07030227 CITY OF CUPERTINO 1
BUILDING DIVISION PERMIT C�ITITQZ I }RMAtTIQN�
BUILDING ADDRESS: PERMIT NO.
10651 MERRIMAN RD TBD — TO BE DETERMINED 07030227
R'S NAME: PERMIT ISSUE DATE
ZHIHONG LIU 7
PHONE: SANITARY NO. CONTROL NO.
ARCHrMCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is S FDWL—2 STORY 4, 265 ' PRO C H 151 GARAGE 495 ' (1ST
y in full force and effect.
o c�? License Class Lie.S FLR 2785 ' 2ND FLR 1480 ' )
E wo Date Contractor
ARCHITECTS DECLARATION
a< 1 understand my plans shall be used as public records
>qU
u.y Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
fi which requires a permit to construct.alter.improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement c,
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 rq.Ft.Floor Area Valuation
tZ$ (commencing with Section 7000)of Division 3 of Ott Business and Professions Code)or $942774
that he is exempt therefrom and the basis for the alleged exemption.Any violatian of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of V4 Number Occupancy Type
not more than five hundred dollars($500). 3421603'
V V
❑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 Contractors License Law dots not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or thmugh 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.).
owner of the property,am exclusively contracting with licensed contractors to
project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Caw does not apply to an owner of property who builds or improves thercon.and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
^rarmexempt y �� .B&PCfor
LA it Date
RKER'S OMPF-NSA77ON 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 Workers 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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier. 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 perfo ce of the work for which this permit is issued.I shall not
employ any person in an r so as to become subject to the Workcri Com 'on
Laws of California.D
Applicant
NOTICE TO AP :If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z t"' CONSTRUCTION LENDING AGENCY
E~-c tom-. I hereby affirm that there is a construction lending agency for the performance of
(1!> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Name
a z Lenders Address
U 0 1 certify that I have read this application and state that the above information is
U.r r CO CL 1 agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
(�Z in consequence of the granting of this permit --7
APPLICANT UI$1^STANDf AND WILL COMPLY WITH ALL NON-P35INT Issued by: Date
SOURCE REG LA NS. 70
1— (((( I! e-roofs
Signatu of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
.fined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
e.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or ffuutturero ovtl gilding 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 materials for inspection.
District?
❑Yes
I have read the hazardc)w rials requiremenLc under Chapter 6.95 of the Califor-
nia Health&Safety Codc,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 t o tssuanec of a Ccrulicate of cu
q p'i�°� _J,Ae F�'9'�/� Signature��f Applicant ate
/( /
All roof coverings to be Class"B"or better
Owner or authorized a cnt Dam