05110042CITY OF CUPERTINO
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CONTRACTOR INF',ORMATION -.:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
ANDY'S CONSTRUCTION
PERMIT NO -05110042
10522 DEODARA DR
O W NEWS NAME:
PERMIT ISSUE DATE
JEFFREY TZONG & CHRISTINE
ANG1354 SAGE HEN
01/17/2006
E:
SANITARY NO. CONTROL NO.
(408)735-0111
ARC11I'18CDENGINEER:
BUILDING PERMIT INFO
eLDG EO PLO
o O
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 lemby affirm Net I am licensed under provision of Chapter 9 (commencing
with Section 7008) afDividon 7 of rite Business VW Poofcaslsms Code, no my license is
in lull fncomd affect
ADD 6801 (FAM./MS. BED/BATH)
License clue Lk,M Contractor
REMODEL KITCHEN & BATHROOM
' ARCHITECTS DECLARATION
I uabcaaund my piens shall be used As public receam
Licensed Pmfcssional
OW NSR -BUILDER DECLARATION
I hereby affirm Net 1 Am exempt from the Contractor's License law for Ne
following mason. (Sect 703 1.5. Business and Profession Cade: Any city or county
which requires a permit at constant. *Icer. Improve, demolish. or repair any structure
prior to its issuance, alto requires the applicant for Such permit to rile a signed Relcraml
Sq. Ft. Floor Area
Val$"i5771
that W is licensed Pursuanun the provisions of the Convector's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Cade) or
that he u oaerept thisrnfmm and We basis for rix Alleged exemption. Any violation of
APN Number
Occupancy Type
Sudan 7031.5 by arty applicant for a permit subjects the applicant W a civil penalty of
not mom than firs hundred dollars (1500).
31630037.00
D I, es owner of the property, or my employees with wages As their Able compensation,
Required Inspections
will do the work and the structure is at inanGA or offered for Ask (Sec. TINA, Business
and Professions Code: The Committees Limme Law does but apply W An owner of
9 P
property who bui Ids m iso prows thereon, end who docs such work domain, through hit
own employees, provided that such Improvements not moRerW for via If,
es. providedthat suchimprovements
bowers' theoy
in you
g or to Abid within one yev o(crmpletion, the owner -
builder will have the burden of Moving that he did amt Wild or Improve for purpose of
Assia�).
&Iv owner of Oe property, am eecliuively convecting with licensed canuactmx W
Ne project (See. 7014, and Profession Code:) The Conuamon,
comm
of property who Wilmorimt and
La owner of
cemelawdoAsnouppr tato daemonComeacoes
for such prajecu with a eoniranmr(q Ilcenad pursuant W the Conwdaea
whowith M the
Lace
License Law.
/
❑1*m nempt un/der Sec. ,B&PCfar this wo—n
0 AM
r }/!is�l� Date I/'—/?-
WORKER'S COMPENSATION DECLARATION
v�
I hereby alarm under Penalty of perjury am of the following declarations:
D Ilaw ono will of -
•donna
sadon, As 37M Code, forPerformanceof
forSection 7700 of the labor Code, for the performers of rix
for
work (or which this permit is issued.
for mi
D 1 have and will maintain Worker's Compensation Insurance, As required by Section
3700 of the labor Code. for the peaformame of the work for which this Permit Is Issued.
My Wallace. Compassed. Inunnm cerin and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section bond not W computed irile permit u forma hundred dollen (1100)
ar less)
1 unify that ib the parfmmanee of the work for which this Permit Is issmd. I Nall not
employ any ramon in any manner W As b becomau Compamation
objeet m th
en'
Laws c f Cellfamiu. Dam
Applicant �T,^�—�
NOTICE TO APPLICANT: If. after making this Oct ifmam of Exemption, you should
become Subject W tW Worker's Compensation provisions of tho UM r Code, you am
forthwith comply with such Provisions Or Nis Permit Shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affann Met then is e comvuctum lending agency for de Merformvm of
the wart for which Nis Permit Is issmd (Sec. 3097. Civ. C.)
Lendee. Name
,
lender: Address
1 certify thin 1 have read this application and ataW that the &bout information Is
'
comm. l agree W comply with all city and county ominaneea and lute laws relining to
building combustion, and hereby utharire repwoadves of this city to enter upon the
above-mentioned pmpeny for Inspection purposes.
(We) Agree W save, indemnify and keep hsamhst the City of Cupertino against
liabilities, judgments, con and expenses which may In say way ammo against mid City
in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R TIONS.
�� '
-�� —
Re -roofs
Type of Roof
Signature of Applicant/Comosetor Dau
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occup&nmrore or handle hvudous material
As defined by the Combine Municipal Code. Chapter 9.12. and the Health and Safety
mk.smtian 2ss32(a)7 L
All roofs shall be inspected prior to any roofing material being installed.
Dyes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuum building occupant use equipment or devices which
emit haeudous air canuminants As dcfrmd by Ne Bay Area Air Quality Management
all new materials for inspection.
District]
DYu Nu
I have mad Ne h®udms mammitis requirements under Chapwr6.95 of tie Califon
ria HmIth & Safety Cad., Sections 25505.25533 and25534.I understand thmilM. Wilding
does not c nand he a tamest. Nat it is my MINFISibillty W badly Ne occupvt of Ne
requimmeu re man W mei wttauanm or a cenifinte orf?M!E 7_?_
ignature of Applicant Date
All roof coverings to be Class "B" or better a
Owner as Authorized agent Date