06080064 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFOT.tMATIO,N
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BUILDING ADDRESS: D & D CONSTRUCTION PERMITNO.06080064
10455 WESTA
NER'S NAME: PERMIT)SUE DATE
LIFENG WU 1447 HAM9/19/2 PTQN DR nJNE: SANITARY NO. CONTROL N0.
(408) 666-5298
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOG EfECT PLUMB MECH
0 0
Too LICENSED CONTRACTOR'S DECLARATION
F I kmby alarm that 1 am licensed under provisions of Chapter 9 tcommercing Job Description
with Section 7000)ofDivision 3 of MC Business and Prafcssiom Code,AM my license is
infullfar¢aMeffect. HOUSE DEMO
License Class Lk.e
F Dam Contractor
ARCHITECT'S DECLARATION
i s o I undersand my plans shall W used u Public mcorN
iyU
°hat; License)Pmrcssional '
g OWNER-BUILDER DECLARATION
iC I herthy affirm on I un exempt from tk Comranah License L,o for IW
N OO following mazoa(Scotian 703 1.5,Business and Pm( oli demolish.or Any city ny s county
f LLwhich m4uisuae.alsl oc[ones;thealmsnt forsu,hpamitor repair ed Hrvment
810000
.zi
met
incensed c.. requites theApplicantfar such pctmiao filmence,Law(chapter
(comms cingwJpurction7 cpmvivisiuo oftheBuacmrsndPrrselzw(ChaPmr9 Sq. Ft. Floor Area Valuation
jhC domm Aaserm Manciournand of Windsonbth gleed ess comop Profc ylicftwo&Catch)or
$ Nat k u evnpt Ikrtfmm and Ux basis far Ik alleged exemption.MY violation of
Section 7031.5 by any applicant for a permit subjects Ne aVpii..L 1.a civil penalty of Occupancy Type
not mom Nan rove hundred dollars($500).
0 1,u owner of the propmy,a my employee with wage As Mea sole compe tori
will do Newark,and Me swcNre is not emended or oRerrA for sale(Sic.7X4,Business
and pmfessioes Cade:The Canuxmr's Liaise Law dons an,apply in an owner of Required Inspections
ppeny who Wildsorimpmves Neuron,and whadoessuchwark himselforNmugh his /
awneen.Me es,ping or I proveat himpmsemenmatanot mfacern ed fomaRcred(wale.
builder.Ne building bu Improvement is sold a dunarc ill of ample for the ownvf
builder will nave Ik W Ncn of purring Nal k did not build or improve for purpose of
),u ower of property, reclusively contracting with licensed oonwnors m
cortZwn ate project
tt(Sec.704,1,,Business inand Prons fessioCode:)The Contractor's Li. 7
terse law does not apply to an owsms of property who builds or improves Norton,And. •CVl
who conuacu for such prejecs with amnon nm(s)licensed pursuant to Me Conuacmes
Liceee Law.
❑lam evemptu Sec .Bk PCfar this reawn /
,or DaIF
ce
ORKER'S COMPENSATION DECLARATION
I hcrtby rm under Penalty of perjury one of du following doilarauaos:
O I ham and will maintain a Cenificateaf Consent to self-inure forWorkers Compen-
sation.ss pmvidid for by Section 37W of Ne Labor Code,far Ne perfarmarmc of Me
work for which this permit is issoec.
❑1 have and will maintain Warkeri Compensation Insurance,as required by Section
37W of Me Labor Colo.for the performance Alma work for which this permit is issued.
My Wma Compensation Inw.carrier and Policy numkr,are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tnlssectim reed trot he conpiemd time permit is forme hundred dollars(SIM)
or less.)
1 certify that in Ne performance of the work fair which this Permit is issued,1 shall Out
employany person inany manner yon beeCme subje tmateW flaeri Comp ishoom
Laws of California.D;f �/'>AWF'
Applicant
NOTICE TOA W NT:If,after making this Certificate m Ube,ion,you skull
become h comp m the W such
r oCompensation erim ha of Ne lebor Code,you moat
.Jz forthwith comply with such provisiaew Nu permitnhallWdrmed revoked.
z O CONSTRUCTION LENDING AGENCY
E+w4 I kaby.M.lot Vert is a construction kridmil.geiny,for dm perfarmena or
LY>, Me work for which Mu permit is issued(Sec.3097,Civ.C.)
1 Q Lender's Name
z Lenders Md.
U O I certify Nat I have read this application and sum Nat Ne above information is
correct.I.,me m comply with all city and county oNnce
inas and sou laws relating to
0U Wilding mnswetion.and kmhy amhorim representatives or this city to toner upon the
r 0. ahove-mentioned pmpeny for inspection purposes.
(We)agree to save,indemnify and kap harmless her City of Cupertino against
liabilities,jud5mens.cass and expemes which may in any way accrue against NO City
U in covequcoce or Me graining of Nis permit
^ APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE�Ec�}ATIONS.
/reKr'/" Re-roofs
Signature ApplicmUConuacbr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant ar future Wilding occupant nave ar handle betwe ous mamrial
az dcroad by Me Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
.Section 255320)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye )8�a
W01 the a I and or future Wilding Occupant aed equipment w&,a.when If a roof is installed without firs[obtaining an inspection,I agree to remove
I PP i1' e P
emit havardous air cmumim ns as dc0ncd by Me Bay Area Air Quality Managcmcnt all new materials for inspection.
Dlatrltt7
❑Yes )<No
I have mad Ne by Nous materials requireu u
menndcrChapurd.95 of Om Califor-
nia Health k SaletyCode.Sectors 25505,25533 w125534.I mdersmnd Mutilate Wilding
docs ret cuncnd nam a want,that it is my mspomibil ity Or nouly Me mcupam of Me
mquimmcnuw chmastWmttpsiormiamenceoraCertiBcamor(keapvmy. Signature of Applicant Date
rZ�D
Owner or adred allot All roof coverings to be Class"B"or better
pare