06100213 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAGTnRINFORMATION,,.
BUILDING ADO0.ESS: PERMIT NO.
OWNER'S NAME: L90UEO TE
UNGTAO CHEN 21009 SEVEN SPRINGS PWY 12/19/2006
SANITARY NO. CONTROL NO.
(408) 996-2670
ARCHnECTIENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
a p LICENSED CONTRACTOR'S DECLARATION lob Description
m N
u I I hereby alErat I am li¢recd under provissansof Chaser 9(commencing P
I<� with Section 7010)orDivision 3 Critic Business and Professions Code,and my Innen=is ADD 1627 ' -3 BEDROOMS/MASTER SUITE/FAMILY ROOM
e m in full farce and effect.
F. License Class Lk,« LIVING RM/REMODEL 1523 ' -LIVING/DINING/KITCHEN
Fp Data CO-11-WI
it
ARCHITECTS DECLARATION 2 BATHS'. ADD .'45 ' ON GARAGE.
1 uw..unu my plall W used as public recut&
ain sh
�LLN Licensed Prefeamul
OWNER-BUILDER DECLARATION
<f 1 hereby alTrm Nal I am exempt from the Contractors License Law for th
:o O following mason.(Section 7031.5.Business and Pretensions Cads:Any city of County
which requires a permit to cnnsVact.alter.improve.demolish,or repair any structure '
-I< prior to its issuance,also requires ue applicant for such permit in Rle a signed stakmanl
i=
G that he is licensed pursuant to the provinces of the Comment's l dente Law Chapter 9 Sq. Ft. Floor Area $504759 Valuation
(commencing wit Section 7000)of Division 30(Ih alleged
Business and on.Any vi Code)or 5 04 7 5 9
s 3$ tat io ts exempt thrtrmm and to burs for the alleged adman to Any violation of
Section dean five
any applicant fora permit subjects to applicant to a civil penalty of Number Occupancy Type
not more to Ovo huMred dollars(SSW). 35918032 .E P Y YP
' ❑T,uowner of the pmpedy,or myemploycu wit wags uthirsole Compensation,
will pr f wort Code:
swaureranoti Lacentor Law
dos.1 apply
in an Bwor of
ma Rty wh ou Code:Tie Contractor's License Law dors nal apply lf an owner of Required Inspections
ow.con who Wslds or ed Oat ulh i m i and who are
in work himself ed through his
awnver.thruiprovided tin such improvemmuartwtnter f or offered for ale.IL
funder the building hor uimprovementis sold within one year of mproe An.toowncf-
Wildcr win have see Wrden of proving tat h did rot Wild or improve for Puryna of
ale.//)...
.,¢,e nR of the prepersy.am excludvely conusaing wit licensed Conusams as
Consuuct to prejcos(Sec.7014.Business and Profns oes Cade:)The Dominator's Li-
ccue law dors not apPIY in in owner of property who Wilds or improve Lemon,and.
who Co...for such prejeas with a atr uacmr(s)licensed pursuant in see Comraaars
License Law.
0 Iamucmplunder5ee .B&PCf th
Owner �irf t N _ Da¢ fL f / v n
RKERS COMPENSATION DECLARATION
I buc by aRrm under pcnslly of perjury ane of the following declaration:
❑1 ham and will maintdn a Certificate of Castsem a self-iuurt for WarkerSCOmpen-
sation,u provided for by Section 37W of to Labor Cade,far the performance of f
work for which this permit fs issued.
i]1 have and will maintain Workers Compensation Insurance,as required by Section
370().f me labor Cook,for see pedo...Otte weak for which to permit is issued.
My Workers Compensation Insumnca maria and Policy number
Camey, Policy No,: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This sc=ion need net Mcompleled if the permit is for one hundred dollars($]W)
m Icu)
1«nifv tat in to perfosmence of to work for which this permit is issued.[then not
cnploy any Penson in arty manner.lo ss b Wcome subject m ted Warkeri Compensation
Laws of Califorma.Dale
Applicant 1 —
NOTICE TO APP ,ahr making to em0cam of Exemption,you should
become Subject m the Workers Compensation previsions of to Labor Code,you mut
.J O tonOwit comply with men proviumma or tis permit shall W Claimed revoked.
'ZCONSTRUCTION LENDING AGENCY
(~ I adds,af0rm act,tort is a consuucdnn lending=Con y for see performance of
ai
the work for which tis permit is issued(Sec.311)7,Civ.C.)
Lcndcr'a Name,
z Undctt Address
V 0 1 codify tat 1 have mad tit application and sure tat to about imontim..is
Ls, cadent.I agree to comply with all city and County ombrome s and sum laws relating to
CU building conswctim,and hereby autorim milescmmiver or tis city to enter upan me
r 0. ahvememioned pmpedy for inspectionexpenses
purposes
(We,)agree to ave,indemnify and keep harmleas the City of Cupertino agaiml
UZ inconsequence ents.of
oastsand of this reWhich may in anyway aaroc agdnsued City
U z A PLIC NT of to granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
( ti ii.A3�a Re-roofs
Stgnature�fo AP runuCanuaaorDale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building aapantamre or Iundle hvared.m=edal
u dehned by to Cupertim Municipal Code.Chapter 9.13,and ole Health and Safety
Coale,Senior 35531(.)7
❑r da All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or future Wildingacupant use equipmemsordevim which If a roof is installed without first obtaining an inspection,I agree to remove -
emh hacallou air astronomer as uefned by tc Bay Ada All Qualily Manag,m rt all new�materials for inspection.
Dislda7
❑Yes ase.
I have mail to ha amour materials requirements under Chapter 6.95 of to Califor-
-in Hcalt&Safety Cade,Sttvou 35505.25533 and 25534.1 undiesuM that iHhc Wilding
docs not currently have a edam,Nat it u my responsibility In notify the occupant of de
mquirewits which mutt W met prior to as...ref.Cerdreaearcajvey. / Signature of Applicant Date
Ownc�uton'rc0 agcm t D,te All roof coverings to be Class "B"or better