06100002 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PEAMITNO 06100002
217nR AT.(''A7,AR AVP
OWNER'S NAME: PERMIT ISSUE DATE
YUN KEI TSANG 14/1_? /?nny
.0NE: I SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
HCj ELECT PLUMB MECH
o`p LICENSED CONTRACTOR'S DECLARATION
V(= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and effect. REVISION- CHANGE FOUNDATION P LAN.
? License Class Llc.#
in Dat- Contractor ORIGINAL PERMIT# 06010014
14 ARCHITECTS DECLARATION
a
_3 I understand my plans shall be used as public records
r n Licensed Professional
OWNER-BUILDER DECLARATION
t I hereby affirm that 1 am exempt from the Contractors License Law for the
:00 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
Z y prior to is 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 Val iqr0 4 7 0
$ (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 APN Number Occupancy Type
not more than five hundred dollars(5500).
0 1,as owner of the property,or my employees with wages as their sole compensation, 35719014 . 00
will do the work,and the structure is not intended or offered forsale(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 riot build or improve for purpose of
sale.).
[11,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 w th'co"tra t r(s)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec. j - j B&P C f this on,
Owners'-j �� Date t'Z t
WSM'S COMF�NSA(fON DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 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:
Cartier. Policy No.-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he 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,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dat-
Applicant A
NOTICE TO APPLICANT: ,after ma i g This Ccni tcatc mption,you should
become subject to the Wor r s Compensation provisions of hot Code,you must
`Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
04> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Nam^
124
z Lender's Address
V Q I certify that I have read this application and state that the above information is
i3+►- correct.1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
O (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
U z in consequence of the g ring 9f this permit.
�-+ APPLICANT UNDE AN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL NS. ` Q
U, I.-/ o/i2��o�`� Re-roofs
Signature of Ap�J ban on or f date
HAZARDOUSITERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as deftncd 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 �No
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 contaminant as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
O Yes V14O
I have read the hazard'us materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,See ors 25505,25533 and 25534.1 understand that if the building
does not currently have a to ant,that t is my responsibility to notify the occupant of the
requirements which must t pri issuance of a Certificate of Oc'pan Date
Signature of Applicant
L,� 1 • 2
owner or autho
7,c gent Date All roof coverings to be Class"B"or better