ
haw and will mal A Certificates of Consent m wlf-amu, for Woraces Cooper.
limon, u for by Section 37M of me labor Cade, for me performance of she
y
.Y
pmvidad
were for which mix permit is inaed.
❑ 1 have and will maintain Worker's Compensation Insures, u required by Section
(�
3700of me Labor Code, (m me performance of me work for which mi, permit is issued.
�
My Worker's Compensation Insunwe carrier and Policy number toe:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu aecOm wed not M completed lithe permit is farm hundred dollm($100)
'
or less.)
1 eemly Out In the pmfmmance of de wart for which this permit is is a d, I shall not
employ any perms in my manrcr an u Is become subject in Ne Worke W Compenution
.
Laws of Califianda. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Esemptien, you should
become subject in me Workers Cmmcnamon pmvisiom of die labor Cade, you muss
forthwith comply wish such provisimu in this pmmi shall W dcemW moked.
CONSTRUCTION LENDING AGENCY
I homby ui in. that Nen is a coutructlon lending agency for the performance of
me work for which this permit is issued (Sec. 307, Civ. C.)
Lmdces Name
Lenders America
1 certify Nu 1 low mad mis application and mm mat me above information Is
comact. I agree in comply with all city and county ordinances and atom laws relating to
building construction, and hereby am ombs, mpmasnutiwa of mi, city to enter upon the
,
slaw-menuansA property for impaction purpoass.
(Woe) agree in Pw, indemnify and kap harmlen the City of Cupertino against
liabilities, Judgments. toss and expemm which may in any way .taus against said City
in consequence of Ninstalled tind of this permit.
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dare�
SOU GULATIONS.
Re -roofs
Type of Roof
'O
Sr une i'ApplicanUComasta, Oa
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building amupenumre or handle Innocent; material
fined by the Cupertino Municipal Code, Chapter 9.12. and die Health and Safety
,
. Seetian 25532(x)7
QYes 6No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will die applicant or future building occupant use equipment or devices which
IthauMnm aI,conumiess defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes
I have mad the haunlnusmemrials mquim ante undercheper6.95 ofthe Califor.
ria Hmlth,k Ssfety Code, Secu=25505,25533 md25534.I understand Ihaifrec building
door mi c ly haw A tenant, Net It is my mpensibility m wufy the ucupwi of me
ich Win W met prior m t.uccuse ofconi tomo cy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
94m or authmbedagent