04060109 (3) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT COIY'J,'RAGiTL1R NF(II MATZO ,
BUILDING ADDRESS: FERMA CORPORATION PERMIT NO04 0 6 0 10 9
22333 STEVENS CREEK SINT)
OWNER'S NAME: PERMIT ISSUE DATE
LING YANG 1265 MONTECTIO AVE 0611412004
g; SANITARY NO. CONTROL NO.
(650) 961-2742
ARCHITECTTENGINEER: ,. BUILDING PERMIT INFO
BLDG I
9LECT1 PLUMB MECH
u O o LICENSED CONTRACT'OR'S DECLARATION (/
Job DOSCfIptlOn
mp 1 hereby affirm Nat 1 am]!=mind under provisions of Chapter 9(commencing
ZW with Section 70M)of Division Sof the Businessand Preparation Code,and mylicensc is �/'
^<<o4 in full force art«t. DEMO v/1/� Q�®
,M4 License Clan Lic.g ®O
n i es Dam Contractor /
Y sy ARCHITECTS DECLARATION `300,
Y 1 undershibe u m
nJ my plans shell used public mNs '
oaD
;Qt; Licensed Pmfcssinnal ®�
3 OWNER-BUILDER DECLARATION
Contractor's
0 1 nanny.(firm that 11. exempt froms an the ContrtcsCod License Law for the �1
p o following mason. (anti i 8onstru Business and Pro(essinns Cole:Any city ver county
which rtquircs a.,ids.reconstruct,almg improve,dconalfiah Permit I m repair my structure
thiar m its i licensed
forward
rd to the the applicant for sucContractor's
License
Law(Cha mens
xx< (commencingwspuntion7 )ofDivision3 ftheB ale's ndProf6w(Choomr9 Sq.Ft. Floor Area Valuation
y F$ Oat M it;examwith Sechenchman
Rad o but&for of the alleged
exempt on.Any
n y vi Calc)or
�.. Net he u exempt therefrom and dm basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a proton subjects On applicant to a civil penalty of
nm mom than free hundred dollars(S500). WOO Occupancy Type
❑I,as owner cribs property,many employes with wages an their sole compensation,
willdathrwmk.,olthrsummure isnotimanied moffercd I...In(S.C.TD44,Business Required Inspections
and Profession¢Code:The Corrector's License Law dors ret apply m an owner of q p
property who Wilds or im proves thereon,end who does s uch work himself or through his
own employees,provided that such improvements arc not intended oro@red for.[.If.
however.the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purposes,of
sak.).
C-]1,as mvrer of the property,am exclusively contracting with limned commcmrs to
consumer the pmject(Sec.7044,Business and Professions Code:)The Conlracmr's U.
cense law docs not apply in an owner of property who Wilda or improves thereon,and
who contracts for such projects with a conuacut licensed pursuant he the Commutes
License U.
Elem sae tunic See. B for this rcuon
O er IM UX 1 Dam
W09KER'S'COMPERSATION DEC &ATJJDN
1 hereby affirm under penalty of perjury one of the following decimations:
sand will Commit,a Canificate of Cement to self-insum for WorkeYsComp
mlaen-
n,an provided for by Section 37M of the bm Code,far Ne perfmmmce of the
work for which Nis permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for the podomtance or tire work for which Nis permit is issued.
My Woi Compensation Insurance cantor and Policy number are:
Cartier. Policy No.: +
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed If Ne permit is foronchundmddollam(SIM)
or leu.)
1 cattily that in the performance of the work for which this permit is issued 1 shall not
employ any pawn in any manner so an an become subject to the Workers'Cronemission
laws of California.Data
Applicant
NOTICE TO APPLICANT:If,aper making Nis Cetifrcnm of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
C)Z forthwith comply with such prnvishout or this Permit shall be deemed makes.
Z O CONSTRUCTION LENDING AGENCY
[-t Thereby affirm On them is a construction lending agency for the performance of
rl 7 the work for which this permit is issued(Sec.709].Civ,C.)
WM A Lender's Nam.
.7 z Lenders Address
U Q 1 rectify Nat I have mad this application and shim Nat the above informadon is
F correct.I agree to comply with all city and county ordinances and sum laws winding an
QO building construction.and hereby audimse representatives of Nis city to enter upon the
LT7 about-mentioned proporty for metrication purposes.
0. (We)agree to save,indemnify and keep homeless the City of CupcAno against
to liabilitres,judgments,costs and expenses which may in any my acerae against said City
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E GULATI NS.
kk a Re-roofs
i m e App is It never - Data
HAZARDOUS MATERIALS DISCLO$BR Type of Roof
will Ne applicant or forum building occupant store or handle herhiMous material
az defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
.de.Stearn 2531(a)] All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building occupant use equipment ver devices which If a roof is installed without first obtaining an inspection,I agree to remove
II terminus air contaminants as Jcfiocd by the Bay Area Air Quality Management all new materials for Inspection.
strict?
❑Yes. 1p"a
1 have mad the muan ens mamrolsrcquirements under Chapter 6.95 of the Califon
nia Hc.lth&SofmyCode,Secdoro 155(15,25577 end 25534.1 undersand Nuifthc Wilding
docs not torte ly hem a mnenc Nat it is my rcaponsihility w nnu occupant of the
taI en inch must be mel priormiuuanec ole Cerd@:am Ora
� o Signature of Applicant Date
weer in au norecd agent Dnm All roof coverings to be Class'+B"or better