05100038 CITY OF CUPERTINO � { °
BUILDING DIVISION PERMIT `, O1C.I I�tAI' R�f?
"x...".
BUILDING ADDRESS: PERMITNO.05100038
10486 WESTACRES DR
OWNER'S NAME: PERMIT ISSUE DATE
is TSENG-CHENG & SHU-ME YANG 11/21/2005
I'MUNE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB WZCH
O
lop LICENSED CONTRACTOR'S DECLARATION Job Description
F 1 hereby affirm that 1 an licensed under provisions of Chapter 9(commencing with
with Section 701MI7 of Division 3 of the Business and Professions Code,aha my licetm is
a in(oil force and effm SFDWL-ONE STORY (26441 LIVING)
Z 4 License Clara LDam k.M Contractor GARAGE-523 ,
ARCHITECTS DECLARATION
I undermand my pians shall he recd as public records
)tu
505 Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Coneraato(s License Law for the
p o following moon.(Section 7031.5.Business and Professivas Cade:Any city or county
5
39 which requires a permit to conalrun,alcor,improve,demolish.or repair my structure
iy prim in its issuance.Am require the applicant for such permit w Jim a signed summent
c that heislkenmdromanticthaprovialOnsoftheCartuocuuSLkenxeU.(Chaprer9 $G.F[. FIOOrArea Valt�®16495
?( B (cammettm0gwith Secdon70DO)of Division3.Rico Suslnesmd Profrasion.Code)ur
— that he is exempt therefrom and the basis for sire alleged exemption.Any Woladan of
Section 7031.5 by any applicant for a permit ubjecu the applkmt in a civil penalty of )TNNumber Occupancy Type
not ream them owe hundred dde,as($50(). 35916013 . 00
0 I,as awne of sire property,w my unployee with ages as dmir solecompensa11on,
wiRdethework.mdthemuctuntsnatemndedwofreredrorsda(Sec.7044.Busimus Required Inspections
and Prafeadmu Code:The Contractor's Lt..LA.does at apply to an Owner of q p
property who builds w improves Obercan,end who does such mark him us tro r through his
own employee,proNded that such improvements ase not intended oroRexe t formic.If. -
however,ma building or improvement is mid within am year of completion,the mvem,
builder will love site burden of proving that M did not build or improve for purpose of
eau,).
C3 1,as ewer M the property,atn exciudwly connecting with limned conumton to
consuam the project(Sac.7014.Businesses and Prolusions Code:)The CommuWs Li-
cense law dace at apply to an Ownu of proputywho builds oriesproves Ihemm,cod,
who convince,for such projects with acommexer(a)licensed pursuant 0 the ContraeMes
License Law.
❑1 rept undersee. .B&PC rthhareason
Date I l 21 0
WORK 5 COMPENSATION DECLARATION
I hereby alBm under penalty of perjury am of the following decl"=
❑I ban and will main sin a Cerdfeas of Consum m selNmums for WorkeYsCompen-
suton,as provided(or by Section 3700 of the Labor Cade,for the perfomane of that
work for which this permit ie issued.
❑1 have and will maintain Werkees COmpensWan hammers.u required by Section
3700 of the Labor Cade.for em performmec of the work formich this permit is Wood.
My Warman s Compensation wurmce carrier and Policy number rm:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE '
Cibts section need Out be completed if Iha permit is fwonohummuldaR4r l(5700)
or less.)
1=Wry that in the performance of the work for which this permit is iatued.I shell am
employ any person in my mmmr w a M become subject to the Workan'Compensation .
Iwo of all us.
Applicml
NOTICE TO APPIEKcAr.if,amej Inalrel tffi ni0em of Exemption,you dwu1J
become subject to the Worka s CompeeNan provisions of the labor Code,you must
z forthwith comply with such provisions or the permit shill be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(•" I hereby aRrm that shred,coasuunm0 lending agency for the pwfomenee of
Gt:17 the ,it for which the permit is issued(Sec.3097,Civ.C.)
W�Q Undoes Name
=z laaderat Address
U I certify that I ban read this application and sum that the show Information is
V,Hcorrect.1 agree in comply with all city and county Ordinances and mm lawn 12141108 to
O C.) building comawtion,ad hereby auhorin rcpruenutins of this City m can upon the
W altow-mentioned property for impecdm purpoxes.
(We)agree to an,indemnify and keep ham em the City of Cupertino almost
liabilities,judgments,ease and expenses which may in my my acerae against mid City
V z In consequence of the scenting of the permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR RE� GULATfONS. p.,
/��•__g:J Re-roofs
Slum ofApplicooKoatreltuir Da,
HAZAOOUS MATERIALS DISCLOSURE Type of Roof
Will alta applicant or building ocoupmewrc or Mtrdk he urdous material
as defined by the CupeninaM.-idcipal Calc.Chapmr 9.13.and the Health and Safety
de.Section 25332.)7 All roofs shall be inspected prior to any roofing material being installed.
[:]Yu lNo
Will the applicant or future building occupant=equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emll hmmdnu air cone,minanu as denned by the Bay Area Air Quality Mmagemem all new materials for inspection.
District?
❑Yea EdNo
I haw mad the h izardtwsmammits requirements under Chapter 6.95 of theCalifor•
nia Health&Safety Code,Sections 25305.25333 and 25534.1 understood that if the building
docs not currently haw a Wank that It is my responsibility to nadfy this comment of me
rcgmrem whmh be meter eancertinemar amp Signature of Applicant Date
Owner gr autharimd alcor
AIT All roof coverings to be Class"B"or better