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07020023 CITY OF CUPERTINO 7 - �T 7 BUILDING DIVISION PERMIT � �� � :��\ � M�TI� : BUILDING ADDRESS: PERMIT NO. 10296 VIRGINIA SWAN PL HSUAN WEA WANG & I FANG LIU 07020023 OWNER'S NAME: PERMIT ISSUE DATE HSUAN WEA WANG & I FANG LIU 02/06/2007 jNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description v[_ I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;zU with Section7000)ofDivision3oftheBusinessandProfessionsCode,andmylicenseis ADD CEILING JOINTS, SHEET- ROCK, CEILING LIGHTS A- in full force and effect. z License Class Lic.a EVERGREEN HOUSE CO IS THE CONTRACTOR. . .THEIR 3 ';:,m Date Contractor � ARCHITECTS DECLARATION i a< I understand my plans shall he used as public records >yU u.in Licensed Professional H OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ZZ20 following reason.(Section 7031.5,Business and Professions Code:Any city or county <m which requires a permit to construct,alter,improve,demolish,or repair any structure Zy prior to its issuance,also requires the applicant for such permit to rile a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation r Fs- (commencing with Scction 7000)of Division 3 of the Business and Profcasions Code)or $9000 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars(5500). 3164600 5 . ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.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 purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law, ❑I am exempt under Sec. B,&P C for this mason �. Owner Date V, WO CER'S CO NSATION DECLARATION I hereby nn under penalty of perjury one of the following declaratio ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I ccrtif-v that in the performance of the work for which this permit is issued,I shall not employ any person in any m r the Workcrs'Compensation Laws of Califoroi Dato Applicant NOTICE APP f,of r rs Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY E~•r I hereby affirm that there is a construction lending agency for the performance of tY. the work for which this permit is issued(See.3097,Civ.C.) ALender's Name z Lender's Address U 0 I certify that I have read this application and state that the above information is IL r- correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in anyway accrue against said City V Z in consequence of the granting of this perms. Date ■" APPLICANT UNDE NDS A ILL GCMPLY WITH ALL NON-POINT Issued by: SOUR I y �"/O v Re-roofs Signature Applicant/Contractor Da HAZARDOUS MATERIALS DISCLOSURE Type of F.00f Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cede,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? ❑Yes CX. I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCode,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my msponsibili to nouf the occupant of the requirements which must be met issuartco en;rrcatc or n, Signature of Applicant Date Owner or authorized Da, All roof coverings to be Class"B"or better