04070025 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAC�TORINFURMATION'` - - - -
'rxx�R
BUILDING ADDRESS: PERMIT N'04070025
O4070025
OWNER'S NAME: PERMIT ISSUE DATE
KENNETH & MARY CHEW r7,1
E; - SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECmis or CON
=�C I hereby affirm Nn 1 am licensed under provisions of Chapter Y(commencing Job Description
n � with Scctipn]pgl)un f�D—ivMqu3of iAc Buypus and�'3' �nd mNlicenu is
wrhSaLi ae)or 111 �- 5 O �[/D REPLACE 2 WI
o n- License Lie.a
—o Dae cemagmr CONTRACTOR: L I OOR CO.
—�� ARC ITECTS DZCLARATION
Plans all he J as public records
Inti° OCT It 2004
3 LL M Licensed Professional
a'O� OWNER-BUILDER DECLARATION
m i Y 1 hereby affirm that I am exempt from Ne Contractors Leda.Law for the D
x O o following reason.(Section 7031.5.Business and Professions Code:Any city or county
m which¢quires a permit to construct.alter,improve,demolish,or repair any structure D
prior in its issuance,also mquine the applicant for such Permit to file a signed summent
Vii' that he is licensed pursuant to the provisions of the Contractors License Low(Chapter 9 Sq. Ft. Floor Area Valu I�oP770
QFC (Commencing with Section 70110)of Division 3 of the Business and Profusions Crde)or
that he is exempt therefrom and the basis for the aNcged exemption.Any violation of
Section 7031.5 by any applicantfor a permit subjects Ne applicant to a civil penalty of APN Number Occupancy e
re N
not moan five hundred delta.($500). P Y 1YP
Q 1.as owner of Ne property.or my employees with wage as their sole compensation. 36217043 . 00
will do the work and the swemrt is not intended or offered for sale(Sec.1014,Business
and Prolmi ions Code:The Coutna tor's Liccrose Law docs not apply to an owner of Required Inspections
property who Words.,improves theman,and who does such work himself or through his
Own employ=,provided that such improvements are not intended moll,red forsale.If.
however,the building or improvement is sold within one year of compiedoa.the owner-
buildef will ban the burden of proving that M did not build or improve for purpom of
sale.).
Q 1,as owner of the property,am exclusively contracting with licensed eom.ctos to
construct the project(Sec.7064,Business and Professions Code:)The Comeaeror's U
core,law does not apply to an owner of property who Wilds or improve themom and
who contracts for such projects with o cont.uons)licensed pursuanun NC C4nb6c1Ur s
License Law.
1 am,acmpt under See, B A,P C far this reazon
Owner Date
WORKER'S COMPENSATION DECLARATION
> 1 hereby amrm under Penalty of perjury one of the following dalaratinns:
have and will mainain a Certificate of Consent to mlr-insure for WorkersCompen-
on,asprovided for by Section 3700 of the Lab Code.far Nc Fu mmame of the
work for which this permit is issued.
❑I hast and will maintain Worker's CompcwC n Insurance,as teyuirttl by Or
3]00 of the labor Code,for the performance of ork rnr which this pe it is issued �r, -
MY Worg Cp Ipe ,�nsumna carni PoBdce No.Y•nu , 1 Z 1
ie IWlCCERTIFICATE OF E%EMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(Thissection nem not W completed Rile pcnnit is forme hundred dollars(SIM)
ser less.)
1 ca dfy Nat in the performance of Ne work for which this permit a ismod,I Nall not
employ any parson in any mannerm as to ocomc subject to the Wormis'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,arm,reeking this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Laor Code,you most
.JO foMwith comply with such provisions or Nis permit mall be darned mmkcd.
Z CONSTRUCTION LENDING AGENCY
rr I hereby affirm Nm there is a comanctinn lending agency for the performance or
0: the work for which Nis permit is issued(Sec.3W],Co,C.)
147 Q Lender's Namc
tl Icnde
Z r's Address
U C I certify that 1 have read his application and sate Nat the above infom.fion is
1y r Coecn.I agree to comply with all city and county ordinances and state laws orating to
�U building convection,and hereby authorise mpmenatives of this city to cover upon the
W move-mentioned PmKmy for inspection Purposes.
6. (We)agree to save,indemnify and keep harmleas the City of Cupertino against
U Z liabilities,judgments,costs and experucs which may in any way section against said Ctry
in msequenee of ting of Nis permit.
APPLIC E TANDS ANq WILL COMPLY WITH AL1,NON-POINT Issued by: D
URC REr h - / \ j
\r�'T/i ���7r7�-�(•� Re-roofs
s Signature of ApplicanUConuactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future building occupant store or handle hvutlous material
u defined by rte CYPertlnn Municipal Code.Chapter 9.12.and the Health and Safety
Me,Section 25532(a)? Nn All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building meti ont esu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ho,ardnus act contaminants as dc0ned by the Bay Area Air Quality Management all new materials for inspection.
et?
Q Yes An
I have mad be Warrants materials ocliremena under C'hapter6.95 of the Calier-
niaHealN&Safety Cade,Sections 25N15,25533 and25534.1 undersand thuif the Wilding
des not h a¢nam, t 0 is 55 3 ard2552lity un notify Nc occupant of the
onfore its hi :tomer or tuiaWanccofacerti 0 Cap Signature Signature of Applicant Date
Owner aurhmiomd agent `) -Date All roof coverings to be Class "B"or better