05100227 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT XQN RACTUR,INFO ANION
BUILDING ADDRESS: PERMITNO.0 510 0 2 2 7
2no CARMEN Rn
'iER'S NAME: PERMITissus DATE
ALEX & ECHO CHOY ----12/2312005
SNE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO PLUMS MECH
O
r�rO00 LICENSED CONTRACTOR'S DECLARATION Job Description
iT I hereby Affirm that I Am licensed under provision of Chapter 9(commencing P
with Schon 7M)of Diviaion 3 of the Business and Profession,Code,and my license is
^ IAnll(oreeandeHea. ADD 599 . 5 ' (MS BED/BATH/BEDROOM)
2 License Class L1c.a
a qqqDan cormater REMODEL LIV/KITCHEN/DINING/FAMILY
;g ARCHTEM DECLARATION
22 1 understand my plana Nall be urAu public mcortls
du6
yC Licensed Pntteuional
y Oat I am cUII.DEfr DECLARATION
E 0 I hmais affirm that 11. exempt from the Contractors : c Law for the
E p O following maw n.permit
t 71131.5,evalteu and improve,
tea Cork:Any city or county
$ which its Isss•pewit nenno,he pins improve,h perlish,mit
tO ore A sig Any structure
pow1,1, luuavo,also rsuantto the he o thefor sucContractor's
onpemitnO.O.Lvdathlement
thatbelscingwidpursuao tithe provisions ofofic BOM lel eL@enso Uw(ChaPnr9 Sq.Ft.Floor Area Vel atT�8622
(commcndngwiWSce0ome And
ndts Division 3 xtitegMd earnAS Pfo Any ons 11Cork)of
that M u exempt therefrom and tie hula for tine die{cd exemptlan,Any violallan of
Section 7031.5 by Any applicant for•permit subjects the applicant to a civil penalty of APN Number Occupancy
Act maze than five hundred dollars(5XXT. 7 . 0 0 p y��
0 I,u awncr of the Property a mY.Ploym with wage u then sale=7 on.
will do the wart,and theauucWnlater,intendedfens@red far•aie(Su.70N,EM'.. s
and Professions Code:Tin Contractors License law dons a,apply n an awnu of Required Inspections
property who build,cr improvns Wemon.and who data such work himself or=ith his
Own employees,provided thatanch improvements ere not Intended woRend for sale.If,
haws:ver,the building or improvement is sold within ane year ofcempletion.the ownery JUNz/a NI11S�
builder will have the burden of proving thathe did not IVIId or improve fm purpose of JUN �0 6 frt!
ule.I.
I, i owner of ct properly,•m sad ss and confession{with licensed un=0era l" 'r ��
wawa the protect(Sec.7041, "clool and Profualav Code:)The d comma, U L
NG
carve Uw dons not•p ly n an owner of ropeny.whe builds or Improvesthereon,an
who coronets lona rokcts wi a cmrO)Rcensed punu•m tithe Canwcur fs
License Law.
❑lam ansa a Sen ,Bk PCI thisriesum,
I DatelLz3ro
WORKERICOMPENSATI NDECLARATION
Ihembyafliwund pevaltyof ane of the following doel•ntionr.
Ilaw aril will main taineCWfiate of Coventrsede,for for WortNsCompem
catioA. r provided(Pe mi Sutton 3700 of tine labor Code,Iso tiro performance of the
work for which this peso,is issued.
❑1 have and will maintain WorkeYs Compensation Insurance.As required by Section
37W of the tabor Code,for he performance of We work for which this permit is issued.
My Worker's Compensation Insurann carrier and Policy number•m:
Caller: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need nothocomplend ifthe permit 1•1arone hundred dollars($]W)
or leu.)
I unify that In the Performance,(the wo a lar w Ich thin perch 4 iatucd.l shill nos
employ Lawsoanypenoni a sones •sLst ,Eon @ eno the Waft"'Lasa of Glifoml
Appliant
NOTICE TO APP ANP.If.after making in cnific•re of Exemption,you should
become Subject to the Worku'a Compensation visions of the labor Code.you must
0 foMwith comply with such pravWov or thio p mit shall be deemed mwked.
z y CONSTRUCTION LENDING AGENCY
E I hazeby Allirm that Were os•constriction lending agency for the pv
erfomae of
rl r7 the work for which this pest,Is Issued(Sec.3W7.Civ.C.)
WQ Undoes Name
P.
U
r7 z nder,Addfras
V0 1 certify that 1 have read thin application and son that the above infomatiun is
fy Pcomm 1 agree in comply with all city and county ordinances and elan laws relating to
0 V building construction.and hereby authorize mpnaenutive,ofthis clay to enter upon the
117 above-mentioned properly fns Inspection purposes.
gy (We)•gree to an.indemnify and keep harmleu the City of Cupertino against
TA liabilities,judgments.cats and expenses which may in any way verve a{aint said City
()Z on onsouence of 01 jfanting of this pem4 �q
APPLICA UNDERSTA S AND WILL COMPLY WITH ALL NOWPOINf Issued by: Date / L -G 3-64"
SOU E U
q/Lp'. 1JLATIgN
ltild'3IsS Re-roofs /r4
Signal=oFAppll an mum` r DA
HAZARDOUS SATERIALS DISCLOSURE Type of Roof
Will the applicant or future budding Occupant von or handle huardous materia
ns defined by We Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
See tian:ss3z(.)7
❑Yns All roofs shall be inspected prior to any roofing material being installed,
�(Nu
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7DiWic,?
haurdna air cont•minanla as dclmod by the Bay Ana Air Quality Management all new materials for inspection.
❑Yes *No
Ihocread do huafdominaseria4 nuPAnr entsum*rChpw6.95ofd.ClifonalWkSafay Cork,Soon.2350.5,25533 and255N.l undcmaM we ifthc Wildin{
u my msponsibili,y n notify the aaupana of de,
m u iichmunb ❑ arniuvaOcxofaCertificanofOccuanry. Signature of Applicant Date
f Dat i B All roof coverings to be Class"B"or better
Owner oramhodm epcnl