06040149 CITY OF CUPERTINO
BUILDING DIVISION PERMITNT{RACTQRINF �e ' Ol!X
BUILDING ADDRESS: GEORGE & ANGELA SHU --rND'06040149
10280 TULA L
0 �ER'SHAME
:WPERMIT ISSUE DATE
GEORGE & ANGELA SHU 2006
PPME: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMITINFO
BLDG EO PLO t�
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LICENSED CONTRACTORS DECLARATION Job Description
I hereby Lamm Net I am licensed under previsional of Chapter 9(commencing
wlm Scmiw 7010)of Division 3 ofine Business and Professions Code,and my near=1.
inmllramecadarrarl. 5 �5 Z SFDWL-2 STORY 3507 ' /GARAGE 452 '
ween= Ise.
i 4Fp Dem LSDECI.A ATION
j a 7W7W� 1 underwnd
my plana shall be used as public rtcafds
t
Licensed Professional
'1 N atI..cemptOWNER-BUILDER DECLARATION
f 073 1 hereby.(Bens on 1 em uemnt from the keatowreh License law for me
:00 o fallowing rea=r.(Soman conker Business and Improve,
de um Com:Any city or county
'$ which is issuance,
s omnis ac eonswct altar.Wprow,demolish,m repair ed swment
pdarbitsieased Pal Palmer,in
me the appnt of the=chprmtitm ale a signedstatementValuation
markhlicenad pSesumt=meproetians 3.fim Businesses
Pmf aw(C Ow Sq.FL Floor Area
i� (commencing with Section 7000)af DivuionJaf the Budnetsmd Profmiov Code)= 851183
9 met k u exempt Nerefraa and the basis for the alleged crempuan.
Any
violation of
Section 7031.5 by any Applicant for a permit subjects the appheant an a civil penalty of APN Number Occupancy Type
not mart than five litualand dollars(5500).
❑L as owner of the property,or my=play.with"gas udealt sele ammo and".
win do the work,and the mumu=u not imended or offered for am(Sa.7014,Buuness
anRequired Inspections
d limitations Cam:rano
Ceanters Llense site,elaw set apply man owns Or 9 P
property who funds ds or Initiatives monsoon,and who dues such work himselfor through his
awn amplaycv,provided wt such Improwmmts ere sot Intended or offered for sal.IL
however,the building or improvemcm Is W14 within ane year of comptetian.the cancer-
builder win haw the books of proving mat k did not Wife or Improve for purpose of
sale.).
❑1.as owner of the property,w tentatively wenvaNng with licensed ceneacma m
cmmrwn the project(se.loan.Business and Professions Coda)TW Cwmmaral u- -
cove taw mm ate apply to an Owner&Property who Wilds arimpawy demon.W.
who contracts for each projects with a co irecmr(s)Reeved pursers=me Contractors
LKC.Y raw.
❑1 anO memos unser See ,B&PC far use...a
Or
Date
WORKER'S COMPENSATION DECLARATION
I hereby aRUrs maker penalty of perjury arc of tie following declarations:
1 hawand will mainWn aCerOmm of Covent m self-ivu=fa Workers Campmt.
swan,as provided for by Section 3700 of the labor,Code,far the pedammnce of am
work for which this permit is issued.
I have and will maintain Workers compensation Issuance,as required by Section
3700 of the labor Code,far the performance of the work fa which the permit is lamed.
My WarkcY C wuoo Tronas carrier and Policynumber 1=:
Cartier. S- f - Bey No.; /7796x-.6
CERTIFICA OF EKEM N FROM WW ORKKERS
COMPENSATION INSURANCE '
CThts secuv wed trotse completed time permit is frecom hnn&rddenem(f loo)
or Ices)
1 unify that in me perfmmaae of m work for which this posit ts listed.I shell not
employ any person in my mannerm U ke become Wbjm In me Workers CMPWWM
laws of California.Dm
Applicant
NOTICE TO APPLICANT:If,after making this Car ianm of Eaempuan,you should
become subject in me Workeh Compensation provltiov of the LAW Com,you muet
3z formwim comply with such provision of this permit shall k deemed invoked.
z o CONSTRUCTION LENDING AGENCY
[.r 4 IWmby afnrm ren dem is a constructions lending agency for the performance of
o >
the wart for whim this permit laissued(Sm 3097.Cia.C.)
W G lancers Name
z Lnenel Address
V 0 I unify that I have reed this application and sum mal the aWw information 4
Iy f~ corms I agree w comply with all city and county ornament and state laws ralaling in
OU Wilding construction,and hereby authorise inpretentstlws of this city to ensu upon he
W above-mentioned property for inspection Purpoma
93. (We)agree to save.indemnify and Yap boost.the City Of Canadian against
rF.t rq Iiabiliues,Judgmcn0,<asts and eapenan which may to my way acc'^m againstvid City
V z In consequence of me granting of this portion.
v"v
APPLICAffr UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EGUI.A 1 NS.
0; w6 Re-roofs
Sigtmum v ren r. Data
H nus MATER IS DISCIASURE Type of Roof
Wlllmcapplicm rfuture Wildingo pant nam Or handle harardans mammal
as m0ned by the Cupertino Municipal Code.Chapter 9.12.and the Hvlth and Safety
Section 35531(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 0 N
Will me applicant in future Wilding Occupant tom equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
..It haaMv air com eninmts a defined by the Bay A=ss Air Quality Management all new materials for inspection.
DiruicO
❑Yes ON.
I have med the h=ahem materialsrequiremenu under Chapmr6.95 of the Center.
Hmlm&Safmy Cade,Satiam 33505.25533 wu135534.1 understand mounds:Wilding
data neME
c Orly hew a tenant,that It i my mpomlhtlity m notary the oaupmt of the
mquim which be a, ' uanecofaCrmWalmofonmpmcy. Signature of Applicant Date
6- ? -04
All roof coverings to be Class"B"or better
Owner of mthoriad ages Dam'