08010169CITY OF CUPERTINO
BUILDING DIVISION PERMITC01'�iTRAG"�ORINF,
BUILpp1 DRESS:
1�Q1� BELKNAP CT
TBD - TO BE DETERMINED
PERMIT NO.
08010169
°NEA'S NAME:
PERMIT ISSUE DATE
TSENG TERNG-TSENG AND YENING
02/04/2008
PHONE:
SANITARY NO. CONTROL NO,
ARCHI=1ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
- Job Description
homey affirm Wet 1 am nicm and under provtoons of Chapter 9 (commencing
with Section 70000) of Division 3 of We Buaineu and Professiuv Cala.mil mylicena is
REPLCE SINGLE GLAZED WNDOW TO DOUBLE GLAZED
in fall fame and effect,
Lima. Class Lt.. a
WNDOW ,
Dam ector
ARCNITECTSnDECL.ARATION
RENEW THE EXISTING STUCCO (NON STRUCTURAL) ,
I understand my plana shall W mind U public records
RENEWING WOOD SIDING
Licensed Profeuional
OWNER-BUILDER DECLARATION'
1 hereby same that I am exempt from the Contractor's License Law for We
following moon. (Section 71315, Business and Professmas Code: Any city or county
which requires a Permit in construct, altar, improve, demolish, ter miss any strucum
'
prior m be issuance, Wu requires the Applicant forsuch Permit to file a signed stanmenl
the Contractors License Lou(Chapter9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant in the previsions of
$480
(commamdng with Section 7000) of Division 3 of the Business and Prof onions Code) or
dim he is exempt therefrom and the basis for Me alleged exemption. Any violation of
y,Tyt�I Number
362.0020.A
Occupancy Type
Sana 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nan fin hundred dollars ($5031.
V'
❑ 1, a owner of the famperty, or my emplayco with maga u Weir sot, compensation,
Required Inspections
e ns
will do the work, and she andam is at intended ar offered fonale(Sec. 70M, Basinev
and Prof essom Cade: The Contractors License Lew docs not apply to an arena of
q P
property who buildsorimprovailummn, and who doaawch work himselfar Waugh his
Own employee, provided thatsuch improverec m; are not intended oroBere t forsen. U.
hooewa the building or improvement is sold within one year of complatims the cone.
builder will haw Ne burden of proving that he did oat Wild or Improve far Impose of
sale.).
I. as owner of We Property, ran aadusively connecting with focused cenbacmn to
conswer the project (Sec. 70,14. Business and Professions Cade:) The Contractors U.
mom Law dots asst apply W ass owner of progeny who Wilds or improve Wman, and
who con r mis for such projects wish s connctor(s) limmend pursuant to the Contractors
License Law.
❑ 1 am exempt undeB & P C fm this reason
Dan Z t/ o
WORKEIVI�S COMPENSATION DECLARATION
1 hereby eBin under penalty of perjury aro of We following declarations:
❑ I haw and will maintain aCcrnlote of Coeentto calf-InsureforWorker'sCompen-
salon, as pmvided for by Section 37M of the Labor Code, fm the performance of the
work for which this permit is humid
❑ 1 ban and will maintain Workers Compensation inaaan<e, u required by Section
37M of the Labor Code, for the performance of she work for which No permit Is issued
'
My Werkera Compensation in=== anier and Policy number am:
'
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This =it. need nor be completed Ifflat permitis formic hundred do ltrs (SIM)
or ins.)
I certify Net in the performance of Om work for which this permit is issued. l shall asst
employ any,emon in my menncrso a a bcrnmenlbiccl to the Warken'Compensation
Laws of California Dam f s T
Applicant tit
NOTICE TO APPLICANT. If, after making this Cenincate of Exemption, you ahouW
become subject in the Worths Compensation provisions of the labor Code, you most
' foMwiW comply with such Provisions or mu Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby that mem U lending agency for W Performance of
which s ed (Section
' me wank for which this permit Is issued (Sec. 307, Civ. CJ
'
Lender's Name
Leaders Address
i I certify Nat 1 haw read this application and sum that me show information is
` coram I agme to comply with all city and county ardimmem, and sun laws missing to
building consnctian. and hereby author= mpresenutivrs of this city to enter upon the
1 abew-mentioned property far inspection purposes
(We) agree to save. indemnify and kecp harmless W City of Cupertino against
i liabilitins,judgmcnts, con and expenses which may In any way seem against said City
in consequence of the greening of this permit.
1 APPLICANTT;UNDERSTANDS AND WILL COMPLY WITIji ALL NON-POINT
SOUR
2� I �.
Issued by: Date -eA
'R1�rkYMONS. Z.I L11q
Re-roofs s
Type of Roof /
Signs= o rcVKontractor Dan
HAZARDOUS MATERIALS DISCLOSURE
Will Me applicant or future Wilding accapantaore or handle hmndaus material
u defined by the Cuper ins Municipal Code, Charter 9.13. and the Health and Safety
sac. Section 35532(a)7
All roofs shall be inspected to any roofing material being installed.
❑Yca tg Na
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or futum building occupant use equipment or devices which
emit hazardans air contaminants u defined by the Bay Ami Air Quality Management
all new materials for inspection.
District?
Dyes JRNu
I haw mal she husrdnu materiabmqumannums under Chapter6.95 often Collor.
nia Halth& Safety Cada, Section 25505,25533 and 75534, I understand Ostrom building
docs not eumandy haw a mnent, Wet it u my responsibility to notify the muWt of she
mqulremcrus hitch be Prior to issuance of a Certificate o(OTaµa¢y.
Signature of Applicant Date
2 u e1
All roof coverings to be Class "B" or better
Owner r authorized agent Dam'