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CITY OF CUPERTINO e0UMAT�43�1«
BUILDING DIVISION PERMIT
IT NO.
BUILDING ADDRESS: WELKIN INTERNATIONAL IND 0 610 0 0 8 5
7811 ORION LN PERMrr ISSUE DATE
OWNER'S NAME:
TIANLHUI TEMPLE 19925 SANITARY NO. CONTROL NO.
JNE:
(408) 733-0188777
408) 733-0188 BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p zO LICENSED CONTRACTOR'S DECLARATION Job Description
U
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
REVISION- ADD HOOD (I) AND WRAPPED DUCT
in full force and effect
License Class Lic•#Contractor ORIGINAL PERMIT: 04060040
in Date
F-ur ARCHITECrS DECLARATION
i a< I understand my plans shall be used as public records
ryU
w0 H Licensed Professional
OWNER-BUILDER DECLARATION
ja I hereby affirm that I am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
,.ff which requires a permit to construct,alter,improve,demolish,or repair any structure Valuaogn0 0 0 0
i- w prior to its issuance,also requires the applicant for such permit to file a signed statement $q'Ft.Floor Area
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
i t=- (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 APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36218010 - 00
not more than five hundred dollars($500)•
FII,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 docs 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.).
❑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-
ccrse 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. B&P C for this reason
❑I am exempt under Sec.
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
aI have and will maintain a Certificate of Consent to self-insure for Workees Compen-
ion,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 arc:
Carrier. 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 Performance of the work for which this permit is issued,l shall not
employ any person in any manner so 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 mist
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Namc
Q4 Lendees Address -
U 0 I 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
0 U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and expenses which may in any way assns against said City
in consequence of the granting of this permit. Date
U Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Conuactor Date T of Roof
HAZARDOUS MATERIALS DISCLOSURE ype
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 ❑Nu
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 dcrined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
1 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 tic building
does not currently have a tenant.that it is my responsibility to notify the occupant of the Date
requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant
All roof coverings to be Class"B"or better
Owner or authorized agent Date