05060178 (2) CITY OF CUPERTINO " ' <,;:;s ' '.va ;,• a."fir'
BUILDING DIVISION PERMIT *CONTRACTOR INFORMATION
BUILDING ADDRESS: QSP CONSTRUCTION PERMIT N005060178
18831 HUNTER WAY
OWNER'S h1AME: PERMIT LgUE DATE
THANH PHUNG 732 SCOTT BLVD 07/21/2005
E: SANITARY NO, CONTROL NO.
(408) 985-8159
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION
F I be¢by affirm That I m liecroeimu d under provisof Chapter 9(commencing Job Description
U with Section 7WB ofDivision Sof NC Rusinccs and Prufcssiom Code,and my license is
n�a imfull tomeandercas IREVISION- -WINDOW IN ,BEDRM/ENLARGE LUNDARY RM
License clue Iy.«
Dae` Luc. ser, ORIG. 404080047 1ST FL. ) /SWITCH WIC W/BATHRM
'l-j
g-o Iv ARCHITECTS DECLARATION
5y m< I undcrsund my plans shall he used as public retorts
JyU
o Licensed Pmrcmimud
3 OWNER-BUILDER DECLARATION
.�<P I hereby zffi m Nal 1 am exempt from the Conlractofs License Law for thc
a O following reason.(Section 7031.5,Business and Professions Code:Any city or county
�wQ which mquiris a permit to emmi tlmr.improve,demolish,or¢pair any structure
prior tet its issuance.also requires the applicant for such permit to file a signed suamcol
EiG OatImislicensedpursuanttoInprovisionsof0.Contractor'sU.. aw(Chapel9 Sq.Ft. Floor Area Valuation 0
set- (commencing with Section 7")of Division 3 of the Business and Professions Cnde)or
Yy - Rut he is exempt therefrom and be bona for the Jlegcd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
.to mom man five hundred dollars(s3Bo). 37534053 . 00
❑1,m owner of the property,or my employees with wages as heir sole compenmtion,
will do the work,and the structure is not intended or offered for sale(Sec.7IM4,Business
and Professions Code:The Conlucmes License law does not apply to an owner of Required Inspections
pmpeny who builds or improves themen,and whodoessuch work himadf or Omagh his
Own employees,provided mal such improvements are not intended oroRered formic.IL
however,the building or improvement is sold within one year of complction,the owner.
builder will have the burden of proving mat he did not Wild or improve for purpose of /
sale).
❑I,as owner of the property,am exclusively communing with licensed contractors to
construct to pmjen(See.7044,Business and Professions Cade:)The Com ena s Li. �r a•.
cense law docs not apply an an owner of property who Wilds at improves thereon,and Com✓"`\"
who contracts for such projects with a contractor(s)licensed pursuant in the Co orm ofs
License La,
❑l am exam (under Sec. ,py..,B facer m/in m ono
Owner �rM 2Fr`1�^-Da¢
— WORKER'S COMP SAT( D CLARATION
WI hereby of lrn under penalty of perjury one of the following declarations:
hem and will maintain a Cenificam of Consent m self.insure for Worker's Compere
sation,as provided for by Section 37W of the labor Code,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance.as required by Section
37W of the Labor Code,for the performance of the work for which min permit is issued.
My Worker's Compensation Insonate carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis nation recd nm bccanpleted if Re permit is foranc hundtr-0dollars($100)
or less.)
I certify that in be performance of me work for which this permit is issued.1 shall nm
employ any person in any manner n m come mniccuo the Workeri Compensation
La of California.Dam
Applicant m .
NOTICE TO 1kP�Pl ICANr: .after making DO;Ccnificam of Exemption,you should
become subject in me Work.,',Compensation provisions of me labor Code, mai must
Z forthwith comply with such provisions or this permit shall be deemed mvoked.
Z O CONSTRUCTION LEN DING AGENCY
E-' ^ Ihereby affirm mat here is a construction lending agency for the performance of
C$ the work or which this permit u issued(Sec.3097,Civ.C.)
�W A Under's Name
7 Z Under's Addmu
U Q I certify mat 1 have rad this application and sum mat me above information is
IL P cornet.I agree to comply with all city and county ordinancceaod state laws relining to
(]U building concoction,and hereby authorise¢prumnutives ofthis city to enter upon the .
r W above-riem oaed propeny lot inspecurat purposes.
gy (We)agree to save,indemnify and keep hornless be City of Cupcnino against
mF'-m p3 liabilitiesjudgmenu,costs and expenses which may in any way accrue against mid City
U Z in consequence of On granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S CE REGU 0
U k9 F/�I,cg
SignJltirkofApplicuNConttacmr [7 oar Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atom or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to an roofing material being installed.
p Yes /' No P P Y g g
'Xg the applicant of tomo:building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t havardous air contaminants as defined by the Bay Arca Air Quably Management all new materials for inspection.
Dixtrin7 t
❑Yea' u!
Ihavemadtheh jar tmsmaterialsmquiremenuunder Chapter695orme Califon
ria Hnith&Safmy Cada Scctimu 25X15,25533 and 25534.)and re=d muifmc Wilding
docs not eurremly M1am a tenant that it u my resgpomibility m notify the a upanl of the
myui menuwhieh met to issuance of a Cenireate of Occupant. Signature Of Applicant Date
9 a c
C ner authorised agent ate All roof coverings to be Class "B" or better