08020189 CITY OF CUPERTINO >x
BUILDING DIVISION PE
RAI
C�NTRA.CTpnR INF�URNI ,N..
mhmrn. s'. r ,.fir .•h. ,
PERMIT N0.
BUa❑yNc3A ' sAZINGWOOD AVE - YOUR RIGHT CHOICE 08020189
R'S NAME: PERMITLSSUB DATE
ERIC S WU 357 DAWSON DR 02/29/2008
PHONE: - SANITARY NO. CONTROL NO.
(408) 981-2878
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
pQ LICENSED CONTRACTOR'S DECLARATION Sob Description
I 1 hereby affirm Nat 1 am Ileensed under powisioosOf Chapter 9(......clog
with Stredon 70M)orolviskon 3 offt Business and professions Cotle.,nd my license is KTCHN,BTHRM RMDEL & WNDOW REPLACE
�-, in full fome and effect.
Llanx Class Lk.0
Done Contractor
44700 ARCHITECTS DECLARATION
i C< 1 undarsund my plans shall he..it as public on nrda
iyU
LLO Licensed Pmfessi...I
OWNER-BUILDER DECLARATION
I
1 hereby affirm Not 1 am ecmpt from the Contactors Liconse law for me
i p o following mason,(Section 7031.5.Business and Professions Cade:Any city or county
Sn which require a permit 1...O.L abet,improve,demolish,n(mpdr any"auto _
prior to itstssuamm,also require the applicant for such Pmmi❑o rile a signed sutement
xx� Nal he is liecmed pursuant to the provislou of the Contractor's Liccnx Law(Chain.9 Sq.Ft. Floor Area Valuation
ul-Q (commencing with Section?000)of Division 3ofthe Businmand ProfessimaCode)or 55 00
c
than he is evempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicator for a permit subjects the applleant to a civil penalty of 3 6 917 011Ab�j Number Occupancy Type
an,more than firs hundred dollars(SSW).
Lothwnerof the psvpmy,remYemployee wishwedsor (sok m .Bunions;
will doth.workCand theThe Com ons Lmkd m Law
On forsaketapply in in o sadness Required Inspections
and Property
wh obu Code:The Commons Liedtke Uw does mot apply lf an ower is q p
property who buiprovi improves abeam.,and who am not Intended It wrk oroffe Orthr ughale hu
hown owemployers,provided prsuch Improwmmsart not arnc mpletied for ale.If.
however.Ne aeUse
building or ireprowmmn Is sold he
oto year ofimprow for the Owner.
boulder will haw the burden of proving Wt he did not build or improve for puspme of
tale.).
.as owner of the property,are eaclusively m.traraing with Roasted..Irani..to
inner do project(Sec.7014.Business and Profusions Code:)The Contractor's Li-
cense law does not apply in an Owner of property who bulbus or improves daemon,and
who contracts for such projects with a condaeor(a)licensed pursuant ode C.nlreemra
License law.
❑IamuenptunderSOP, ..B&PCIw Ouncason
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury One of tha following declarations:
rI 1 haw and will maintain a Certifies of Consent in elf-insure for Workers Compere
cation,as provided for by Secdon 3700 of the labor Code.for the yerfamn.of Our
work for which this Permit I.issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37M of the labor Code.for Ne performance of the work for which this permit is issued.
My Worker's Compensation Insurance barrier and Policy number am:
Carrier. Polity No, ..
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Mix at.need oat be eanpked I(the Permit U for.l undreddallan(SIM)
m lens.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any Person in any manno uobmomc�sabjenotke Wmkers'Compensation
".a of California.Dae 2—�`a- off"
Applicant mss-)
NOTICE TO APPLICANT:If,after making this artifice of Facmption,you should
become subject to the Workers Compenaition providoat of the labor Cede.you most
.JO forthwith comply with such provisions m the permshall all be lamed revoked.
z0 CONSTRUCTION LENDING AGENCY
Fr I hereby affirm Nat them is a construction lending agency for the peformanm or
Ca7 the work for which this permit is issued(See.3097,Civ.C.)
W Q Lenders Name
az Lenders Address
U O 1 certify Nal 1 have mad Nis application and sue that Ne show infmssitiun is
W Correa,I agree to comply with all city and county ordinances and short laws misting to
OU building conswction,and hereby authorim representatives of this city o enter upon the
Ushove-memioned pmpcny for inspection purpoxs,
(We).,me to saw,indemnify and keep hannlus Ne City of Cupertino against
Vy Iiabiliue,judgmcns.cmis and teape.which may N any toy amus agsiicasaid City
V z APPLANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2 - ¢_1�f
SOURCE REGULAT NS. Q -
61L%
IE_ l�� 2M—C Re-roofs /
Signature of AppliendContrxmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicad or forum building oceupant more Or handle hmardoos material
at defined by the Cupertino Municipal Code,Chapter 9,12,and de,Health and Safety
de,Section 25532(+)? All roofs shall be inspected prior to any roofing material being installed.
❑re
Will the applicant or future building=upon[use cquipmmt a devises which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazsrh us air contaminants as dert ed by the Bay Ase Air Quality Management all new materials for inspection.
District? L/
Oyu6u - -
I have mad de hvaNmsmaterials mquimmens under Chapmr6.95 ofthe Califor-
me Hwlth&Safety Code,Sections 25505,33533 and 25534.1 undersond Nat if the building
dens oat currently have s mnanl that It is my mapouihility to notify the occupant of Ne
requimmcns ydsich-noun mel pd.,o issuance or a cwrkun or@apan Signature of Applicant Date
CL.•' 1) 2 All roof coverings to be Class "B"or better
Owner or awhodnd agent I Dale" ._