04080231CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACT,ORAN"*QRMATI0N :
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BUILDINGADORESS:
CUPERTINO CONSTRUCTIONS INC
PERMITNo04080231
22260 CUPERTINO RD
OWNER'S NAME:
PERMIT ISSUE DATE
DANNY LEE
10079 SAICH WAY
08/26/2004
E;
SANITARY NO. CONTROL NO.
(408)253-9000
ARCHITECTMNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR S DECLARATION
Job Description
I hereby affirm Nn I am licensed under provisions of Chapter 9 (commencing
with Sccuon ]sxlfil Of Division3ofthell 'neseand Pmfessiees Code.indmylicenseis
imm�to= and effeeL �
License I .e. n u 8
Dam-7� conta� �-
&
REVISION --FOUNDATION TO PIERS
'es
NO NEW PERMIT ISSUED/ORIG. #04040097 Y/
f
RCH]ECPSD RA ON
I understand my plans shall W uxJ as lie rtcnNs
f
"",a, bA'
Licensed Professional
OWNER -BUILDER DECLARATIONf
License Law for my
I hressi affirm Net 11. tusin from tW Cmdurecessum.
J1n Ls, B. Co
following mama. and Pmfoatimn Code: Any city or county
alum, improve.
which myuscs a pumit t alum,
permit demolish, or repair any swment
cams
forma
prior mits issuance,rainnito uthe,mods of formuch file a
r the
Im purstion7
Sq. FL Floor Area
Valuatio$115
(that
Business and Professiam Cade)ser
) of Division 3ftConuumr'snd Prollaw(C Code) or
commencing with of Division3
(commencingwith Section
and the al
Net he is exempt therefrom end the baso for dm alleged oxempdon. Any violation of
APN Number
Occupancy Type
Section 7031.3 by any applicmt for a permit mblecu de applicant o a avil penalty of
not mom thin five hundred dollars (S500).
32650031.00
1, as Owner of the property, or my employees with wages to their into compensation,
Required Inspections
will do be work and the structure isnot intended or offered for safe (Sec. 7014, Business
and Froin:. cox: The Conmaors Lt.. Law docs not apply in an owner of
property who builds m im proves thereon. and who does such work himul f or through his
own employees, provided that such imprisonments me nminunded oro0cread for We. If.
however, the Wilding or improvement is sold within one year of completion, Ne owner -
builder will have the burden of proving Nat he did not build m improve for purpose of
sale.).
1, as owner of she pmpeny, am exclusively contracting with licensed cemmedre to
construct the pm)ect (Sex. 7W. Business and Professions L'odc:) The Cout aebr3 Li
terse taw dors not apply to an owner of preps ny who Wilds or improves Merton, and
who contracts for such projects with a conuactor(s) licensed pursuant to the Conuacmfs
License Law.
1 am exempt under Sco. . B h P C for Nu mason
Owner Dat
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury We of the following declination:
have and will maintain aCenifimm Of Consent m self -inure for Worksh Cori
tion. as provided for by Section 3700 of the labor Code, for tW performance of the
work for which this Permit is issued.
1 have and will maintain Worker's comu eequo
pme ation Isumance, uimd by Secn
Y9m of the tabor Code, for the performance of N ork for which this permit is issued.
Myrx;CmnfUcm/uuonlnxunnaf/sscvricr\m olicy..mso�k,crpaarre.,;
J0 ������
Caplets ay�QT e Fi.+11 eC- rf'olicy NO.: aL�
\/ CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fThu section need not W completed if t e permit is forone hundred dollars (SIM)
or less.)
1 cenify that in the performance of the work for which this Permit is issued. I shell not
employ any person in any manner so es w become Subject 0 the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Ccnificam of Eaemptirm. you should
become subject to the Worker's Compensation Provisions of the labor Conic. you mum
forthwith comply with such provision or Nis permit shall v xcmed invoked.
CONSTRUCTION LENDING AGENCY
I hereby thi But Nem u agency for the Performance of
which sedSee.construction7,
' tho work for which thH permit is issued (Sa. J097, CO.Civ. CJ
Lender's Name
-
t<mcrs Address
j 1 cenify that 1 hays mad this application and sine that information is
and stabovel
I agree m comply with all city and County Ordinancesof and sou laws relating to
Woking
Omand tiro of this city us enter upon the
V
I shove- forcbyauthouxrpose&
athow-recationd purposes
propane for emnity
an
(We)
(wju agree to cove, indemnify and kith City of CuPenst
may in m w s id City
j judgments. cowing may in any way ettme against said City
in consequence
inconseq of thisnmit.
UNDERSTANDSANDWILL CVZPV WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS
P12
Re -roofs
Type of Roof
Signuurt R 'ApplicardUCenulactiorD
HAZARDOUS MATERIALS DISCLOSURE
Will the applicam or future building occupant store or handle haafdous material
as defined by lW Cuperuno Municipal Code. Chapter 9.12, and the Health and Safety
Code. Scetien u532(a)7
❑Yes ,-�j No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant orlorfture buildingoccupam esu equipment ordevio-s which
ba room air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
tiinl
❑an CPQ No
Ihavemm Neh,S=fi smaterialsrtquimmentsunxr Chapurb.9softho
'`
ft Wilding
m cupmt Wilding
ria Hcilthk5s(nYhave
\--,--i it
iti My
dors not currently hint a tenant Nat it is my responsibility m notify tM occupant of Nc
a mount. to notify
��\
rcyuircmc nienn tx no -by mcor`=reateor� /
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or int rirc`d agent Da/D—T�