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CIT% OF CU;PERTINO77777777777777.
INFORMIA ATION•
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
20323 SILVERADO AV
CONDIT:=
OWNER'S NAME:
PERMIT ISSUE DATE
JIM ZHOU
1701 L:TTLE ORCHARD ST
01/05/2007
JNE:
SANITARY NO. CONTROL NO.
(408) 2:)1-2220
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
REMOVE AND REPLACE FURNACE AND ADD A / C
in full force and effect.
License Cl ao Lic.fi � L
—Contracwr,MJOA'it��►
Date {�
ARCHfTECTSDECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
•1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
S Ft. Floor Area
q
Valuation
prior to its issuance, also requires the applicant for such permit to Ole a signed statement
9
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
$6200
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
3 6 9 3 9 0 i) 7 Number
Occupancy Type
not more than five hundred dollars (5500).
.
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work• and the structure isnot intended or offered forsale(Sec.7044,Business
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.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) Tee 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 contractoes
License Law.
E] I am exempt under Sec. B & P C for this mason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 Workees Compensation Insurance, as required by Section
40 0 of the Labor code, for the performance of the work for which this permit is issued.
My Workces Compensation Insurance carrier and Policy number are:
Carrier -Policy 1(l P Policy No.: O C01 . - -61
CERTIFICATEPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workeri Compensation
Laws of California. Date —
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
forthwith comply with such provisions or this permit shall be deemed revoked.
4 CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
y the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
L.cndees Address
1 certify that I have read this application and state that the above information is
" correct. I agree to comply with all city and county ordinances and state laws relating to
" building construction, and hereby authorize representatives of this city to enter upon the
ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued t y: Date
SOURCE REGULATIONS.
�1 - `J- c)
-uJU A 44�
Re -roof;
Type of Roof
Are cant/Co for Date
HAZARDOUS MATERIALS DISCLOSURE
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 roofs shall be inspected prior to any roofing material being installed.
Yes Z51�10
If a root' 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 materials for inspection.
District?
0 Yes
,[:JAlo
-._1
I 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 mus be met prior ssuance of a Certificate of occupancy.
Signatu:'e of Applicant Date
Da
"B"
All roof coverings to be Class or better
w or authorize agcm Date
CITY OF
7UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
-20323 S11ve�! Acle-
PERMIT #
CnD10 (D
OWNER'S NAME: j
PHONE # (650- -q 3-7
GENERAL CONTRACTOR: , PV1 C 34}
FAX #
r-)�I am not using any subcontractors: G
Si gn ture Date
Please check applicable subcontractors and complete the following information:
Date
SUBCONTRACTOR
BUSI14ESS NAME
BUSINESS LICEN E #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
CITY OF
CUPEkTiNO
CITY OF CUPERTINO (jq.1cor6c)
'FLA P-N7VC/Acs
PERMIT APPIJICATION FORM
APN #Date:
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BUILDING
PLUUMBING
BUILDING
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Building Address:
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Owner's Name:
tPfho ne #:
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Contractor: Phone :�
License #:
Contact: Phone:
Cupertino Business License #:
Building Permit Info:
Bldgr ❑ Elect C®` Plumb ❑
Mech =❑ .
Job Description:
Residential: Commercial ❑
Cost of Project:
Strapped ❑ On Platform ❑ Bonded ❑
New Location ❑ Replacement
Qty. if
Raa 1lPcrrintinn
Fee Group
Applicable ree tL
BPWHEATER
\ PPERMITFEE
BENERGY
BUSLIC
Water Heater / Vent
PlumbingPermit Issuance
EnergyBUILDING
Business License
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BUILDING
PLUUMBING
BUILDING
E T
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