12090151 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10376 NIENIIART LN CONTRACTOR:ZHANG WENTAO PERMITNO: 12090151
OWNER'S NAME: ZHANG WENfAO 10376MIiNIIARTlN DATE ISSUED:0911812012
OWNER'S PIIONF.: 4085166357 CIIPERTINO,CA 95014 PHONF.NO:
❑ LICENSED CON'I'RACI'OR'S DECLARATION - BUILDING PERMIT INFO: BLDG C ELECT(_ PLUMB 1--
License Class Lic.N
01F.C11 r RESIDENTIAL(J COMMERCIAL t
Contractor Dale
I hereby affirm that l am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACING EXISTING TAR AND GRAVEL ROOF WITH
(commencing with Section 7000)of Division 3 of the Business& Professions NEW
Code and that my licenseis in full force and effect. SHINGLE ROOF,INSTALL NEW GUTTER LINE AND DOWN
SPROUTS-15 SO
hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certificate of consent to sell'insure for Worker's
Compensation,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 provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Arco:0 Valuation:$6000
AI'PILIC,%N'I'CER'1'I IFICA'I'ION
I certify that I have read this application and state that the above inflmmtion is APN Number:37516011.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances mid stale Imus relating
to building construction,and hereby authorize representatives of(his city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of(he
granting of this permit. Additionally,the applicam understands mid mill comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 1S0 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Issued by: Date:
❑ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to my roofing material berg installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all nese materials for
will do the work,and the structure is not intended or o0'ered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
hereby affirmunder penalty of perjury one of the folloo ing three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations: _
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California I Iealth&Sufe(),Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the perfommnce of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health S
Safety Code,Section 5532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of die work for which this permit is issued,I shall contaminants as defined by the[lay Area Air Quality Management District I will
not employ any person in my manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Ilealth&Safety Code.Sections 25505.25533,and 25534.
become subject to the Worker's Compensmion provisions of the Labor Code,I must
forthwith comply with such provisions or[his permit shall be deemed revoked. Owner or authorized agent:
Dale:
APPLIGS\1'CER'1'IP]CA'1'ION CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above infomnmion is
correct.I agree to comply with all city and county ordinances and stale Imus relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against I iabil dies,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIUTECf'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Dale
Licensed Professional