07090120 CITI' OF CUPERTINO x�' 7
BUILDlNG DIVISION PERMIT ������� �����
,::. ... _ _.
PERMIT NO.
BU1LD ��� o BE'I'TE AVE NICE & F:IGHT CONSTRUCTION 07090120 �
PERMIT LSSUE DATE
R'S NAME:
ZEZHANG HOU & AIYUN ZONG P O BOX 2285 10 2 7
SANITARY NO. CONTROL NO.
PHONE:
(408) 86:_-0928
BU(I.DING PERMiT MFO
ARCHITECClENGINBER: gLDG ELECT PLUMB MECH
� 0 0 �
� p � LICENSED CONTRAC7'OR'S DECLARATION JOb D2SCT1pIlOi1
: v� t hcre6y affirm that I am liccnsed undcr provisions oC Chapicr 9(commcncirtg
; Z � wilh Scclion 7000) of Divisian 3 of Ihc Business and Profcssions Codc, and my littnte is REV I S I OT J- GARAGE REV I S E WALL S& ROO F FR.AM I NG . OR I G
�� y in fuli Cocce and etCect # 0 612 0 0 � 3
� v� Z Licensc Class L�. #
p Datc ComracWr
: � � ARCHI7'ECTS DECLARATION
j a .a
a I understand my plans shall bc uscd as public rccords
)yV
° u. y Licenscd Pmfcuional
: � a OWNER-BUILDER DECLARAYION
� a� 1 hercby atTrm ihat 1 am exemp� Crum �he Conuaceors License L.aw !ac We
p O (ollowing rcason. (Sccuon 7031.5, Busincss and Profescions Ca1c: Any ei�y m eaunty
�,°, �i which rcquires a pcmiit ro cnnswct, alicr. improvc, dcmolish, or repair any stnrwre
°" y prior �ci ils issuancc, alsu rcquires ihc applicant Car such pertnit �o filc a signcd statanent ��, Ft. Floor Area Valuation
-?< �hat hc is liccnscd pursuan� lo thc provisions of Uic Conuactor's Liccnsc law (mapa 9 �'q � O
x t �(commencing wi�h Sation 7(l00) nf Division 3 of Ihc Busincss and Profcssions Cadc) w
y�� that he is exempt Nc�cfrom and ihe basis for the allegcd exemption. Any violuioa of
Secdon 703I.5 by ary applicant tor a pumit subjecu ihe applicant to a civil pmalty of 3 6 9 2 4 0 5 i)�� Number Oceupancy Type
not more than fivc hundrcd dollars (5500�
❑ I. u owner o( Ne property or my employces with wages u the'v solc compeaatiao.
wi!1 da Ux: work, and ihe stiucture is notintended or ofLered forsale (Sec.7044. Baaarss Required Inspections
and ProFusions Code: The Conuactor's License Law does not apply m an owo� of
property who builds or improves thereon, and who does such worlc himselCor tluoa66 his
owa employces. provided that such improvemmis are not intended or oQered [ar sak. I[.
however. the building or improvement is sotd within one yeac of completion. ihe owner-
builder will have the burdee oC proving �6ai hc did not build or improvc for parpoae of
salc.).
I, as owner oC the property, am eaeclusively conuacting with Iiansed coovae�o�a �o
nstnut ihe projen (Sec. 7044. Business and Profcssions Code:) The Conaaeta�s ►r-
cense Law does not appty w an owner of propeny who builds or improves t6e�mo. and .
who contracts tor such projects with a conuactor(s) liceeued pucsuant to ihe Cmuactofs
License Law.
^( am uempt unde�r Sec . B dc P C fqr thia iessm
Date �� �
� . _. .
O ER'S COMP T[ON DEC RATION
I Aereby afCirtn under penalty o[ perjury one a( the following declarafioas
❑ i hs.x and will maintain a Cenificate ot Consent to self-imwc for WorkdsCampcn-
sation, as provided far by Section 3700 of che Labor Code. [ar the pe�ormmoe d d�e
waric tor which Ihis pertnit is issucd.
� I have and will maintain Worker's Compcnsadon Insurance, az rcyuired by Section , ,
3700 oC �hc labor Code, for thc pecformance a[ �he work for which this pertni[ is imied.
My Worker's Compeasation Insurance carricr and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPfION FROM WORKERS'
COMPENSATION 1NSURANCE
(This sccGon necd not bc completcd it the permit is for onc hundred �Ilas (5100) ,
oc Icss.)
I cenify �hm in thc perfarmancc of thc work for which Ihis pertnii is istucd. l shall not
cmploy any person in any manncr so as lo o jcct to ihe Worlccrs' C��
Laws of Califo Datc
Applicant '
NOTICE TO C1C : If, aftcr 'ng tfiis crtiCwtc of Excmption, you shou�d
bccome subject to ihc orker s Compcnsation provisions af ihe Labor Code, 7rw muu
� O forthwiW comply wi�h such provisions or this pccmit shall bc dccmcd ccvol¢d.
Z � CONSTRUC7'ION LENDING AGENCY
(.~.� ►�.+ 1 heceby aliirtn that there is a cor�swctinn lending agency for the perfarmance uf
�, � thc work Cur which Utis permit is iuucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Namc
� z L.ender's Address
[ cenify Uiat 1 havc rcad ihis application and siaic �hat �hc abovc iofamation is
�� corrcct. I agrce io comply with all city and county ordina�es and sute lavrs �elating w
O U building conswction, and hcreby authori�t representativcs of �his city to cntcc upon thc
abovc-mcn�ioncd property tor inspccuon purposes.
�"� a (We) agrce lo save, indcmnify and keep harmlcss the Ci�y of Cuperneo agai�t
` H, y � liabiliuu, judgmcn�s, costs and expenscs which may in any way accruc against said G�y ��
() z in consequcncc o[ thc granting of Ihis permit. D3CE ' Y'��
�-" APPLICAN'f UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE C6lj..A'[70NS.
%�' �j1/r/' �iv�� �o���v � Re-roofs .�1./
Signu ofA licanl/Con or T of R oof
HAZARDOUS MATERIALS D[SCLOSURE YP
�II �he applicant or futwc building occupant storc or handle ha•ra�doas maoecia�
lcfincd by the Cupenina Municipal Codc. Chapicr 9.�2. and the liealth aod Safay
��. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
� y� �No .
Wil1 the applicant or futurc building accupant ux equipmen� or de�ices w6ich
If a roof is installed without first obtaining an inspection, I agree to remove
emii harardous air contaminan�s az dcfincd Ay the Hay Area Air Quality Manx�Cment all new rr aterials for inspecr.ion.
Districc? �
� ya u
I havc rcad the ha�ardous ma�erials requircmcnts unJcr Chap�er6_95 ofthe Califoo-
nia Hcalth & SafetyCodc, Secuons 25505.25533 aru125534.1 undcrstand tLxiCtRe huildin8
docs not curtently havc a �cnan4 lhat it is my responsibility to notiCy Ux acaWant nf U�e
rcyuircmcn�s which must bc met ' r u� issu� Ccrtifica�c of Or.cupa�r Signature of Applicant 11 Date
'� All roof coverings to be Class "B or better
Owncr o authom agcnt ��