05040003 (2) CITY ILDI c DIVISION
PERMIT CONTRACTOR INFORMATION .
BUILDING ADDRESS: PERMITN"O 5040003
20781 CHERYL D
ER'S NAME: PERMIT ISSUE DATE
YONG ZHANG 06/17/2005
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� l�
=oo LICENSED CONTRACTOR'S DECLARATION
F❑ I Wreby affirm Nat I am licensed under pmvislonc of Chapter 9(commencing Job Description
iW with SCcl10n 70M)ufDivision 3 ofthe Business and Professions Code,and my license is
^ it full res Class and erect ADD 411 ' (STUDY/M. BI{ �y Il�T t�
j M an License roua Lic.X ®i®�®d 989th®®!!5®5®688�''�A``��
�o Dam Cnntmcw, REMOEL MS . BEDROOM
ftJ' ARCHITECT'S DECLARATION
'�z I tualwotand my plans shall W used aspublic.,arm
JyU
Licensed Professional /1 ///17'j- 2,'(t
�5
OWNER-BUILDER DECLARATION
<� 1 Wmhy air.Not I .eumpt form the Continuous License Law for the
0 0 following reamn.(Section 7031.5.Business and Pmfessiutu Code:Any city or county
K m which requires a permit m construct alter,improve,dcmulish.m repair any structure
poor yai poon is issuancere
,also qPermit ulms the applicant for such peit m file a signed suumm
c ��..a
< hat he is licensed pursuanttothe provisionsoftheConuacwriLiccnseLaw(Chapter 9 Sq. Ft.Floor Area lf$tldp577
YFG (commencing with Section 7W0)of Division Sof the R usiness and Professions Cade)or
W3$ that be u exempt thertfrom and the hasu for the alleged eumpdon.Any vw auan of
Section 7031.3 by airy applicant for a permit subjects the applicant to a civil penalty of ApN Number Occupancy Type
oat mare than BK hundred dollars(MM). 35914011 . 00
1,u corner of the property,ser my employees tush cages az their sole compcnution,
will do the wads,and the structure is not intended or offered for sale(Sec.7064,Business
and Profession Cadc:The Contractor's License Law does not apply m an owner of Required Inspections
property who Wilda orimprows therron.andwho doessueh work himselfor through his
own employees,provided that such improvements are not intended or offered for sale.IL
however,the Wilding or improvement is sold within one year of completion.Ne owner.
builder will have On harden of proving taut M did ant Wild at improve for purpose of
sale.).
tq�t/L as owner.(ft property am esclusively contracting with licensed rontrum.m
Imudict Ne project(Sec.7814.Business and Pmfcsoms Codc:)The Comraemr's Li-
ccnu law docs not apply to in owner of property who builds or improve thereon,and ,
who contracts for such projects with a cantracmr(s)licensed pursuant an the Contractors
License Law.
Cj I so acmpt under Sec. .B h P C for this mason
an' Date
WORKER'S COMPENSATION DECLARATION
1 hereby alEmt under penalty of perjury ax of the following dalarxtimen
❑1 haw and will maintain a Cenificam of Canent to self-insum rot WarkeriCompcn-
ration,as provided for by Section 37W of the Labor Cade,for the performance of the
work for which this Permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
37W of dw Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Immune carter and Polity number are:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not W completed if tic permit is furore hundred dollars(SIM)
ser less)
I terrify that in the performance of the work for which this permit is issued,l mail not
employ any person in any mennerm as to become subjauo tW Workers Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CcniEcae of Exemption,you should
become subject in the Worker's Comparesation prevision of the Labor Code.you most
.J O forthwith comply with such provisions or this Permit shall be deemed revoked.
Z .. CONSTRUCTION LENDING AGENCY
[-.� I Wmby affirm Nat there is a construction lending ageney for the performance of
ce the work fur which his perm it is issued(Sec.3W7,Civ.C.)
W�Q Lender's Name
2 Lender's Address
U Q I cenify hat 1 have read this application and same hat the above information is
correct,1 agree to comply with all city and county embracer and state laws totaling to
O V Wilding construction.and hereby authome mpreuoutives of this city to caner upon he
fS.l shove-mentioned property for inspection purposes.
f' gy (We).,me to save,indemnify and kap harable¢the City of Cupertino against
lin liabilities,judgments,costs and expenses which may in any any ac me against said City
U 2 in consequence of the granting of this permit 7
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH fyLL NON-POINT Issued by: Date I
SOURCE REGUL NS. /
CCC 777 —� Re-roofs
Signature ofA IicanOContract Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle hvafdous material
cfincd by the Cupertino Municipal Code,Chapter 9.13,and on,Health and Safety
Section 25532(.)' - All roofs shall be inspected prior to any roofing material being installed.
ElYcr tgka
Will he applicant future building occupant use,equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
pP g e yuipr Q
` emit harardnas air contaminants as defined by he Bay Arca Air Quality Management all new materials for inspection.
Dixuict? LL''''
O Yes Afro
Ihavc real the hmaNt/me materials neyuimmcn¢undcrChapur h95ofhc Wilding (/ ^/ �^ D�
ria Help6 mad On
materials
requirements
under
Chapter
fah Wilding
dor not currently have a venom,that its is my mapomihility to mdfy he occupant of the
reyuiremcnswhmh must met priormel aofa CcrtiOcateor Occupant. `Signature of Applicant Date
- ^� �y All roof coverings to be Class"B"or better
Owner r moAdolagcm Dam