06120094 CITY OF CUPERTINO
BUILDING DIVISIONl:� 11W-TO I �ItM TION`
PERMIT
PERMIT NO.
BUILDING ADDRESS:
10440 AKVILLE AV
_EHE L7
PERMIT ISSUE DATE
OWNER'S NAME: 01/04/2007
SHENG LIANG
SANITARY NO. CONTROL NO.
TONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
40 p LICENSED CONTRACTOR'S DECLARATION Job Description
e v 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing REMODEL.:NG FRONT PORCH - LOWERING FRONT WINDOW
=Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
y in full force and effect
D n? License Class Lic.#
E a Date Contractor
t
ARCHrmcrs DECLARATION
w U I understand my plans shall be used as public records
a
4 Q H Licensed Pmfcssional
OWNER-BUILDER DECLARATION
i<m 1 hereby affirm that I am exempt from the Contractor's License Law for the
%C O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K which requires a permit to construct,alter,improve,demolish•or repair any structure
11 Z; prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation
E=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $4000
yF- (commencing with Scction 7000)of Division 3 of the Business and Professions Cade)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of pR
Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty or 3 6 913 0 0 3 .tiItJN Number Occupancy Type
not more than five hundred dollars($500).
❑1,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
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.).
I,as owner of the property,am exclusively contracting with licensed contractors to
t�nstruct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs 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.
❑1 am exempt under Sec. — B&P C f r this n
Owner
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,forthe performance of the
work for which this permit is issued.
❑I have and will maintain Workces 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 am:
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 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J,Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
F~•t r-. I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Name
a,z Lender's Address
1 certify that I have ad this application and state that the above information is
LUL recorrect.I agree to comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
rFt liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b,r: Date �'-�
SOURCE REGULATIONS.
41g4,9-7 Re-roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type Of.ZOof
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
Code.Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
❑Yes Vt4o
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new I naterials for inspection.
District?
C]Yes ❑ru
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor.
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be or W issuance of a Certificate of Occu Signatur°of Applicant Date
` C All roof coverings to be Class"B"or better
Owner or authorized agent Date