04120020 CITY OF CUPERTINO n�ae�ss,,-�� ar/-� z+ a@«^'•,4x1,^x'n" 3L °+�` _
BUILDING DIVISION - PEnLYgyT
•wf1E•7a'9 . .,.5'13 .yX°• ., tr5+.r..,iq�l,. 3, a,as ,S
BuaDING ADDRESS: MASTER BUILDER & CONSTRACT A"T"°()4120020
510 S TANTAU AVE
R'S NAME: P®2Mrr LSUB DATE
WAYNE LIN 2003 ABBEY LANE
HE: SANrfARY NO.. CONTROL N0. -
(408) 866-0999
ARCHIIEC(ENGINEER; BUILDING PERMIT INFO
- BLDG ELECT PLUMB MEC"
+�oo LICENSED CONTRACTOR'S DECLARATIONlug JobDescription
U00
1 hereby affirm tirom flamedO
1 a
under provisions of Chapter 9(commencing
with Section 7000o1'Division 3o1'the Busircu and Pmfeulw Code,and my licence is - - -
P Eafull fo=andaReer. TEMP ' POWER SERVICE
SR? Uwaducas Ln.N
z Das - Contractor
? ARCHITECTS DECLARATION
1 u ellma id my phns"I ha
Ise mod public records \e
3 G Licensed Potfcealnnel ` \
S Oat I am exempt
fr DECLARATION V
a 1 hereby.(Sion that 11. exempt form the Caninctoad License Law for the
p o following reason.(Section 7831.5, L Business and improve.
Profession,Code:Any coy ai county
$ which requires;a e,tilmre cores cl aper.impmw,demolish,or mpsir any umme e
priormsl iensedpauu requires theappficant fmsuoh Pcmr's Liens,ic ,Lmdsummenl -
gg <
that
ermarccenwdpuewam to the of Division
of the Contractor's Uccna6s4(ChePter9 SQ.Ft.FloorArea alUatlon
g thammenang withhSection
refrom and
basism3 ofsWBmineuand Prates s Cade)of
that ho h eumpt therefrom and the bah for the alleged eavnption.Any violadon of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penally of _. - -
not more then five hundred dollars(salla). or - Occupancy Type.•...' �.
❑Las ownerof the property,ar my employem with wagon a their solacompenadan, .
and do Ifs work,end the tectum h n ces Lhded,Law itd f an,a(Sec.7016, water of ,
and enywh obu Cade:The Conuactota Ucense Law dm ort apply if an owner of - Required Inspections -
pmpertywho builds mimpmwa therenmatidwW dmasuchended w saUarthmugo his
own em.the
provided that such Improvements wit are not year
cdc martrnd foesaln IL
hawser the Wilding at Improvement ovemmtgshat he
rare)ld ofImprovforompletion,theawun
builder will hove Us burden of paving that he did not Wild or Improv for purpose of
u .1.
owner of the Property,am exclusively contracting with licensed conaatnn in
construct the project(Sec.7044,Business and Pnfrviom Cade:)The Cmeacmr's U.
mole law does not apply m anowner of property who WilN m improves Nelson.and.
who contracts for auto projects with a conusaor(0 licensed pursuant Indo Conuames
Ucena Lie.
lay^, pt under .B k PC forth n
/ 11 Dam K
WO SA FL RA
I heabyefllrm erpe ty ofpedury ontofthe ing declaWiom: _
1 haw and will maintain aCerdfieae of Commt malf-insum fm WoduYs Compen.
cation,a provideA for by Sutton 3700 of the Labor Cadc,for.We performance of the.
work for which this permit is hoed.
❑1 have and will maintain Worker's Compensation Insurance,u required by Section -
37(0of he Labor Code.for the performance of Ne work for which this permit is issued.
My Workers Compenation minumme carter and Policy number am:
Carrier
Policy No.:--
CERTIFICATE
o.:CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section meed out ho complem i If IW Permit is fmamhundsed doilies(5100)
or lass.)
1 mnify that In the perfomance of the work for which this Permit is Issued,I shall not
employ any person in any manoer an as to become subject to the Workers'Compensation
Laws f California.Data
Applicant -
NOTICE TO APPLICANT:If,eller making this Oci ifims of Exemption,you should
become abject In We Worker's Compensation previsions of We Labor Code,you most
Qforthwith comply with such pnvhinm or this permit shall be dcemod mwil ed.
r 4CONSTRUCTION LENDING AGENCY
[•+ thereby affirm that them is s construction lending agency for the periomau:e of
> the week fee which this permit is issued(Sec 3097,Civ.C.)
GQ Landers Nme
=z Landers Addrus
U Q I ceNfy that I have ress!this application and sum that We show information is
IL �' comm I agree to comply with all city and county ordinances and some laws misting to
C U Wilding construction,and hereby memorianprvsnmiwaofthis city menter upon me ,
{17 strove-mentioned property for inspection purposes.
(We)agree In saw,indemnify and keep harmless the City of Cupertino against
y Rabflfdm,judgmenu,cmuudexpemeawhichmayfn Nywyatemelgdmtmid Ay _
t)'1 in
nce of Ne grand g this Permit. - —
F7NT UNDERST AND WILL COMPLY WITH ALL NON-POI Issued by: 67Date
GUl.AT10N
le-roofs
D 3 MATERIALS DISCLOSURE 'I Dam Type of Roof
l dw appllcan Into building mcupanl store or handle hasallous material
by the Copan o vdPal C.
Chapter 9.11.and the Heath and Safety
on 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.et aIf a roof is installed without first obtaining an inspection,I agree to remove
l the applicant or future Wilding occupant me equipment or deviaa which
om air conmmtnents a defined by the Day Area Air Quality Management all new materials for inspection.
on /,aqs\',u
wmadthehaaNnusrd rials ngWmmeou order Chap.A95afds Glim,
nit Hcalm&Saety Code,
SE
1505.35533 au125534.1undcramddmffihebuildinit
dose not cumn0y hawamne Ntiamy mspomlhilily ptonoYly accts InI the
myvimmenu m_be t orInfaderwo eCrh03uof
_Q a, Signature of Applicant Date
Ownerarauthorized e a gm All roof coverings to be Class"B"or better
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
i UPEI�TINO
Building De artment
JOB ADDRESS: PERM k QL w2®oz-o
.OWNER'S NAME: U->C�-ktrE Ltrk PHONE # t(,�S 666 D Q
GENERAL CONTRACTOR _ FAX# 4�
I am not using any subcontr l`L 2-
Si a Daie
Please check applicable subcontractors and comp to the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�Z2 O
Owneryo or Signature at
CITY OF CUPERTINO 6 b Z
tai TEMP POWER
CUPEkTiNO PERMIT APPLICATION FORM
APN# Date:
D p
Building Address:
0510 'S. —CAts t�
Owep is Name: hon #:
Contractor:' License#:
Contact. Phone: Cupertino Business License#:
Building Permit Info:
Elect ❑
Job Description:
Residential �gf ommercial ❑
Cost of Project\:
,Xppl)cwe Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE 'Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
� � 7 ^2,