07120036 CITY OF CUPERTINO :, sr ' "b ''`* "�' s ':`''•
BUILDING DIVISION PE MIT �Wggp ACTOR II kORMATIO, N ^s..,
PERMIT NO.
BUIi.gIblG ppn�aFSSy BLANEY AVE TBD sy TO BE 07120036
1 U 4 l S PERMIT ISSUE DATE
_ sCR'S NAME:
-KUEINUNG KAO 03/05/2008
PHONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT7ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
oreLICENSED CONTRACTOR'S DECLARATION Job Description
m1 hembY affirm that 1 am lived under pmvivi ess of GuPlrr 9(commencing
i wiNSccdw7O(kl)afDmtion3ofOaBusi wdProfcWd CM .aMmYl¢cnseu ADD LV RM & PORCH (496SQFT) &RMDL INTR
o.z in full force and effect
;qList.Class Lie.p KTCHN,BTHRM,MSTR BDRM,DINE RM & 2ND FLR BTHRM
Data ConARCHITECTStDECLARATION
< 1 undersand my plans shall be used as public recorder .
iyD
W Licensed Professional
IOC OWNER-BUILDERDE RATION
i1 hcrchy alTirm that I em exemptnemptfare ft Ne Contractors ntrars License Law for the
D O following mason.(Section 7031.5,Business and Profmaiov Code:Any city or county
i$ which requires a permit mo conduct,alter.hnpm e,dar allsh,or repair any strctum
xa prior an is issuance.also requires the applicant for such Permit o file.signed suNmentValuation
N Provisions that he is licensed pursuant e provisloof the Commoner'sCommoner'sUse=Law(Cltapmr 9 Sq.Ft. Floor Area $125000
i (cmnmeming with Sccdon]000)o(Divuion 3af NC Business and Pmfessiav Cadc)m
Nat he is exempt therefrom and the basis for the alleged assumption.Any violation of
Section 7031.5 by any applicant far a permit subjects Ne epplicaaf in a civil penalty of Number Occupancy Type
net mom Nan five hundred collas(SSW). 36928040
❑I,as owner of the property,or my employees with cages as their sole eompenestion,
will do Newark,and the structure 4 not ldtendL'd oraRcrtd forsak(Ser.]04a,Busirm Required Inspections
and Professions Cod.'The Committees License law don.nom apply man nam of
property who builds or improves Nermn,and wh tdneasmhwarkhimself of On ugh his
awn employees.provided Nmauch improvements art tatinu:MM wortered for sale If.
however.Ne bending or impmvemant is sold within ore year of Compkdon.the ounce-
builder will have the burden of proving Nat he did not build Or improve for purpose of -
sad).
;r0-I
,u owner of the property.am esclusivcly contracting with licensed samncmas to
must the Project(Sec.7614,Business and ProRsans Code:)The Contractors LI-
e law does am appy m an owns of property who builds or improv thrown.and.
contracts for such projects with a conuxmr(s)Ilansed pursuant te the Cnmaaemre
me Law.
amder See. ,B A P C fo Nuler DaaON
1 hereby of irm underpevltyofperjusy amofNe following decline imts:
Aswandwill mainsna Cesfiate of Cansentmself-inwrefm seaters Compen-
sation,as provided for by Section 3700 of the Lahor Cade.for flue performance of the
work for which Nis permit is Issued.
❑1 have and will maintain Workers Compensation Imuran¢,as required by Section
3700 of Ne Labor Cade,far the performance of Ne wok far which this permit is imued.
My Workers Compensation Insurance nMer and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This ewtion need not he completed if Ne permh is foram hundred dollars(5100)
or less.)
1 cenify that in the performance of Ne work for which Nis permit is issued,l lost ret
cmployany person in anymanrcrmasla b W^eptbjatmOe Worken'Campenv0on
Laws o(Califamia. �� / G - .
NOTICE TO CE In On :If,after making Compensation p enlRate of Labor io d you should
became subject m it Workers onsorthsprovisions of the labor Coke,you most
�z faMwiN comply with sucA pmWiov or this permit NJI he dcesned revoked. ,
,ziO CONSTRUCTION LENDING AGENCY
(-. 1 hereby affirm that there is a c rostructinn W Wing agency far the Nd...f
tx> the work for which this Permit is issued(Sec.309'1.Civ.C.)
QLenders Name
0,Z Lenders Address
V O I comfy Net 1 have mad Nis application and sun:Nat Ne shove information is
U. f^ correct.1 agree to comply with all city and county eminences and stale laws relating to
O J building convection,and hereby authorize mpwnatim of this City to enter upnn Nc
r W above-mentioned property for impecuou Purposes.
gy (We)agree to save,indemnify and keep harmless Ne City of Cupertino against
cry Iiabiliues.judgments,thus and expenses which may in any way accrue against said City r
U Zin consequence of the granting of this Permit.
�-' Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REG—LATIONS, �� 1�
Re-roofs
Signature of Ap aRDO Date
HAZA
HAZARDOUS MATERIALSDISCLOSUREType of Roof
Will the applicant no Muni building e.Chammom or handle h eardous material
defined by Nc Cupertino Municipal Code.Chaplet 9.12.and the HVIN and Safety
de.section 25532(,)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Na
Will Nc applicant or aura building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardov air contaminants u defined by the Bay Amo Air Quality Management all new materials for inspection.
District?
Ym
I have mall the OoO4 materials requirements unkerChaptar6.95ofthcCelifa-
.is HcaIN&Safety Cede,Seedans25505,2S533 inal I undersand that lithe building
doer not currently have a meant.that It is my mapamibiliy W Any dm oaupant of the
requirement which xnmt priermissaana err r mar Occupancy/ Signature of Applicant Date
All roof coverings to be Class "B"or better
Owner or stuh.dved cm Da —�