07060092 CITY OF CUPERTINO
BUILDING DIVISION PERMIT FMtrnl(�N;
PERMIT NO.
BU"'Y9A lt"ffONEGAL DR ALLIED IiIRE SERVICEINC INC 07060092
OWNER'S NAME:LJ PERMIT ISSUE DATE
KUANTAI CHEN 661 SINCLAIR FRONTAGE RD 06/12/2007
NE: SANITARY NO. CONTROL NO.
(4 08) 934:-8844
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION
I Vi I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
;N m with Section 7000)of Division 3 of the Business and Professions Cod/e,and my license is REPLACE FURNACE & ADD A/C
H in full force and ffecL 3� �G�3J
t ? Licensc C1a Lie.#
t Date �I Contractor
ARCHITECTS DECLARATION
i a I understand my plans shall be used as public records
LU
> U
U.H Licensed Professional
H OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
:p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e�ff which requires a permit to construct,alter,improve,demolish,or repair any structure
Z> prior to its issuance,also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $ Valuation
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 0 0 0
.. 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($500). 3 661602-, :'C)V
❑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 trot 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.).
0 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 U.
cease 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.
Q 1 am exempt under Sec. B&P C for this reason
OwnerDate
WORKERS COMPENSATION DECLARATION
t I hereby affirm under penalty of perjury one of the following declarations:
Q I have and will maintain a,AFrLificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Sdiflon 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
1 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 WorktCompensation I rance carrier and Policy number am:
Cartier T la' , lJ6 Policy No.:bWOC 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 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 manncrso as to become subject to the Workers'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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z' CONSTRUCTION LENDING AGENCY
ham+ I hereby affirm that there is a construction lending agency for the performance of
fZ> the work for which this permit is issued(Sec.3097,Civ.C.)
Cw Q Lender's Name
z Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
U.'+ correct:I agree to comply with all city and county ordinances and state laws relating to
0 Ubuilding construction.and hereby authorize representatives of this city to enter upon the
a above-mentioned properly for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgments,toss and expenses which may in anyway accrue against said City
U z �E�
►" MPLY WITH ALL NON-POINT Issued by: Date
Re-roofs ,'�
Sig re of Appl t/Contractor Da
HAZARDOUS MATERIALS DISCLOSURE Type of Ro ff
Will the applicant or future building occupant store or handle hazardous material
as dcfinccd by the Cupertino Manic al 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
r 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 mal erials for inspection.
District?
O Yes No
1 h ad the h ardtws materials requirements under Chapter 6.95 of the Califor-
nia Heal &S ety C
.Sections5505.25533 and 25534.1 understand that if the building
does n cu fly ha responsihility to notify thet of the
rcqui mcn whim of a Certificate of O/571
Signature o f Applicant Date
Z All roof coverings to be Class"B"or better
Owner or authorize gent 1 6atc