00120155 (2) « CITY OF CUPERTINO
9TILDING DIVISION - PERMIT CONTRACTOR INFORMATION:
BUIIJANGADURISS'. PERMIT NO.
10239 S FOOTHILL BLVD JIJfiT warER I-IERrms INC W120155
OWNER'S NAME: APPLICATION SUB DA'Z'E
CHENG GNW F' f- qD YW 1.1Gi1bl"-f' 11=N I.7fs4 I%nT7:OIJFIL AVE" 1.1:1 29/20MI)
,PHONE: SANITARY NO. CONTROL NO.
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00 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MUCH
fnaa CJ 1—I C= G1
LICENSED CDNTRACI()R'S DECLARATION
z = 1 nerebr aman that I at,,licensed ander...vision,of Chat ) Job Description
O per' ndrity coring
F veC wiin fullSectionreland of Division Sof the BusinessnnJ Professions Gde,tint mylicense
-a in full force and eReq.
Date eGlnas Lie.« r IraeE 40 Glu rml wraTF I E71TEFi„
je y LL F Dulc CntltCLA ,
W Ane,shut]ECT suit
DIiC1blicreord
I ION
I undersrnJ my plata zhnll M coed as public records
IBJp o Lwcnved Pndessianal �S/
c OWNER-BUILDER DECLARATION - aJ
1 haraby ulBrm the' urn exempt I'rnm the Contawmr's Liters,Luw for IIIc /
C$< following reason.(Section 7031.5,Rosario.and Pmfe_,sions Code:Any city or carry un
❑ which requires a permit to emiswa,ager,improve,demolish,or repair any mr6ture
tplr
we
prior to its issuance.also requires the applicant for such permit to file a signed statement
that he is licensed pursoaln to the Provisions(if the Contractors License Law(Chapter q S FL Floor Area Valuation
(cunanencing with Secti�n 7110111 of Omit.,n 3or Oaia,inessnnd Pmrersions CtulaJ q' -
or deal tie es exeolpl howaror and the basl.s fm'he alleged wands n.Ally vmlutit,n j1;11�1
of Section 7031.5 by any applicant for a peanut s iderts the applicant to a civil penalty .
ar pol male man live nandred donor,tsvny APN Numb
er. Occupancy Type
❑I,as owner,l the property,or my employees is an wages as their sale campcmmtion. i3427.k6%1:1.,61'1
will do the work,and the structure is nm intended nr uHired for,ale(Sec.71144
Bminess sad Pro2ssians Cade: Una Cantraor'a Liceme Law asses not apply men Required Inspections
owner of prospeny Who Wilds,or impmves thereon,and who does such work himself
or through his own employees,provided that such improvements are not intended or 562 — FIHAL FILU'IBING EIxi
_• offered for sale.If,hawevea the budding or improvement is.sold willtin one year of
completion,the owner-builder will have Ile burden of proving that he did con build or 5W, -- G613ITEM' .
improve far pamowa] ale.). 507 — FINAL PLUMBING
❑I,os swnen,l the property,a xel.evely ememaling with lwari...mameam
construct the Project(So,7(94,Business and Processions Cove:)Thu Contractor's
I.ic, a Law does un apply ai innoluclol pmperly wus hWWs nr inlpm lie tlmreon,
and who sti Cur such projects with a eonlmOur(s)licensed purntant or me
C"moolors License law.
Q 1 am exempt under Ser. ,B&P C for this reason
Owner Date _
WORKER'S COM PENSA'1'I ON DECLARATION
I hereby affirm under penally of 11.1 nue of the following declarations: s
CI 1 have and will mannan a Ceailiaute of Conserv la ,cif-ImUre far Worker's
Compensation. Ls provided or by Section 3700 of the. Labor Code, for the
psrl'onn urce of the work fur which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as requited by Section
3700 of the Lahur Code,for the performance of the work for which this permit is
issued.My Worker's Campensntinn Insurance carrier and Policy mmuberuc: -
Carrier. Policy No.: ,
CERTIFICATION Or EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Chis section need not be cnmplmcd if rte permit is ror one hmWoed dollars
($HXn or Iew.)
I certify that in the performance of the work far which This permit is issued.1 -
shall not emplay any person in tiny moner so as n,Iverson,subject to the Waders'
Cnmlenmtian Luws al'Calif..nit.flue
Applicant
NOTICE TO APPLICANT:If,after making this Cenificale of Exemption,you should
Z Weome uhlost ,,the Worker's Compacnlionpmvisiar,of the Labsr Cede,you must
Q-I C, forthwith comply with such provisions or this permit shall be deemed revoked
.^� 4 CONSTRUCTION I-EN UI NO AG HNCY
�i > I hereby affirm that There is a combination lending agency far the pstformance
W of the work for which this pemeit in issued(See.3f97,Civ,C.)
L Q Lender's Name
Z z Lender's Address
I certify that I have read this application and sale that the above infiermation is
[..a correct.1 agree to rurality with all city sad.,duty ordinances and sun.laws relating
U mbuilding samurai and hereby eathmec represenuinws ofthis city to enter upon
17a w the ubnve-mentioned progeny for inspection patriots.
ty ly (We)agree ul save,Indennuil,and keep harmless the City of Cupenlno agoitul
Vi iia hiblit,,judgments,rests and expenses which may in any way iwari ogmad said
U City in consequence of the grilling of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY Won ALL NONPOINT Issuedb
SOURCE REGULATIONS, y: Date
Signmare of ApplicanUComouctor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fntnre building auction,score lir handle hmallous maenal Type of Roof
as defined by the Cupcninn Municipal CND,Chapter 9.12,and the Health and Safety
Cale,Section 2553904! -
❑Ye, 0N All roofs shall be inspected prior to any roofing material being installed.
Well the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtainin an instion, I a ree to remove
cart all new materials for inspection. Applicant understands and will comply with
mit hazardous ma,amaminanu m defined by the Bay Area Air Quality Management �' p g
. oyes 5N all non-point source regulations.
1 have read the heznrdnus maternal,requiremems under Chapter 695 of the
California Health&Safety Cale.Sections 255115,25533 and 25531.1 Indentm l that
if the building docs not currently have a tenant,that it is my«spunsibidity to notify the
ceupanl of the regnlr...lar s which n all he met prior ,,mran ce of a Canifteate of
Occupancy. - •
Signature of Applicant Date
Owner maatnaneedagent - Date All roof coverings to be Class sB"or better
OFFICE