06070043 CITY OF CrjPERTINO o- awcq.ua 4X•b- 'x�` '' ' �"i
BUILDING DIVISION PERMIT .. .'<Sl'dT.l2.�f�"rbj"NFOM�1T—Tp
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BUILDINGADDRESS: JACK CHANG CONSTRUCTION PERMITNO.06070043
7645 DUMAS DR
OWNER'S NAME: - PERMIT ISl1E DATE
WANG GENE S AND KRISTINE Y 10220 STERLING BLVD n7/i2 /2n06
Eu SANITARY NO. CONTROL NO.
(408) 517-8878
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� t�
�oo LICENSED CONTRACTOR'S DECLARATION lob Description
W. 1 thereby affirm Nal I am licensed under pmvid"ns of ChuPW 9(cemmenclut - P
?� with secLion70W)of Division3of Ne Businmod Profcasws Code.aMmylicenwis
±� in full force and affect. 8 SQUARE FOOT ADDITION WITH NEW SLIDING DOOR
>gaLiammLtM.
Dam CGonvainenor WINDOW CHANGE OUT AND KITCHEN COUNTERTOP
aa
Tw ARCHITECT-S DECLARATION
f 77< 1 understand my Plans shall he used as Public records
y6U
sad Licensed Pmfcnianal
b°3
OWNER-BUILDER DEMe
a
coo amhy.(See that 1 am vest. from Ne Conroe Col :My c Law for Co
coo fallowing rcasdn. omnis t 70!si B,'Imr. and vefeWum Cam:Any city ar mums
3$Iii which us issuance,
n permit m cnnstract alcor,improve,de ermil t ter e a sig any nrumcm
pnormits Wsapursuangn the the isionsnt offor such permil Lecuse Ijw(ned atatsment
�< wnaisuascdparaeammtheprovislhwhrtheehnscor.lea<lee�w(chaPW9 Sq.Ft.Floor Area Valu$tID8000
$ (commacinl with Section 7000)of Division Sof the Buamess and Pmmuions Cam)un
that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of ppN N
Section 7031.5 by any applicant for a permit subjects Use m applicant a civil penally of 3 5 9 2 5 04 bei0 0 Occupancy Type
nor mon Nan Oro hundred dollars(5500).
❑1,as owner of Ne property or my employes with wets as their wk eompeseUon,
will do the work and the mmemm 6nm intended"r offend for%Me(Sec.7044,Budnrn Required Inspections
Nd Pmfeyll"N Code:The Character'LlttdSe LiveIXa d0"r apply an N awKr Of 9 P
property who build,rr improves thereon,and whodoessech work himaelfar Waugh his
own employes,provided that such improvements are not intended oroffered f"reale.If,
however.Uta building or Improvement 4 sold within one year of compledon,the Owner•
builder wN Itave the burden of proving that he did nut build or Improve for purpose of
al9
I,aowneroftheproperty.m Business
sad Professing with:)Thelicensed Ccmnuacmn -
cosrun Um project(SMapply
7014.Business red Profession Cade:)The es ft...V•
cense Law drs not apply je to with a of property who Wilds m Improves Contra,and
whocontractsLace for such projens with a anuucmrtU licensed punuantm the Contractors
Lice
❑lam uempn MeSMBRPClm this reason �®
nen Gr/L Dase
WORKERS COM,, ATIONDfSZ"KATIO
I thereby affirm retft
at huehrthe following
declarations:
O l h.wond will Wm2O06
sWan,
as Provided fm by Section 3700 of W Labor Code.for acre pelfrmatne of Co
wart for which this permit is IouN. ttQQ��,,44,��pp Bq1
❑1 have and will maintain Workers Compensation Insurance,u mqulmd by SeNon ®�N�
3700 Midst Labor Cads.for the peRarmana of the work rarwhlch 444 Permit 4 Jawed. UI
LU Workers Compensation htsmanae carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
. COMPENSATIONINSURANCE
This section aced nut aeomplemd Iftins Permit Is forma hummaddellaa(SIM)
or mar)
I cardry that In the performance of the work for which this permit is Issued,I shall not
employ any person in any unsecured as m beeomo wtw bjmthe Worken'Compesa0on
Lawn of Calif tsrats tl
Applionl S�—o
NOTICE TO PPLICANr:If,& r making this CeniOcate of Exemption.you should
become subject m the workers C mpesaCan Provision,of the Labor Coda you mel
.J O forthwith amply wed such provide.or this permit Nall a domed mmked.
zti CONSTRUCTION LENDING AGENCY
[.r Ihtnbyalrum that tnn is a connmctma lending agency for ter performance or
a Cn war for which 444 permit 4 issued(Scc.3077,Clv.C.)
W Q Lenders Nene
z Landolt Address
U p 1 unify that L Mve read this application awl seats than the show infhrmadun 0
Cis F Corton.I&&me to comply with all city and county on inanas and fun laws misting to
C U building convection,and hereby amhorireac rescnwivca or this city to cmc'.Nn the
W ah.v.-menti...d property for i.S,cdon purposes.
(We).gree to save,indemnify and kap humlw the City of Cupertino against
TaA IiabiliUn.judgments,costs and O.F.which may In any way same against aid Cit
U Z in c"sequence of the granting of this Permit.
^� APPLICANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE N Idne r�/Y O
/� Re-roofs
Sigstun hfA ican anuacmr Dam
HAZARDOUS ATERIALS DISCLOSURE Type of Roof
Wil the apPlicanthr lmun bat dintaaupanswremluadlchvadowmamrW
as de0ned by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Section 15531(&)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya N"
Will to applicant or future building oampant use a pilptuot at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnndons air contaminants u de0red by the Bay Ana Air Quality Managcmcm all new materials for inspection.
Disuict7
❑Ys OrN.'
I have real W hanNunsmamriab nquimincnu under Chapmr6.95 of he C.lifm-
niaHcalo&Sifcty Cat.Sccdas25505.25533and15534.lunwc dWtlfNe building
dos not currently how a conn,Lha l 4 my maponalhility to notify Ne occupant of ft
requirementsw 'amen ueisansweof.cenifnamoras Signature of Applicant Date
owner or barna .<d agent ts All roof coverings to be Class"B"Or better