06070093 CITY OF CUPERTINO A "' `,`
BUILDING DIVISION PERMIT C®NTRACTORINF,ORMATION,
BUILDING ADDRESS: GEORGE & ANGELA SHU NO 06070093
10280 TULA LN
O NF.R'S NAME: PERMIT ISSUE DATE
GEORGE & ANGELA SHU
PRUNE: '
SANITARY NO. CONTROL NO.
ARCHITEC`ENGINEER: BUILDING PERMIT INFO
BLDG EtFcr PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION Job Description
w F I hemby affirm that m banned al 1 ad under provisions of Clasping 9(commencing
:ZW with Sanirn7")of Division 3 of the Business and Profession Code.and my license is
F to fall fame ad cffca RE V I S ION-STRUCTURAL .CALCS
? License ClassLie.9
mo
• o Dam Comrxw, ORIG PERMIT 406070093 NO NEW PERMIT
ARCHITECTS DECLARATION
i I understand my plans shall h used as public records
ayU
'Oy LICCOSCd Pmrna4lanBl
OWNER-BUIIDERDECLARATION
<S I hath,sifirm Nat I em exempt from Ne Canvaears License law to,the
:❑O fallowing return.(Section 703 t.5,Business and Profession Code:Any city ar coumy
jm which.quires a permit m creatine,after,improve.dcmaiish.or repair any ssmesure
Prior 41 its issuance,also mxUimS the appllCLtt forsuch permit in EIC a signed stanni O that he u licensed Purwamt m the provision m
of the Contractor's limns Law 9 Sq.Ft.Floor Area Valuation
2x
d l-0 that W is(commencing with Section, ad of Division r of Nc Buiegeineeampt Professy vi Code)or
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that h u exempt therefrom and ate bazu for the alleged exemption.Any violation of
Section 70315 by any applicvu for a permit subjccu dm applicant to a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(sell). 35913102 . 0 0
❑Las own«of the propmy..my employes wgh wags as trek soleeompenutbn,
will do the wok,and theamcsure treat intended oraffered Russia(Sec.7014,Business
and Prafesdan Cads:The Convaeme,Limns,Law does rot apply to an awn,of Required Inspections
propcny who builds o improses demerit,and who does such work himself m through his
Own employees,provided that such improvements are not intended oralfered for sale.B.
however.the building or improvement is mid within oro year of complcum,the owner-
Wilder will have Ne burden of Imaging that h did not build or improve for purposes,of
Sale.).
03Z.swan of the proPeny,am exclusively coeuaeing with licensed comae om m
cuct the project(Sec.7004,Business and Professions Code:)The Con esu is U.
cense Law aces not apply in an owner of propmny who tactics or improve thereon,and
who contracts for such projects with 4 conuanor(s)licensed primate to the,Carmelites
License Law.
❑ 1 an exempt under Sec —//�/�.—�� B&P C nor this..an
« f Dam
WORKER'S CPENS TION DECLARATION 11
I weby asrum among penalty of perjury rn of ft followingsoubmi. dmlanriwns:
O I have aro will marmots season
37M of Conan or Code.fuss for WarkcrSCompcn-
..rcf ss which
thin
(W by Sanson 3700 of the labor Code.far ate performan¢of Ih
WOfk for WIIILII NIS pefmll Is ISSUCd. '
❑1 have and will mainuin Wof er Compenatian hang .mond by Secure
3700 of the labor Code.for the performance of the work for which this perark i5 issued. '
My Workers CwmPermuam lnsumnm carrier and Polity number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ITU section reed not h completed if Ne permit is franc hundred dollars(5100)
or leu)
1«Oily Nat in the performance of the work for which this permit is issued,1 shall not
employ any perms inany meanerm become eabjecs le;Workcri Compensation
Laws of California.Date
APPliant
NQIICE TO APPLICANT:IL ter gNiaQenifca. Excm on,you ..
become comply
it Workersmimpeomtian provisions of de labor ode you muse
.J z, forthwith comply with such provision or this permit shall be Deemed marker.
z O CONSTRUCTION LENDING AGENCY
[-r I hmhy affirm that them is a construction lending agency for the perfmmanen of
fY the work for which Nu tenni,u Lssued(Sec.3071,Civ.C.)
ALenders Nation
7,z Lcndcrs Address
V Q 1 c«ufy that I have tend this application and sum that Nc above information is
correct.l agree m Comply With all city and county chimeras and Sum laws mlating to
0 C.7 building eonsvueeian,ad or this city to enter upwn thc
above mentioned property for inspection purposes.
Hy (We)agree to save.indemnify and keep humless Be City of Cupcnino against
fg Iiabilitig.judgments.coss and a xmisci which may in any way accrue agvnstsaid City /
V z s Permit.
in
STANDS AND of tire granting of WILL COMPLY WITH ALL NON-POINT Issued by: 6i Date
SOURCE REGULATIONS. ^ ,,,,//
/ \ - rdf so
HAZARDOUS
) Re-roofs
SigSignature
Signature wf Appliater r Da
HALS ebMATERIALSDISCLOSURE Type of Roof
Will the a C.Pem ror mfrauni building e.Charter
or handle Highth amaterial
az
defined by Ns Cupertino Municipal Cade.Chapter 9.13.and Ne HcaIN and Safety
.omGTss3z(a)? ❑NamAll roofs shall be inspected prior to any roofing material being installed.
o If a roof is installed without first obtainingan inspection,I agree t
WiII Ne applicant or(wort building 0ecap (noncom el o dcORes which pg o remove
'
emit boardmin air conmrmanu as dctimd by the Bay Area Air Quality Managcmnnt all new materials for inspection.
Marron?
Oyes ON.
Iharc mol ate hue x.materials trete vAdci CTrap r the Gal iror
nia HcalN&Safely Codc,Sccuom Z5D5, 533 dn5534.iundcmasnd Natlfds building
docs not cunmlly have a wnam,oast it u my responsibility to notify Ne weather of the
requirements which mug W met poor in issuance or a ccrurcale ofocmpar.y. Signature of Applicant Date
Owner ofaunhorivndageot Date All roof coverings to be Class "B"or better