06100017 CITY OF CUPERTINO C1�ITIAGTE)�Z I1t}RMATIO�1�
BUILDING DIVISION PERMIT
BUILDING ADDRESS: DIANLI CHEN CONSTRUCTION PERMIT No.06100017
10700 LA RODA DR PER Irr ISSUE DATE
OWNER'S NAME:
JUNE YANG & YONG TIAN 951 COVENTRY CIR 0103/2006
SANITARY NO. CONTROL NO.
(408) 888-2898
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
i p LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 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 BATHROOM REMODEL NO. STRUCTURAL
r=y in full force and effect
? License Class Lic.8
F-a Dam Contractor
ul ARCHITECTS DECLARATION
ce.< I understand my plans shall be used as public records
)yU
Luy Licensed Professional
60, OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
00 following mason.(Section 703 L5,Business and Professions Code:Any city or county $3300
2 Vi which requires a permit to construct,alter,improve,demolish,or repair any structure
Z r prior to its issuance,also requires the applicant for such permit to file a signed statement $ Ft.Floor Area Valuation
c 2� that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
i[- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of r Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500).
❑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 Conuactoes 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.).
Q I,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 with a contractor(s)licensed pursuant to the Contractor's
License Law.
O 1 am exempt un rB&P C far rs ason
rtwner f Dam
WORKER'S COMPENSATION DECLARATION
ereby affirm under penalty of perjury one of the following declarations:
❑1 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 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 are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis 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 ap 6 bacOm��bject to the Workers'Compensation
Laws of California.Date I ,2
Applicant
NOTICE T A LI after makm rs Certificate of Exemption,you should
become subjcc c Workcr's Compensation provisions of the Labor Code,you must
,Z forthwith comply with such provisions or this permit shall be deemed revoked.
z� CONSTRUCTION LENDING AGENCY
E..t►.+ I hereby affirm that there is a construction lending agency for the performance of
p�.> the work for which this permit is issued(Scc-3097,Civ.C.)
W Q Lender's Name
z L.endees Address
Address
certify that I have ad this application and state that the above information is
uU O recorrect.I agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorize 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
tom- liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
P• APPLICANTPERSTANDS AND WILL CIIMPLY WITH ALL NON-POINT Issued by:9f��LcaSOURC ���`. ,- Re-roofsSignature UContractor °ald
Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
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 �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 contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requireme ch I be mel prior to issu f a Certificate ofoccupan Signature of Applicant Date
''`'� - 7� � rC All roof coverings to be Class"B"or better
Owner ihorized agent Da