07090155 CIT� OF CUPERTINO � ' 7�g 7
BUILDING DIV1S10N PERMIT �*��� ����������
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PERMIT NO.
BUILDI � rc �� q 1 ss HILLCREST RD JERRY i�ANG JUI CHOU 07090155 �
b
PERMIT ISSUE DATE
OWNER'S IYAME: ,
GRACE KING 45450 �UTHERFORD
SANITARY NO. CONTROL NO.
VE:
� BUILDWG PERMITINFO
ARCxrrECr�xcir�ER: REVISI�N-REDUCE SHEAR BLDG ELECT PLUMB MECH
0 0 0 0
i p p LICENSED CONTRACfOR'S DECLARATION � O escr�ption
: � � I hcrcby afGrtn that I am licenscd undcr provisions oC Chap�cr 9 (commcncing - ^- -- ^ ^ ^ ^ ^. . ^ ' ^ ^ � ^
; z� with SccGon 7000) of Divi ' n 3 of �hc Busincss and Profcssiuns Codc, and my liccnse is
�= y in full forcc and cCCec�
� v� Z Licensc Clacs L� # �/� � �. NM
� F o Datc Con�rac�ur
� ARCHCCECTS DECLAR ION .
i� Q 1 undcrswnd my plans shall bc uscd as public rccords
�qU
' a y Liccnsed Prufcssional
: � a OWNER-BUILDER DECLARATION
�y�
1 hcrchy alTirm thal 1 am excmp� Crom thc Coniractors Liccnse I,w far thc
� p O Collowing raason. (Scction 7031.5, Busincss and Profcssians Codc: Any ciry or county
�,°, �i which rcquires a pertnit to conswc4 altcr. improvc, dcmalixh, or �epair any suucture
t7^y r
rior to i�s issuancc. also rcquires �hc applicant for such pertnit to Glc a signnf swement Valuation
�?< �hat hc is liccnscd pursuant to �hc �xovisions of thc Conuactor's Li��cnx Law (Chaptcr 9 ; iq. Ft. Floor rea
� t �(commcncing with SccGon 7000) o( Division 3 of Ihc Business and Profcssions Codc) or
y�� that he is exemp� therefrom and the basis Cor the allcged exemption. Any violatian of
SecUon 7031.5 by a�ry applicant for a permit subjects the applicant w a civil penalty of APN Number Oeeupancy Type
not more thm fivc hund�cd dollars (5500).
❑ I. as owner o[ ttie propc�tY or my employces with wages az the'u so(c compenvtian,
willdothcwurk.andihestcucwreunotintendcdoroffered Required Inspections
and Professions Code: The Conuactors License Law doc4 nat apply �o an awner of
proputy who builds or improves thercon, and who does such work himselCor Uwug6 his
own emplayccs. provided that wch improvements are not imended or otleced for ak I[,
however, the building or improvemmt ia sold within one year of compleua6 d►e wrtier-
builder wiR have the burdee o[ proving IAat he did not build or improvc Cor parpox of
sale.).
❑ I, as awner of �he property, am exclusively contracting wilh licenxd contractors w
cons�run U�e peojeci (Sec. 7044. Business aad Profcssians Code:)'ILe Can�s Li-
cense Law docs not apply �o an owner of property w6o builds or impmves i6e�. and .
wAo conuac�s Cot such projeca with a contractar(s) licensed pursuant to �he Conuaewfs
License I.aw.
❑ I sm exempt undu Sec. , B& P C for this e�eswn
Ownu Dau _ .. _,
� WORKER'S COMPENSA'I70N DECLARATION •
1 hereby affirm under penalty a( pe�jury onc o! the fallowing declaratiaos
�] 1 hove and will main�ain a CeniCicate of Consen� to self-iasum for Wortels Canpen-
satian, as providcd far by Sectian 3700 af the Labor Code, for �he performaoce of the
work for which this permit is issucd.
0 I have and will maintain Workcr's Compensatian Insunnce, u �cquircd by Scction ,
3700 of the Labor Codc, fw U�c pcdormanu of the work (or which this pecmit is issued.
My Worke�s Compensation I carticr and Poliry n� b�r a�c:� �
Cartier. � � f" Policy No.: _, l � � � � ��
� CERTIFt TE OF EXEMPI70N F'ROM WORKERS'
COMPENSAT[ON INSURANCS
(This section necd not bc comple�ed if the pertnit is for anc hundred do�us (5100)
or Icss.)
1 cenify that in ihc perforn�ancc of tdc work !or which ihis pertni� is issucd. t shall not
e�ploy any person in any manncr w az to becomc wbject io �he Workcrs Compensation
Laws of Califomia. Datc
Applicant
N01'ICE TO APPLICAM: If, af�cr mating �is CcrtiGcatc of ExcmpGon, you should
bccome subjcct to thc Workcr's Compcnsation provisions of thc La6ar Codc, you muu
� O fonhwi�h comply with such provisions or this pccmit shall bc dccmcd rewlccd.
z �""' CONSCRUCTION LEND(NG AGENCY
Fr � I here6y afGrm Wat there is a constcuction lending agency Cor the perCormance uf .
p; �✓ thc work Cor which �his permit is iuued (Scc. 3097. Civ. C.) .
W A Lendcr's Narnc
� z (,endets Address
V � ► �ertifY �ha� I have rcad this appliution and sta�c ihat thc abovc infamation is
�, � corrcct. l agree to comply with all city and counry orJinances and sute laws relaung to
� U bui)ding conswction, and hereby authori�e rcpresentatives of this ci�y to enteru�n ihe
� W ahovc-mcntioncd pcoperty for inspccuon pw7�oses.
a (We) agree to save, indcm�i(y and kecp harmlcss thc City o[ Cupertino against
H r/� liabiliues, judgmcn�s, costs and expenscs which may in any way accruc against said Cicy
(� z in conuqucnce of thc granting of Ihis permit. Date �� �� L�
►-y APPLICANT UNDERSTANDS AND WILL MPLY WI?H ALL NON- INT Issued by :
SOUR EGU 1'lONS �O � O
Re-roofs �1✓
Si m ot �an n tor �� T of F.00f
� � �ARDOUS MA'I'ERIALS DISCLOSURE YPe
�II'du app t or fuwrc building occupantstorc or handle haarudaa ma�crial
u dcfi�d by �he Cupenino M�cipal Codc. Chaptcr 9.12. and t6e Health and SaCay
Ca1c, Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Y� �� .
Will thc applicant or fumre buitding occupant usc cyuipmcnt or deviccs which
If a roof is installed without first obtaining an inspection, I agree to remove
cmit harardous air con�aminan�s as elcGncd Ay the Bay Area Air Quality Managemcm all new a.aterials for inspec :lOil.
Disuict?
❑ Ycs g] No
! \
I havc reaJ ihe ha�ardcws maicriats requiremcn�s undcr Chap�cr 6.45 of the CaliCor-
nia Hcalih & Safcty Codc. Sections Z5505, 25533 and 25534.1 undcrstand that iCUic huilding
docs no� curtcntly havc a tcnant, that it is my responsibiliry w noufy du occupant ol' �hc
rcyuircmcn�s which/�'Q�st be met prior issuancc o a Ccnificatc of cupann! Signature of Applicant Date
(�
All roof coverings to be Class "B" or better
Owncr authori�.cd agcn °�