06070048 CITY OF CUPERTINO � }++any) 1"•]I �' 'q`T �.rl
BUILDING DIVISION PERMIT #�CIOl'(:+:L+1 � Q�� O.�,q'n ��csj �;
BUILDING ADDRESS: t� PERMIT NO.06070048
10873 BARRANCA DR
R'S NAME: PERMn''SUEDATE
WAYNE KOGACHI & JICHI CHEN 08/28/2006
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG rO PLO MEOCH
0o LICENSED CONTRACTOR'S DECLARATION lob Description
Fpy 1 hereby main,that 1 am licensed under provisions of Chapter 9(commencing
E with Section 70M)of Division Sof the Businereared Professions Codc.and my license is
y In full to.anderfecL SFDWL-TWO STORY LIVING 3 , 505 ' /GARAGE 473 '
y z License Class Lk.M
F Dem Con DELL
p
ARCHITECTS used
DECLARATION
i$< 1 understand my plana Mell h used ss public rtcnrt
yU
G Licensed Professional
OWNEm aU rept fr DECLARATION
Z M i 1 hereby.(Sinn on I em exempt from the ConionsCo :Any c 4w for Ne
.O O following mason.(Saturn 7 ons ru t.shims and Pre.de ons Code:Any city or county
3 3- which require•pcmlte re cnnsuuc4 altes,improv,demolish.t or repair any swnum $778034
.zy "he isliensedr staterequiresWe ft pmvid applicant Certisuieh ficates
toiecoIC m Law
atammam
I � thathculicaMedpurmanttoteprovivisMoflheConuendProfelaw(Code)in Sq.Ft.Floor Area Valuation
that he us m&wit Sectiamron 7 and of Division 3.1'the Business edxcept on.Any vi Calc)or
3 dist b esempt therefrom and the basis for the alleged exception.Any l violation of
noSection e Chas l w hanyea applicant for a permit mbjecu the appliesnt m a civil penally of r Occupancy Type
rot more dun low bundmd dollars(5300).
❑1,as owner of the propmry,or my employees with wages as their sale eompensaton,
windnteworE.sadteawmnmlanatmmndedarormedto,we(See.7a,,Business RequiredIns cellons
and pmfeNlPN Code:The Con mernes LNCnR Law does Out apply m an owner of P
property who bulldsorimpmM3 teleae,and who dIXenuch wort hlmRlforthmUgh his
ownemployaes,provided dial much improvements are not intended oroffemd forsale.If,
however.the building or Improvement is sold within arc year of completion,the owneo-
builder will haw the burden of proving that Ile did not build or Improve for purpose of
sale.).
g I.as owns,of to property,am exduaively conouting wit licensed ommacmn in
censwm the Project(Sec.7044.Business and Profrumom Cade:)The Corrramrs Lb
cense Law docs not apply man
owner of Property who hard,or improm Lemon.and
who contracts for such projects with a canuacmrts)licensed purmam he the Commerce,
Licca law.
❑1 me emmpl under Sao .B d P C for this moon
Date F14106
WORKERS COMPENSATION DECLARATION
I hereby dorm under Pa dty mf perjury one e(dm mltwing declaradmta:
❑I have and will maiouin a CeniRcam of Consem in self-rams fa Wo l cel Compen.
sation,as provided for by Section 37M of the Labor Code,for to performance of tee:
wort for which this permit is issued.
❑1 haw and will maintain Woreces Compensation Insurana,as required by Section
3700.f tle Labor Code.for to per(....of to work,for which this permit is issued.
My Workee,Compcamdmn bu mance wrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' .
COMPENSATION INSURANCE
(This section need net be completed If the permit is(moa hundred dollsm($IIX)
or Icss.)
1 certify tot in the performance of to wart for which tis permit is issued.I shall not
employ any person in my mannerm me, bject m the Wmkcrs'Compensation
Laws of Califarnla te ` yZ �O
APPliunl l� (<k^
NOTICE TO APBCANT.If,Commuting to Certonsoficate of FLabor oil youshould
umeet
become subject y that Worker's ro Compensation provisions of do ed(Cede,you mull
.J Q fmrtwit comply with wch provisions or thus permit shill nd tamed revoked.
Z y CONSfRUCTON LENDING AGENCY
[r l hereby afftrm Net tem lsa amlmctnn dndin5 agency for the par r.on.=of
g1i
the work fur which to permit is issued(See.3097,Civ.C)
WQ Lenders Name
M
=2 Lassen Addremm
U 0 1 cenify that I haw mad this application and sum that the above information 6
F' conch.l agree to comply with all
city and county oNinsmes and mule laws mining m
DU building construction,and hsreby authority represenutim of tis city to cnmrupnn the
r0. alavcmentiuned property for inspeeuot purposes.
(We)agree Ire an..indemnify and keep harmless the City of Cupertino against
hI'"r V! liabiliueafudgmants,coed and expenses which may in my way acc=against aid City
U7 in cmumquence or the&Miles of this Permit
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCE CULAp�
/ oil ?12910 6 Re-roofs
Si¬a,�ArApplicantiCooloscior t Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or run.Wilding ampantemm Or handle lonsa dans meo:rial
de0ned by the Cofferdam Municipal Cade,Chapter 9.12•and the Health and Safety
Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yns Iasaa
Will dm applicant or future building ampant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit lumafdous alt cmnuminsnu as de0rcd by the Bay Arta Air Quality Management all new materials for inspection.
D rict7
❑Yns Phi-
Ihew revel the hmidous materials requimmrms under Chapter 6.95 of the Califor.
Tia Hr alt k Safety Code.Savau 23705.25533 and 25534.I vrdemaM that lflM bolding
data not currendy,have a wnam,tet it b my rnsponsibilily to noury Uv eaupsnl of the
require whichmuR met pd i of aCenificawOfOc cy/o 6_ Signature of Applicant Date
Owner uthorivcdagent Dale All roof coverings to be Class°B"or better