06050177 CITY OF CUPERTINO
BUILDING DIVISION PERMIT LnCONTRACTR INFkOsRMATIQN
BUILDING ADDRESS: PERMITNO.
ALEX HUANG 06050177
O E: PERMIT ISSUE DATE
ALEX HUANG SANITARY N OL N0.
ARCHITECfIFNGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
jp LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 M¢by affirm Nn 1 am licensed,under provisions of Chapter 9(commencing
w
2i hb Session7000)of Division 3 of Ne Business and Professions Code.and my license is
a in full forand cffms
az License a., Lic.as REVISION TO ORIGINAL PERMIT #06010020
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DAM-CO-bounins
ARCHITECTS DECLARATION STRUCTURAL REVISION - REPLACE CEILING JOIST FRO
s e 1 mndemmod my plans shall he used As public records 2 X 10 TO 2 X 8
U
>'~^ Licensed Pmfcssional
ng OWNER-BUILDER DECLARATION
i f 1 hereby Affirm the,i em exempt from the Commetona License Law for the
O following reason.(Section 7031.5.Business and Pmfeasinu Code:Any city Of county
which requires A permit m..newel,alto,imProw.demolish,m repair any avuelure
prior An Its Issuance.also TQumcs the appileant for such peflnh to file a Signed statement
Z< Net he is licensed pursuant to Ne provisions of the,C.mouter'.U..Law(Chap=9 Sq.Ft.Floor Area Valuation
-a (commencing with Section]000)of Division 3 of the Business and Profusions Code)or
L_ Nu he is exempt aheemm and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant fa a Permit subjects the applicant to a civil penalty of APN Number Occupancy Typ
not more don Bw hundred dollars(S5004
I,ua of Nepropmy,errmyrmploymwithwagesuNabsokeompecation,
wet dodewmk
and Professions Code:The Corenfenumar'anLLim.LfwfcadedoT no,apply in an Manor uof 32615037OO Required Inspections
Own enywhos,pirtarimpmvu N,fimp andwho Amnouchworthimselfuthmugh his
owo=.due Wilding
pmwmimpmwmonu in not imerdW mofforededon.Tote B,
Wider ,Ne Wilding fu improwmvnt is sold within one year of ropnew for
the ownu-
bullder will hew Ne burden of proving dot he did not Wilo or Improve for purpose of
co s u owner of a property,,Business udus and confessions with 11auW ronucmrs m
consumer des not
(Sec.s an wnofand Professions Code:)The Conucmns Li
ante law doss r such
apply a an with
a of property who Wilds or improves NemOn,and,
Lwho kmm Lads for such projects with a cantnaa(i)licensed pursuant m the Convanons \
license taw, r
glom ucmpt undo en .B&PC Air this mason
Owner Date S1 O
WORKER'S COMPENSATION DECLARATION
1 hereby aRm under penalty of perjury arc of de following declamminc
nam and will maintain a Cerdfsam of Consent to self-insure for Worker's Compem-
sation,As providW for by Section 37M of the labor Cade,fm Nn performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker.Compensation Insurance,u required by Seedon
37M a the labor Cock,for de perfmmarcc of the work for which this permit is issued.
My WMixA&Compensation htsumna carrier and Policy number Am:
ciums, Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu=am need not W completed if the permit is fortune hundred dollars($100)
or less.)
I amfv that in the performance of Nc work fu which this permit is issued.I shall oat
employanyifotunina ymanncrsoum tlo thf Workers'Compcuadon
laws of Calif wn in is 1 uh
NOTICE TO APPLICANT-.rise
ANT:1,a er me mg u cnifns o of Exemption,you shoos
become subFcE m Nc Worker's Compcoudon provisions of the Iced t Cada you mica
OftuMwiN comply with such provisions m Nu permit.hail bu tamed rewkW.
CONSTRUCTION LENDING AGENCY
i; Ihereby Mm that then is a coutmctirm lending agency for the performance of
.. chic wort fm which Nis Permit u Wood(Ser.3097,Civ.C.)
Q lander'.Name
Z Lcnd.ea Address
Q 1 minify that I haw read Nis application and sue that the awO mfomotion is
Fconte-1 agree An comply with all city and county onlinamees and sum laws mlating m `
,U building construction,and hereby auNotia mpruenutivu of this city to cru upon Ne
a1aw-mentioned p.Nny fm inspection purfa ms
G (Wer)agree to saw,indemnify and keep harmless da,City of Cupertino againa
h liabilities,judgments,costs and expenses which may in any way accme against mid City
Z
in^ s emnit.
APPLICeof due of n
ANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCERDate
EG LATONS. (,
Signature of Appel else polo Re-roofs / .
HAZARDOUS MATERIALS DISCLOSURE Type of Roof v
Will Ne applicant in future Wilding Occupant store or handle haaardous mammal
as dcBned by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cad,Sudors 25532(4)t
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or comm Wilding«er ant use If a roof is installed without first obtaining an inspection,I agree to remove
fN g p equipment of dMana which g
hevardnus air contaminants u dehrcd by Ne Bay Area Air Quality Management all new materials for inspection.
District'
❑Yu X.
1 have mad the heasrdm s mao:rials requirements under Chaperd.95 of Ne Califor-
nia HcnlNhSafayCode.Sections 25505,25533 and 25534.1 uMcrsund NetifNe building
does rot currently haw a enanl that it u my rupoo3fluthy m Mdfy the Occupant of the
requiremcn hich a be met prior m issusom of a Comm, a of Ott pen
j 3'('31 j d Signa[ureofApplicant Dale
Ownerma\uthooriizedagent D,re All roof coverings to be Class"B"or better