06020043 CITY OFCUPERTINO T
BUILDING DIVISION PERMIT CONTI2AC'TOlit TN 'U12MATIUN
BUILDING ADDRESS: ABCO CONST PERMIT NO.06020043
208
OWNER'S NAME: PERMITISSUEDATH
KATIE SU 14880 LLAGAS 03/10/2006
E; SANITARY NO, CONTROL NO.
(408) 779-7577
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BIRO ELECT PLUM O MECH
l� O
30, LICENSED CONTRACTOR'S DECLARATION lob Description
v� 1 hereby affirm thin 1 am licensed under provisions of Chapur 9(commencing
with Suction 70(18)ofDivlalon 3 of the Butiness end Prof caluru Code,and my It..u
^ in fun force and effect. HOUSE DEMO
? Lueoc Clan Lk.9
DLJ? Dan ContractorCL ALE®
ARCHITECTS DECLARATION
U 1 understand my phna shall x used u public reenrds
{u� Licensed Professional 2UU6
y05 OWNER-BUIIDERDECLARATION MAR PA L
1 herohy oRmh
that 1 am exempt from the Ccan sctar's License Law for tx
t
oo following rasa..(Section 7MI.5,Busiws and Proposal Calc:Any City.1 Count
W$P! which requires a permit to c nmroat.alter,lmproe,demolish,a repair any moors m 1^11000
Zi prior on its issuance.also requires the applicant forsals Permit to file a signed suumem
Fr�E< that he is licensed puruentmthe provisioaofJmConmeterilxsnseLaw(Chapter 9 Sq.Ft.Floor Area on
S$ (Commencing with Section 7000the)of Division 3 of Business and Profesions Cath)or
3 that he is exempt acrerrao and the basis fa an alleged exemption.Any di lawn,of
Section 7031.5 by any applicant for a permit subjects the applicant to a rnIl penalty of r Occupancy Type
ooh Come Nan It.hundred dollen IS500).
❑1,u owner of du proprny,r my employm with wa{ea u hues sale eomRnsaton,
will do the wM,and to strumae is nataneMed a Offers!urasu(See.7044,Business
and Pmfessiona Code:The Commosurea License Law due Out apply to an owner or Required Inspections
prepeny who builds v Meow thereon,and who due tach sash hinhsel f or IMu{h his
oweemployees,proAded that such ImPmwmnnes art Out Intended!oro0ertd forsau.If.
however,the building or improvement Is sold within one year of Completion,the Owner.
bullar will haw the bunion of proving that he did rot build or impro a for purpose of
ane.
I u owner of the Property am aclushtly canuaating with licensed Conussnon to
Combat the pmjem(Sec.7044.Business and Professions Code:)Tlw ContracmYs U.
cense law does not apply u an owner of prepenywho hulas or improves thereon.aM,
who anuacu for such projects with a eonuuwr(O licensed p usuam m to Contractor's
Liatm law.
❑I am camps under .B&P C for this
owner l _ Dare 3 0 a
SAflFIVN DECLARATION
1 hereby air=under penalty or perjury one of to following declanumme .
flaw and will maintain a Certificate of Conserv m self-insure far Worker'sCospen-
.ml as provided for by Section 3700 of the labor Cade.far the performance of to
wort for which this Permit is issued.
❑I An and will malmain Worker's Compewll I..,as required by Section
3700 Oran labor Code,for the perrom once of the work frwhich this permit Is inued.
My Worker's Compensation Insorarue wrier and Policy number art:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSA71ON INSURANCE
mamNon need notbemnpleted iftbe permit n form hundred dollen(5100)
or Iva)
1 certify that in the performance of Ix work for which this permit is issued,I shall not
emplay any person in any ma nQer)p�ulo becoungbJect m Ne worken'Comper adon
Laws of 481 amu! V�O b
ApPlican -
NOnCE :If.alRer�ng this CcNBuu:of Exemption,you should
become subject to the Worker's Compensation provisions of the tabor Code,you most
,J Z faMwith comply with such provision or this permit thsil be deemed revoked.
.Zn O CONSTRUC ION LENDING AGENCY
[+ I hereby Milan that dem is a construction lending agency for the porformance of
C
the work for which this permit is Issued(Sec.309'1.Civ.C.)
0 Lamdces Name
.7. Z Lender Address
U Q 1 certify that I law rad this application and sum,that to Mon information Is
Conom I agree u comply with all city and county ordinances and Anne laws relating to
pU building construction.and hereby authodne mimusmmiwa of this city u Omar upon the
W shove-mendoned property for inspection purposes,
(We)agree in saw,indemnify and keep hrmlem the City of Cupcnina agaimt
raA liabilities,judgments,cents and expenav which may in any way accrue against sold City
L) in consequence of to{naming of this permit.
APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date '_::7-/D61
SOURCE ONS. 0A
/
O Re-roofs
r{ a of pp an r Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant AMC or hmdlc hraAoos maurial
as defined by the Cupertino Municipal Code.Chapter 9,Ix,and tyre Hcala and Safety
cavi, MY.xsslx(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yon i'�'fqu
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havmmus air contaminants v defined by the Bay Area All Quality Management all new materials for inspection.
District?
❑Yes grvu .
1 hew mad the benrdousmaariats requirements underChapter695 of the Califor•
nu Halth&Safety Codc,Sections 25505,25533 md25534.1 uMcrstond owifthe building F•
does not currently haw a unant,that it b my war a nubitity se wtii'y the occupant of the
requirements which aux normnt.ns res cemne. .roue .nay. Signature of Applicant Date
o t Dna All roof coverings to be Class"B"or better