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06020021 CITY OF CUPERTINO BUILDING DIVISION PERMIT C01 CTOR NE q.S'il krdeY f^.n K h'!e;^ � 5n ioay u. li rr YnsA v�: BUILDING ADDRESS: PERMIT NO.06020021 10200 CARMEN RD NER'S NAME: PERMIT wuE DATE CHOY KWONG P ET AL 02/21/2006 7PME: SANITARY NO. CONTROL NO. ARCHITECVENGINHER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 X00 LICENSED CONTRACTOR'S DECLARATION ] b Description +(� 1 thereby&(firm NoP at 1 am licensed under provisions of Chapter 9(commencing with Section 7")o(Divhdon 3 of the Business and professions Cade,and my license is in(allforeeandaf(ect. REVISION--RAISING (E) HALLWAY CEILING P. Date Contrxnor ;'.z anxclaaa oal CHANGE STRUCTURAL pp D 3 pppp ARCHITECTS DECLARATION NO NEW PERMIT ISSUED/ORIG. #0510227 1 undcrttanJ my plum shell he used As public records 5 ktsd ,Deemed Professional y OWNER-BUILDER DECLARATION z<I I hereby,(Elio that 11. exempt from Use Cssion Co eLicense Ac Law for my i 00 following neroaPerm(section 703 1.5,Business and ve.de ons Cale:Any city or county S$VL which requires a permit re amwc,alcor.Improve,h Permit t or c a sig any atmcture go met imitscensed eMae uantto umovisio s of rotthe sucContractor's License, Ulase,Law malemcm EES< NommerkcnwJpunuamxOmofDivionsooftheBrumr'andProfesonCedc)or Sq.Ft. Floor Area Valuation e g R than he 4 fing exempt Section and001y)the bans n 3far t f the Business and on.Any of $0 .- duet k k&amps therefrom and Use bsats for the Alleged!exmption.Any violation of Salton 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy not more than faro hundred dollars($500). Pane Y •T I 7Pf' ❑L"Wour cruse property,ormyemployca with wagoas theirxle compensation, will do Ute work and use su ec u e is not intended oroRefed foraale(Sec.70th.Business and Profaniom Code:The Coruscate.License Law does trot apply on an owner of Required Inspections property who s,pmvidcd Out suthereon,andwho duesxch work oroffrer through his �\ own employees,provided Out such improvements are netyear ofIntended moQered tforhe tale.If, \ however,me building or Improvement is hold within one year ofimpro a for me meet. Wilder will have the WNcn of proving that k did nM Wild u improve for purpose of Gale.). }� ® L n owner of the property.am exclusively contracting with licensed contractors in \�. wnswet the project(Sec.7040,Business and Professions Code:)Tbe Conuacmfa Li. came Taw does not apply to an ownu of propeny who buil"or improves thereon,and whoconuacu for such projects with a contractors)licensed punmm m th&Contractors License law, ❑1 am exempt under Sec. .B&P C for this pass ® ser Tax ,lVn V RKER' C AIPENSATION DECLARATION I bereby affirm under penalty of perjury as of the fallowing declarations: 0 1 have and will maintains Certificate of Cometh m sal&inaum fu Workees Compen- sation,As provided for by Section 37M of the labor Code,for the performance of the .,it for which this permit is issued. ❑1 have and will maintain Workers Compensation instmnce,as acquired by Section 3700 of the labor Cade.for the performance of the work for which this permh is laxed. My Workers Compensation Insurance artier and Polity number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Dissection recd not beamplemd irthe permit is(none hundred dollars(SIM) lir less) I ani(y,that In the performance of the work for which this permit tsissued,I shall oat employ any person in any manner^aalWbccpm�mbicct I�Ige Wmkcri Compensation Lawtof Califeraia.Datc !/�'21f-L6� T 0 Applicant n NOTICETO APP CANT.Jr.aft making this Certificate of Exemption,you should become auhject to the Worker's Compensation previsions of the Li Wr Crede,you must O forthwith comply with such provisions or mis permit shall be deemed revoked. Z y CONSTRUCTION LENDING AGENCY [-+ Ibereby a(Rnn mat there is a ennnaocumn lending agency for the performance of C 7 the work for which this permit is issued(Sec,3097,Civ.C.) - GQ Lender's Name z Laders Addnsa U0 1 certify that I have read misapplknd.a and data information the aW.informon is D,^. correct.l.area in comply with all city and county Ordinance,and sum laws relating to C) building construction,and hereby authodx representatives of this city to enter upon the Is7 akve-memioncd property for inspection purposes. (We)agree to save.indemnify and keep harmless the City of Cupertino against v) Iiablliexpensesan judgments,costs and expenses which may in y wry accrue against said City V Z in consequence of the gaming of U"permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ® SOURCE E LTO Sri r,l a /y�J/ I D �J Re-roofs SignatureofA icatort m HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the r ent or future billing occupant9.1 or motile hazardous material x defined the Cupata Municipal Code,Chapter 9.12.and the Health and SafetyCOJc,Section 25532(&)' ❑y" 01N. Ne © All roofs shall be inspected prior to any roofing material being Installed. Will the applicant of future Wilding occupant Out equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emir hayardon air contaminants as defined by the Bay Area Air Quality Management - all new materials for Inspection. District? ❑Yes 94. .® 1 he.real the board.,material,acquirements underCNpmr 6.95 of the Califer- ria Health&SafctyCoEe.Sections 25505,25533 and 25534.1 underamnd dust if the Wilding does not currently hew a moan,that it u my responsibility to redly the occupant of the npdooacnts w' hmustbe 'mwianuanccofaCcnipcateoroccpanty./ ® Signature of Applicant Dale ® Owneroramn 'cdgcm Z v Data All roof coverings to be Class rB°or better