07100112 CITY OF CUPERTINO � ('� '
BUILDING DIVISION PERMIT �����^"'"�� ���������
_ ,.. ::.. . :
<.. ;:' ; ....:....
PERMIT NO.
BUILDING ADDRESS:
10490 DAVISON AVE TBD - 7'0 BE DETERMINED 07100112 .
PERMTT ISSUE DATE
,,.oNER'S NAME:
YONGZHONG LI & ZHONGYING CHEN � 11/16/2007
SANCfARY NO. CONIROL NO.
PHONE:
BUiLDING PERMIT INFO
ARCHI'IECI'/ENGINEER: BLDG ELECT PLUMB MECH
� 0 0 0
u p p LiCENSED CON!'RACTOR'S DECLARATION JOU DCSCT1pt10I1
V� 1 hc�cby a[frtn tha� I am licenscd undcr provisions oC Chapur 9(commcncing
�� wi�h Secdon 7IXw) ot Division 3 of thc Busincss and Profcssians Codc, and my licensc is S FD ADI ) I T I ON ; ADD A 17 ' X 18 ' B �Nj.T S ROOM @ REAR � F
�� y in fuu fo�ce and eftecc Lic. +r H OU S E 1 � 1/ 2 BATH
� � � Licenac Class ContracWr
^ �,,, � Dalc
ARCHITECI'S DECI.ARATION
�� 6 I u�crswnd my plans shell be used u public rccorda
�y[�
4 O y Licensed Pmfcssionat
y � OWNER-BUILDER DECLARATION
� I hcreby affirm t1�at I am excmpi from U�e Conuacars Liccnsc Law far thc
� p O following rcason. (Sccuon 7031.5, Busincss and Profcssions Cadc: Any ci�y or county
K,°, � which tcquires a pertnit to conswcl, alicr. improvc. dcmolich. crc repnir any swcw�c
rior �o i�s issuancc, alsu icquims thc applicant (or such permit to filc a signcd s�ammcnt Valuation
�' Z� � Ft. Floor Area
< that hc is liccnscd pursuant to thc provisions of thc Conuactor's Liccnsc Law (Chaptcr 9 S9• $ 6 5 5 9 7
z t �(commcncing wiih Scction 7000) of Division 3 of ihc Busincss and Profrssions Cade) or
y�� �hat he ia exampt the�efrom �nd the besis Cor the allcgcd exempuon. Any vioiauon of
Section 7031.5 by a�ry applicant for a pertnit subjects the applicant to a civil pcnalty ot 3 6 9 2 6 0.3 4`��'I Number Occupancy Type
not more than five 6und�ed dollars (5500)•
❑ I, u owner o[ Uie property. ar my cmploycrs with wages u their sole compensadon,
will do the work, snd �he strucuue is not intended or oRemd for sa� (Sa. 7044. Business Required Inspections
and Pco[essions Code: The Conuacmr's Lianse Law docs not spply w an ow�r of
property who builds or improves thercon, and who does such work 6irtuelf or Wroagh his
awn employces, providcd that such improvements are not inunded or otlemd fm sale. lf,
hawever, the building or impmvemenl ia sotd wilhin one year of complcGon, the owner-
builder wiLL have the burden o[ proving �hat he did not build or improvc fa puryoae of
saleJ.
I. ss owncr o[ the property. am enclasively conuacting with liansed rnntractors W
ns�mct Uie project (Sec. 7044. Business aad Professons Cade:) The Contracwr's Li-
ccnse Iaw docs not apply �o an owner of properey w6o builds or improves thaeon, and ,
who conuacts Cor such prajects with a conuutor(s) licensed pursuant to the Conuscwrs
' '�ense Law.
am exempt undq S . B� P C[or this reawn
Uwner _1y��b �/�L Date � �( � O
�. frORKER'S COMPENSATION DECLARATION
I hercby �rm under ponalty of perjury one of the follawing �clarations:
❑ i hsve and will mainain a Certificam of Consent to xlf-insure (or Workcls Compen-
sation, at provided for by Sectian 3700 ot the Labor Code, far �he pedormance of the
work for which this permit is issucd.
❑ I have and will maintain Worker's Compensation Insurana, u required by Scction ,
3700 of �he Labor Code. Cw the pedormance oC ihe work for wAich �his peemit is issued.
My Workers Compensadon Insunncc cartier and Poliry number a�e:
Cartier. Poliry No.:
CERTIF[CATE OF EXEMPTION FROM W ORKERS'
COMPENSA'[10N INSURANCE
(7Lis scctian need not bc complcmd it tde permit is for onc hundred dollua (f 100)
or Icss)
1 cenify �hnt in thc perfortnance of the work for which �his pertnit is issucd, l shill not
employ any person in any mann�r so az ap� me b' t to �he Worlrcrs' Compensuion
Caws of Cslifomia Da�e n '`��" �A� A
Appiicant r 1 -cr c �
NOTICE TO APPCIC : I(, aftcr making ihis Ccndicatc of Ecempuon, you should
bccome subjcct to thc Worlc�r's Compcnsation provisions of tlfc Lsbor Codc, you must
, O foMwith comply wi�h such provisions or this permi� shall bc dcemcd �cvokcd.
z '"� CONSI'RUCTION LENDING,4GENCY
F r r�-� 1 hc�cby aRrtn Uut thcre ia a consWCtion knding agcncy (or thc perfarmaru:c u( .
�, � ihe work for which this petmit is iuued (Sec. 3097, Civ. CJ ,
W Q Lendcr's Nunc
Lcnder's Addtcss
V � I certity �hal I have rcad Ihis application and stalc that thc abovc information is
w ►�" cortca I sgrce w comply wiU� all city and county ocdinancea and state laws reladng w
0 U building conswcGon, and de�eby suthori�e ccprescntativcs of ihis city to entcr upon �Ac
� W alwvc-mcntio�d p�operty for inspection purposes
a (We) agree �o save, indcmnify and kecp harmless ihe Ciry of Cupertino against
H � liabilitia, Judgmcnls, casts and ezpenscs which may in any way accruc against said City /
V z in consequence oCthe grandng of ihis permiG Date ( "'�,�"-��
� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�i:
SOURCEREGULA'I70NS• ,��� / ��/
��-�-%�� � Re-roofs �
Signature af Appiican Co uactor Da4 ��
HAZARDOUSMA7'ERIALSD[SCLOSURE T}�� Of .ZOOf
�Il lhc applicant w futwe building occupant storc or Aandle haiardous matcrial
cfincd by Ihe Cupenino Munieipai Codc. Chaptcr 9.12, and che Hcalih and Safcty
_�de, Scction 25532(a)? � All roofi; shall be inspected prior to any roofing material being installed.
❑ Yu
Wiil thc a�licant or future buiiding accupant usc cyuipmcnt or dcvices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit ha air conuminants u dcfincd by �he Bay Area Air Quality Managcmcnt all new i naterials for inspection.
as�����
❑ Yes �JNu
1 havc rcad the hvardous matcrials �cquiremcn�s under Chapler 6.95 of Ihe Califor- ,
nia Fkalth & Safcty Codc, Sectio�t 75505. 25533 a�ul 25534.1 undcrsund tlu� if ihc huilding
docs not curtcntly havc a icnan4 � it is my rcsponsibiliry w notify �he occupant of ihe
requircmcn�swhichmust m�lpn toiss j o[ ��r�oro���ry. Signatur° ofApplicant Date
��1����" "_ " ��b�`� r All roof coverings to be Class "B" or better
Owncr or authari�ed agcnl ���