08040082 CITY OF CUPERTINO -BUILDING DIVISION PERMITCONTRACTORINFORXATIO'1!I.
BUILDING ADDRESS: PERMIT NO.
10475 BEARDON DR TBD — TO BE DETERMINED 08040082
NER'S NAME: PERMT7ISSUE DATE
'rXr, 'KINO ROCKY CHAN 07/08/2008
PHONE SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
NEW 2 STORY SFDWL, 4556SQ 0 O O O
opts LICENSED CONTRACTOR'S DECLARATION
m 1 bemby amml dust I w limrned under pruvsiom Of Chapasr 9(comMactn& Job Description
2,M with Sermon? erreroiHdanJarume Baalnma wma Pmre�earp rpagpl�my cress
in full fame end eRM. b ' 0 ,
,,Z Lice I Wc.N
RCHDECPS DECLARA71ON
U 1 ursu« m
ndeI my Alashall W used as public mmNs
It" Licensed Pmressonal
qs O 5 OWNER-BUILDER DECLARATION
y F 1 hemby affirm that I M 4Gnpt from IM ConnYlaYe License Law for NC
L O pOpH, following moon.(S«tim 70313,Businma old Pmfr om Code:My cily m county
40 a. which mgnbn a pelmll m co1WN«,alhL Improve.demolish.or mpalr my structure
°2t prior n its issuance,him requirnNeapplicant fors«h permit us rile a sigrcd wmment
FF `e wlneis IcemcaPar>�tW0. m.;rionordrtCarnahan'sLim�I.w(Chap=9 Sq.Ft.Floor Area Valuation
Y� (commencing with Srrion 7080)of Division 3 of dw Business and Professions Codc)or
i 9 dol he is swept m«efmm and Uu basis f«w alkged assumption.Any violadm of
Seevan7mL5byany applicamfor apermit subleasdic&pplicaalmacivil pewtrof APN Number Occupancy Type
non mom dm five husband!dollars(S500).
❑Loa as work,Na themuc«mywphry«a.0111. masdmvrole mmpensWon.
wmdn InswoksCo the sh Car manses Licdean Law does no, (Sec.7a4,mmar Of
ns
,rld Pram« Case:The Cm rY1oY, ndumo law dor ar apply lf ut«,rte or Required Inspections
properly who WRds«improwach imps andwbo doessuc mange biroffamr though hu
own wplayebuipwviOfi dol smhERL is sements ase mtinmhd«oemea forme.if.
howernarWilder she building lat arWprovemnng oldediinarcyen of inspro um.Nep.of
hada«wB hw Ilw Ixmrden Of plarine urn W aid w noun«improve r«paryw or
rete).
❑1.as..of de properly w evJumely corseting wish Iichound contractors m
construct Ilse project(Som.7044.Bassoons aaa Profession Code)The Cmucloh Li-
c.law dare ml appty n an owner a property who build,ar)mprovca dawn.and,
who cmuorts for such projects MN a conuect«(s)licensed puramm an do Cmuclofs
License LAW.
❑IwevempLunderSec ,BdPCf«Nismasm
Dase
WORKERS COMPENSATION DECa1FAr[ON
1 hereby alBm adder penalty of perjury Was of do following decimations:
❑I W m And wBl malnsin aCenificase ofConsem m self-insert f«WodulaCwpen-
mian,as provided for by Section 3708 of dte lab«Code.for the performanm of de
work for which flus permit is amad.
❑1 haw and will maintain Worke ,Cwpsnatim Innvanm,as required by Scclion
371)Bofdus Lalsorcode•for the performaameofftmusic for which duspermitlsi '
My W«kd,Co� renact In mmc and w
Policy nbass;
:
tinier. 0 Policy No.:
CERTIFICA •OF EXEMPTION FROM 0 ERS'
COMPENSATION INSURANCE
Crus wa m seed mu W mmpkmd 61W pormh isfor.hundmd dollars($100)
or leu)
I certify drat s Ne wrommce of the work for which this Pewit is Wood.I shall nor
employ my person in my maemrm as an become nbjen to de Warken'CwpsnNan
Laws of California Due
Applicant
NOTICE TO APPLICANT:If,after making Nis Cerufrou of Enmption,you should
become subject M Ne Workers Cwpenadon provision of Ne Labor Code you,muss
O Zforthwith « rm
with comply with such pro u this peit shall W dcmW mvakcd.
O
y 2 CONSTRUCTION LENDING AGENCY
[-r 4 1 botchy afram Ibal Nem s a camumcdm sliding agenoy for the performlms:of
Cri the work for which do;permit sin«d(Sec 309'x,Civ.C.)
Ig1 Q lessors Nalco
lenders Address
ZD
U O 1 mordf,that 1 haw Ion Ns,pplicatim asld anon Inas IW above information i,
w F e«RL 1 all.m comply with all City and sorely Ordinances and a=laws mladng m
OU building construction.and Wmeby suNodc repwounivrs of this city m mmr upon lM
6Wi above-mndonea property for inspection purpoms
(WC)lg.m..indemnify and kccp hanr ws dC City of Cu«mm,(aims
rFr 4 liabilids judgmenu,cawndexpeasa wh)ehns,inanywaYcrne againlsak City
U Z in consequence of the gmdng of Ns pewit
roti APPLICANT UNDPSTANDS A D WjjjLLLLLL COMPLY WITH ALL NON-Po Issued by: Date ^�-/;-^U'—
SOURCE REGUt�TIf1NS. / / �v �y
//'/ T / I T Re-roofs
Signssuro of IlcamCmlracl« V Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or futw Wilding occupanlmum or londle hanrdom material
as de0md by Un Cupertino Municipal Caso,Chap al 9.11,hold the llcalh and Safely
Schon zs532(A)?
❑Tee t�}ao All roofs shall be inspected prior to any roofing material being installed.
Will the applicant«f«um building amupant w equipmnl or dcviara which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha ndnm air cor m ninants as&food by tW Bay Arta Air Quality Mamgcmenl all new materials for inspection.
Dieu set?
❑Yn �Nu
I have and UW hnallous malarial,roquimmrns under ChaPmor6.95ofdse Calif..
.in HnW h SafmyCaso.Scd«s25505.25533 ud25534.1 Walmland Naifde Wilding
darn ml curm aly Ww a rnarn.Nat is is my mrymnaild(fty an mory mW ommasr of ds
mquimmcnts which most bc rens prior m imanm of a CmrdBcan or Occupancy. Signature of Applicant Date
Owmror auN relam All roof coverings to be Class an"or better