04080001 CITY OF CUPERTINO
BUILDING DIVISION PERMIT y pCONTRACTORIINFORMATION ...
BUILDING ADDRESS: PERMIT NO.
WONG ELECTRIC INC 04080001
OW NEWS NAME: PERMR ISSUE DATE
WTI]RCH IN 4 06:7
E RT ST SANITARY OL NO.
ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_op LICENSED CONTRACT'OR'S DECLARATION O O O O
mut❑❑ Iion7 affirmOR,I 3limnedunderprow'oreofC000r aC.de. 9(commencing JobDeserip[i ���
<iW with Section IDlgl)uf Divisionlof the Businm and Pr rcssions Code.and myliccnse is
in full force rad c ret.f\.�Q aLf :Vl
LiccED
ns Claz \ E15' TI--ELECT. WIRING SYSTEM/HVAC
=p Dam 110 Camrumr OCT � '
A CHITI C RATION 2004
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` S OWNER-BUILDER DECLARATION II[IIg6YTjjYgll gfft]'�gw tlOy1
'110 3 1 herchy.(Sere that 1 1. exempt from the CnnuanCals:Any t Law for the
00 following rcazan.(Section 7(13 L5,Business and Pmfc since Code:Any city nr crony
3..
m which morulas a Permit to Construct,alter.impmw,demolish,ar.pain any structure
in
FZ6Plano its issumacc.also rc(Pul.ashe applicant for such Permit.file a signed n.mmen,
ththe Hlimread Pursuant tock Pmdaiora of the contncmr's ia:cnsc lew(CmPmr9 Sq.Ft. Floor Area Valu hon
yr0 (commeneiagwith Scction7")or Division3oftk Businessond Professions Cadc)or
A. dust k for emmpt therefrom and the basis for the alleged exemption.Any violation or
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 2'��r�'l10er0 p Occupancy Type '
not more Nan five hundred dollars(5500). e
❑I,u owner of the property,or my employees with wages u their sole compensation,
will do the work and the structure H not intended or ofrero l for And,(Sec.]Dad,Business
and Pmfcssions Cade:The Couracmrs Licence Law dao not apply to an owner or Required Inspections
property who buildsar improves thereon,and who doessuch work himself or through his -
own employers,provided Nat such impmsemenu m not inmtdmd oro02red for sale IL
however.the building or impmwment is sold within one year of completion,the owner-
builder will ban the burden of proving that he did not bdld or improve for purpose of
salt.).
❑h az owner of the pmpeny,am exclusively contracting with licensed cameraman to
construct the project(Sec.7(aa,Businu,and Profusions Code:)The Contractor's Lt.
term law docs not apply to an owner of property who hui1W of improves the.om,and,
who concocts for such prefects with a contractor(s)licensed pursuant.the Contractors
Lice s Law.
l am eacmpt under Seo. B k P C far this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aBirm under penalty of Perjury am of the following dmlmtions:
have and will maintain a Ctrifeam of Consent to self-insure for WorkeriCompen-
az provided for by Section 3700 of the Tabor Code,for the performarec of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,az required by Section
3700 of OR Labor Code,for the performance of the work far which this permit is issued.
My Wo Compe,s Ins,u��n tt�� Po'c bee
G 01dFF " � QOGO
CERTIFICATE OF E%EMPIIq MWORKER
COMPENSATION IN URANCE
mossection need not kcomplemd if the permit is for one hundred dollen(518(1)
Lir ICs.)
1 unify that in the performance of the work for which this permit is issued.I shall mat
employ any person in my manmr s u As become subject to the Workers Com,creadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL aper making this Cenifcare of Est amen.you should
became subject m to Worker's Compensation previsions of the labor Conic.you muse
.,Z forthwith comply with such provisions or this Permit shall he deemed revoked.
Z O CONSTRUCTION LENDING AGENCY >
Ihemhy aMd.Nat there is a Cmuwctum lending agemry far OR pcirmaanm of
!Y> OC work fur which this permit u issued(Sec.3897,Civ,C.)
�W A tender's Name
Lender's Add.
U 0 1 certify that T have read this application and sum Nat the above information is
U. P: torr".I agree m comply with all city and county ordinances and sum laws relating in
C)U building Construction,and hereby authors.tp timadives of Nis city,o matter..tht
move-mcnuoncd Property for inspection wuryasea
F C (WC)agree to saw,indemnify and keep harmless the city or Cupertino against
pr' in
r OR gauand expensof this Permit. may in anyway acerot againstsaid City
(„)z in consegmnet of the Branting of this rcrmit.
AP 1 NT UNDERSTANDS AND WILL COMPD 1711 L NON-POINT Issued by: Date
SO REGULATIONS. /
Re-roofs
n roof ADPlicanUContncmr Datc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Lir fate.building meupant stare or handle hxuarduus maunial
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(.)?
❑Yes T-�No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hazardous air conmmirants az d,rmcd by the Bay Area Air Quality Managcmcat all new materials for inspection.
ar,
❑Yes �No
I ertAd thehvard' maurialsaquinamenu under Chspor 6.95ofthe Calor.
ria Hcal afcryCodc,Smdb,s 8505,25533 and 8534.1 undcrsund NmiftM Wilding
Joy t 8y,Ilan a mnana Nat it u my respe t m my 8m acupant of the
rtuhi ch mustWmetprior'.is et orae ra f0mapaney. Signature of Applicant Date
V /r— O O(
owneraraa,hoti,<d,gem, Data All roof coverings to be Class "B"or better