05100231 CITY OF CUPERTINO p 7• ''�. �yT�/�"^^`FORM '
BUILDING DIVISION PERMIT QQNTRACTQR INFORMATION:
BUILDING ADDRESS: PERMIT NO.05100231
y
10422 BRET AVE
'R'S NAME: PERMIT ISSUE DATE
XU DONG DONG 01Z25/2006
PHONE
SANRARY NO. CONTROL NO.
ARCHRECT/FNGINEElt: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0
300 LICENSED CONIRACIOR'S DECLARATION
F 1 bemby alfrm that I.m lian,<d oda proviaiou of CLeper 9(mcn<
mmIn3 Job Description
4 " with Becher(7q )or Divkdn Sof the Basinger ad Profcssturd Code.ad my li.is
infull force and dftt ADD 1658 ' BEDROOM/REMODEL
; Z Diem cCWv Conti
actor
7W ARCball Ix S DECLARATION
lunduaad my pWNll.she u¢dupolio,rcmN
U
a LLp Lkcnud Rofuuon.l
Oar I.. a rDER DECLARATION
.� I bcmby (srm Nat 1 I2 lump(from tM Camnd Cod LiA n C law for kc
p o following maven.(stttiun TI1313.Busisras and Rofuaitm Cade:Any dY or munty
whkb m9ukcs a .it n cmrlmcL ahm,hnprove,mmobob,or mplr any arunum $3 9 8 2 9 9
°rior un its ozm=..Isu m uiru kcal Irnnt facwch tm Rk a sl ncdsummam
i,al,ni.lladpu,a,.rnloutnpm.'°on.nrotaconu°.�m� :wtcn,plmv Sq. Ft. Floor Ar Valuation
(Cron.n ing with SCCb.70110)of Divvian S of do Buxi.r nd Pro(m.u Cdc)a
$ Nat M W comp kemfrom ad Ibe buts fa the alkgcd eaemp ton.MY noWimt of
Schon 7MLS byany appncant for.pump subJm.ka spplinm to.coil pi of r !! Occupancy Type
not man than fire hundred dollars(SS0
❑1.so owner of ft pmi or my anploycna Mk"gent u Heir toll camputvJon. M
MII do do walk,and the...V nor unuo ded aroRud for uk(Sec.TD.a,Bodnw y F.
ad Pmresdoru Code'De Cone s Lime Law dots rot apply n an owner of UI d ypy�uj��
properly who balkier or improbi thereon, n does such and wisuch wart himself or through hal AN ^ V
ton emplayces,provided that such lmpmemen.on,mat inRnded m offod for sold U.
lura, u,dx bnllding or iopowmrm is sold Malin arc yW of mopinlon.the ownu
bonder will hue on,burGn a(proving dot ha did not Wild or 4nptove for purpo¢d
sale.).
CiL u owner of dtc poputY..m ududKly cenbaaing Mk Bansd conv.csora n
cauvum dm pro)=(sec.70".Bus4tea.nd PmfCW..Code)The Calumet U.
CC.Law don.Wily o.n owe of praPerlY who builds Or myon.thereon.and. .
wbo coronets for such pmjoC•Mth a cm.amar(s)naeasd prnuam m the Conv.enr.
Lice.Law.
nrtiu
I.m aL p�under .B&P C fm kis rdm
Dae /-7�-0F
W RK PEIISA'110N DECLARTION
herA
1 by off rm uder peaaly me of psrju' of die T ms
follawin A •^' .
❑1I..e.d vent m.in.in.CesWfamdCvucntnseU.lnwnrar Wartcri Camprn
utbngovlded fir by Sction 3T00 of the labor Code.nor die pRormarta of th
f
wNa farr wbkh Nrn
is pnit H iaucd.
❑1 Wvc um
and will maut Warta"Cmt� ^ nver.• I .u�uirW by s d.
My iters orke Luba Code.ion thepedamut¢ofdiework forwbkh that pamisuloud.
MY Worker;Campeasadm Imtnnce and Pmlryum
nber arc:
Carriu: policy No.:
CERTIFICATE OF EXEM MON MOM WORKERS
COMPENSATION INSURANCE
(Tb'n allot reed not h canpktd Ifft pntdt V fa ane hudtd md.n(Stmt
a that)
I m fv kat to the parform.nce of the work fn whicb kis permit is issod,I shill not
employ any prson in any martyr an u in
� D•WTsubj=a r
WourtmcKCompuaboR
Lan of CalfnroiaCSu .law of Epian,you shouldNOTCE70APP :If, �
bcmme subject to the Wortu's Compoullon pmvidorts of tY labor Cade,you in=
Z foMwik comply wile such porrimm on dw proom,"I be dnmd rnm d. '
ZOCONSIRU=NLENDNOAOENCY
Ihc,,,a(Rrm kat ken kacowtniw kMinS.aocY for kc pi fornaccd
W> the wort run which dila pumit Is iaued(Sec.3041,civ.C.)
d A 4xdcr.Name
l
7'z 'Address
U0 1 certify kat 1 Nvc roil k4 applicuim roil veru kat dc.hove krmmation u
W cor.ca I.grog n comply with all city Id c ty oMrunces and JbW Ian milling
U U Wilding conamcdon,and bemby aukurim mpresenutivca of this city n Cour upon kc
r G ahove-mandamd pmperty for Itopmian purposes
(Wc).girl n som indemnify and trop barm is the C'ty of Cupmitn.a.
II.Wlitiu.Judgments,cos.aatl eapemu whkh may in any nyamueaWmt said City
ur
U APPANcf UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
atyutum of AppbnnuCFaR Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WUyftCpmel(uunibuildinga.cupad acreu and haiardawd Safety
:IoW DY th Cuprnim Mutmipal Com.mapkr 9.11,ad the Hedth and Safety
Sccdon 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
ED Y. '0Na
Will kc applkant ormuac Wtildingacaupm me eRdp.L.mikes wbirn If a roof is installed without first obtaining an inspection,I agree to remove
ami(hvardno. it rontabrout at mind by kc Bay Aro Air Quality Managcmcu all new materials for inspection.
Diwian ,,,...,,,(((
❑Yn yNa
I bare rad the Wardw./ `matrialsrcqu'nemcnuudvChapow4YSoftheCalifu-
ma H th&Salmy Gam.Srnia.25505.25533 aa125534.I unmmad kat Ifdc building
ts
donm ewmmly have am kat Ie h my mapndhility n ndfY the ucvpant of the
myalmmcm+whl foe tpvamivtwocar.canakararoaupucy. Signature ofApplicant Date
o m audwriv< am v4—>k—D4
�,o4 All roof coverings to be Class"B"or better i,