01100104 CI DING DIVISIIONNO
BUPERMIT CONTRACTOR INFORMATION:
BUILD I NO ADDRESS: PERMITN0.
10108 TANTAU AVE. CHI-KIN LAN & CHUNLING L ANG 01100104
EMsur—TIN LAN & CHUNLING LIANG 10APPUC8/2001
PHONE: SANITARY NO. CONTROL NO.
q 0 Zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
EL'w BLDG ELECT PLUMB MECH
aiq� u u u u
8,aa
y Z LICENSED CONTRACTOR'S DECLARATION Job Description
M1crcby affirm that 1 am licensed undo provision of Chapter 9(commencing REROO F .
•yew
its. 7000)p(Uivi on3of she Busin<a and Promssions Code,and my license
imE.Ji ismmuforce and evea.at ADD 2ND LAYER WITH UL.
o,ae,a License Class Lic,It
'0 a O Date Contractor
LLO ti ARCHITECT'S DECLARATION
gI understand my plops shall Ive used m public records
i
i d o Licensed Professional
OWNER-BUILDER DECLARATION
Iherebynaso affirm that 11. exempt from the Contractor's License Law for the
I_•Z0
following reason.permit
tt ]onstrBusiness and Professions Code:Any city or county
Y o which rcquves°gamest to conawn,alma improve,demolish,or repair any stmnttrt
a3$ ,..prim.msli rwealwreq rcthermons of for Contractor mOkaeLaw(Chmmem� - . .. - ..-- _ - - .. _ _ _ ------
_ ______
0mldslde licensed am tWISH sof the Contractors ad se Law(ChapterC 9 S /1% A. ACC. a- "\ Valuation
Teo g.iwith mip,Naq mina r me
aofineBnmasanlumh. anonaeod i' �.t@)'l ,(:t'.eq'704 x.<i•va��1''k't
or mai he&eacmpt zany applicant
ordant the basis for the ctYgm pkeica t to Any l Penton 1
trisection a than v any hundred
d ll for a permit subjects the applicant m a civil penalry-
•or not more man Ewe nuaarca eonars(aspt). APN Number • , Occupancy Type
❑1;n owner ork. progeny,ser my employees with wages offered their r s le(S e 7 i4,L
305 — FRAME
win ne me work.ane me inmcme,is not mtermea er seLaw for axle apply toa n 307 - I N S ULAT IIQ p
'Bu§mean and Professions code:The Contractor's License Low does not apply to an aired Inspections," '
owner of proxy who Nil&or improves d erw.and who does anon work himself 601 — ROOF TEAR OFF
or through his own employees.provided Out such improvements am not intended or -
Coffered foi-ride.IQbowever,the building or improvement is.sold within one year or 602 — ROOF- PLYWOOD
pletion,the ow er-Imider will have she burden of proving thin he did not build or r
ro fit p 603 — ROOF BATTENS
604 — ROOF IN—PROGRESS
sownerehhep pent'am Businevely ontmaivical license oCost norsto
License
consumer the does
no(pec. to a,Business pro Professions Code:)The Contmaor's f ., .',I .,,
License Law docs pat apply to an owner of property who builds s impnva d.to the
7. -and who Gannets nor such projects with I a conuactI I licensed Pusauans.to the
01C.ram
License Law... 1 'g&P C for this mason '1 h'•",'1 „',❑
_ ❑1 em tempt under Sec_ II�,r� C •�
Owner, WORKER'SOMPENSATIONDtlECL/RATION DEC O 5 ZOO1
Ithereby aRrmuad erpe nal. f irejury.7no hefmlowingdeclarations: BUDDING
° 1 have and will maintain's Ceeificaie'uf Conxni ro self-insure for Worker's
Compmoinion, as provided for by Section 37W of the labor Cade, for the
_ pnfbnnance of the work for which thispantie is issuci ,
❑1 have and will maintain Worker'.Compensation Insurance,as required by Section
3]00 of the Labor Core,for the performance of the work for which this lateral is
ixsued.MY Workeh Campmution lnumnce canter and Polity�umberam:
}r� {'•off '�s�a ......_...
Carver a..' i i .l''u Polly No - f'Y'•R dr" �i: t f7. f.a'.e'Ll A...11 ii9_J_4;:
I ,1 CERTIFICATION OF,EXEMPTION FROM WORKERS', -
(This septan deed nen be'av!COMPENf5PT1�N,INSURANCE". . r .. _.------
If she Permit Is for m e hundred dolling -
f$100)or 1p,,) h
l ri ft'that n the performance of Oo rk'forwhich mu pennis is aucd l' •. . - , '. li t..l l�t.�i' 1 Ht1,, '."t,
tehell'not employ any person in my ma es as to become subject to she Workers
compcnnion Laws of California.Data r
on
NOTICE TO APPLICANT:If,after making this Cmuftimte of Eaempuon,y.'..Omle " `•" "
become subject tb the Worke s Compsmation Provisions of the labor Cade,you must
C) 0 forthwith comply with such provisions or,this Permit shall be decided revoked. '
. ._. _...
r'Z+.� CONSTRUCTION LMDING'AGENCY '
1 hereby affum that tem is a conswcton lending agency for the perfomurrcc
of the wore for which this permit is issued Istt.3097,Civ.
Id_Q L<nder'S Name... .. r .. . .. . . . . .. .. _ .
U ! I certify thou l have rend this ii licmion and ante rhaphe above information is
W=E" 'correct.I agree to comply with all city and county,ordinances,and state laws relating
U m Wilding contraction.and hereby authorimiepresensatives of Nis city to enter upon
rig) sure eboWil'a om(6 property for inspection keep
pmlhous. � _ /
E,h S es.judgme m.costs and
expenn0 k hi h may intmy wa accrue
gain',
liabilities,judgments.coxa and ng Of.Or which may in any way nccrve egainn said
U ► City in consequeece of the gmming of this gam.
APPLICA UNDERSTAN ND WILL COMPLY WITH ALL'NON+PoINT
. _ souRcz� L3�ATION .� l�.;r. � Issued by: Date
si'mume ofApplicanUCo tractor - /Dae Re-roofs
; HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or mate,baldmg=Want strep or batidl ba3mdew mammal' Type of Roof -- --- - . . ...-- ..-
-" ss delved by the Cupertino Municipal.Code,Chapter 912,and the Health and Safety -
Code 5 t n755R1 )7t ,Y s•„,,, l •• t f,t� �' `
1.0 Yes ; IN. t,
- All roofs shall be.inspected.pnor.to.any,roofing material being.,mstalled..
. _� A, .
Will he pg0 to future Wim ng ,nt use can pment devices which If a roof is installed without first obtaining an inspectiori;'I agree�to remove
coil h d s it,co tem t elfin d by theB y Arte Air Quality Menegcment
n.tr n all new materials for inspection,. Applicant understands and will comply with
°ren all non-point source regulations: ,
,t
"I have rtatl she loo,i doua mmmals rcgairemI am under Chapter 6.95 of 0,
,Calirornda Health&safety Code.Sections 25505.23533 and 25534:1 understand that
hf the Wilding deer not cursendYheveamnona that it is my responsibility canonry the lD/�tr �Q /
occupant of the normo idents which mast be'riin prior m issuance ora Certificate of
"np°"` Signature of Applicant Date
_r Dwnt"m oge�t ” �a'1CJ I All roof coverings to be Class"B"or better
OFFICE
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