06010047 (3) CITRfiU' 'Y OF CUPERTINO r
BUILDING DIVISION PERMIT %SCOTOW NF:URMATIOIV' =_
OUILDINO ADDRESS: PERMR NO.Q 6 O Z O 4 7
10428 S FOOTHILL BLVD
NER'S NAME: PERMIT ISSUE DATE
GARY & DAPHNE LIU 02/03/2006
NE: SANFARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG SECT PLUMB MECH
l� 0 0
3 p p LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description
with Section 7000)of Division 3 of dm Business and Professions Code,And my license is
is in full forte sndeffem. FOUNDATION REPAIRMENT
j
qZ Lkns
ec Clw Lk. Z/
FFF Dam Conover
ARCHI DECLARATION
i I understand my plans shall he useddAsu public rtenrN 7
k c Licensed Professional
OWNER-BUILDER DECLARATION
1 hemby affirm that 1 am exempt from the Commctafs Lice =Law for the
O following reason.(Section 7011.5,Resew and Professions Cade:Any city at county
S$ which Inquires a permit m construct,alter,improve,demolish.or tepair any someone $9000
prior In its Issuance.alto requires the applicam fwsuch permit to rile Asigned statement
Ez�F< filet he is licensed pursuant to the provislom of the Cantruwfe License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Z� (commencing with Section 7000)of Division 3 ofine Businwand Profcuiona Code)or
3 Nat he 0 exempt therefrom arta the bah for Ox alleged exemption.Any violation of
Session 703 L5 by any applicant for a permit subjects ftapplicant m a civil mouthy of r Occupancy Type
Am muse siun five hundred dollars($500).
❑I,u o-xner of sire pmpc y.w my wploycu with wm u dxb wle emmpemgm.
will do Newark,and the swcwne itnatimendedmoffewd fmaale(Sec.7044,Business Required Inspections
and Pmfwiom Code:The Commune,License law dos but apply m e an owner of q P
properly who builds or im Provex thermn,ape who dao smh wart himsel f or through his
Own however.me Wilding or
Improvement
hlmProwmmthin not oundWaraBered fa newer. �'��®
however,Nc building u improvement Is told within amyouhave.
for Ne ower- L
builder will haw sire burden of roving Wt k did not build m improv fa purpose of
ole.).
ED
❑1,u owner of the properly,am exclusively contracting with Bcemed omnmom to fk Q
consumer the project(Sec.7044,Business Pro(uslam Cade:)The Conmaor's Li. JUL 1 yi 2000
came w dues not apply an mum,of propeny�whrovm o builds or impthemon,and,
who contracts for such projects with aconuacmr(q licensed pursuant be the Cogmmars RI 1g
Licence law. — BUILD
❑I am exempt undo See Bk P C far this tenon106 afir-1A
nes Dete7--3–V 6
BR5 COMPENSATION DECLARATION
I hereby afrim under penally of perjury one of site following declarations
1 hswaad will mountain a Cera R.M of Consentm.lf-inure fa WarkelaC.Ma-
ution.u provided for by Section 3700 of We labor Code.far the performance of the
work for which this permit Is Tuned. ,
❑I haw And will maintain Waaw's Compensation Insurance,As requited by Section
3700 of the labor Code,for the performance of the work for which this Front,is Issued.
My Wmisse.Compensation Imaoce earner and Policy number aIn:
CamenPolicy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed Wise permit is foram hundmddollw(5100)
or less)
1 cerdfy that in the performance of We work for which this permit is issued,I Nall Out
employ anppersen In any mune so V bean%:subject to de Waners'CompewUm
Laws of CaliforolL Dam 6
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificam of Exemption.you should
become subject in,the Workers Compensation provisions of the labor Code,you must
.J 0 forthwith comply with such provisions or this permit Mill be deemed Invoked.
Z oCONSTRUCTION LENDING AGENCY
F-t Ihereby AM.that Nemiso constructions lending All for sire perfurmamx of
the wusk for which this Permit b issued(Sec.3097,Cih,C.)
W Q Lender's Name
Lenders Address
U Q 1 certify Nu 1 haw mad this application and tum that the shave information u
D,!' comm 1 agree in Comply with all City tad county ordinumss and tum laws Inhting in
O trJ' Wilding onsmuction,and botchy tutoda mposenmives of this city menta upon the
W shove-momirmcd property for inspection purpmes.
W (We)agree m taw,indemnify and keep harmiw the City of Cupertino against
r to) IIabIIWes,judgments.costs and expenses which may in any my seers,against said City
L)4 In consequence of the granting of Nb
permit.L) 6
G APPLICANT UNDERSTANDS,AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2
SOURCE REGIIUTiON
j i•3 Re-roofs
Si nrcoT usuVCmmcmr Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thus applicator future building acupanutow or handle hazardous material
ude0ned by do Corcoran Municipal Code.Chapter 9.11.ape site Health and Safety
ode.Section 1553:(.)7
❑Yon ONO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It huardom air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Dletricl7
❑Yon ON.
IhawmW Nchaurdmumatedtltm4uimmenuunderChapmr&95ofNeCelifor-
nieHalgt&SafetyCede,Saico15505.25533WM534.Imdcrmnd NniitM building 7c
dao an,currently Mw a um4m Net It is my emponsiAithy in redly me Occupant of the
mquimmcntswhie gLiwkumceoracc,uRcatearOccupancy. Signature of Applicant Date
s 2-3 `6 All roof coverings to be Class"B" or better
0.IMf.—A.t ff,—"agml Dam