05070006 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONY.RACT0RANFORMATIQN.
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BUILDING ADDRESS: PERMIT Nib 5070006
10238 E ESTATES DR
OWNER'S NAME: PERMITIsiUEDATE
11 ANDREW & MOONY CHUM 2005
.JNE:� SANITARY NO. CONTROL NO.
I
ARCHITECT/ENGINEER: BUILDING PERMIT INFG
BLDG ELECT PLUMB MECH
0 0 0 0
uoo Lm tat
LICENSEDCONTRACTOR'S
under SDisiom, ATION
rchap Job Descri tion
<�C 1 Mmby affirm Thal l am fffic Bd under provision ors Corer 9(commencing - }1
is with SccuonJglU)af Division lof ibe Business and Profession Core.and my license is
^iaa in fall rode and affect. ADD 448 ' (MS BED & BATH)
License Class Lim.0
Dale Contractor
ARCHITECTS DECLARATION
a�a I understand my plans shall he used as public records
paU
C G Licensed Pmfcuianal
3 OWNER-BUILDER mDECLARATION
.�a 0 1 Wrtso .Bim Nal 1 I. czcmpl from to Conessmx Cod License city
o for my
p O whop following Permit 703 omartS.Business, lms. and w, un demolish.or epaiAnyr ay or county
m which ms Its a s permit m camuucL alcor,impmsu hPermittor repair any swoon $96037
Fi< tm he its Issuance,it also to LW applicant for wchprrmiuoiensele a Lsw(Chaned statement
.Fpthommecccnud purstion700)provision of she Conbumr'snd Pourlaw(Chaldcr9 Sq.Ft. Floor Area Valuation
(et,he
(commencing it therefrom
and of Division of the
eged exeendon.An vi Cadc)of
i�� that he is czcmpl therefrom and the buts for IW alleged cumpumt.Any violation of
Salton 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than Eva hundred dollars($500). a Occupancy Type
0 I,uo mroftepmpmy,ormyemploy withwageutheirmlecompenvdon.
will do the work.and the structure is nmimmndcd or offered for sale(Sec.7061,Business
and Professions Code:The Conmmors License law docs not apply in an owner of cored I pections
property who buildsor improve thereon,and whodoes such work himself orderough his
Own employees,provided that such improvements are not intended oraffered for sale.If.
however.the building or improvement is sold within one year ofcomplction.Ne oweir-
ve him
builder will haw butdan of proving Nat W did not build or interest,far inorganic of
ale.). h LLSS33
❑1,as owner of the property,am exclusively contracting with licensed contractors to
convect the pmjcm(sec 7044,Business and Professions Code:)The Contractors Li.
corse Law dam not apply in an owner of propcny who Wilds or improves IW mon.and
who contracts for such pmjccu wit a room uor(s)licensed pursuant to tW Commencer
Lkcnu law.
El l am exempt under etc B h P C f r this mason
Data 7
�'
worn
�- ?YORKER'S COMPENSATION DECLARATI
I hereby animl under penalty,of perjury one of the following declanuans:
❑I ham and will maintain a Cerdfcam of consent to self-insure for Wo t es Co gal er- .
rasion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Smuen
3700 of Nc Labor Code,for to performance of to work for which tis permit is issued.
My Workers Compenation Insurance carrier and Polity number aa:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W compared if the permit is Torpor hundred dollars(SIM)
or less.)
1 certify tat in to performance of to work for which tis permit is issued.l shall not -
employ any parson In any manMf an as in become Nppl�a1 In tr Wprker3 enmlmnatims
Laws of California.
Applicant (
NOTICE TO APPLICANT:If. this Certificate of Exemption,you should
become subject to the Worker's Campenaallon provisions of tr labor Code,you most
,JO foMwi th comply with such provisions or this permit shall Ise deemed mwrked. .
z Vy CONSTRUCTION LENDING AGENCY
I-. 1 hereby aRrre tat tart is a conttatinn lending agency for tc performance of
x 7 dm walk for which this Kirsh is issued(Sec.3037,Co,C.)
Lenders Name
=z Lenders Adtcss
U O I eenify tat 1 have mad tis application and sum tat the above inromutiun is
D. P correct.1 agree to comply with all city and county ordinances and am¢laws miming to
0U building conswction,and hereby authoora mpmmmacivcs of tis city to enter upon the
Y'a ahovcmentioned pmperiy for inspection purposes.
(We)agree to save,indemnify and keep humlest the City of Cupertina against
F+� Iiabiliticsjudgments.eosts and apnoea which may in any way same against said City
U z in eorvegvenee of the gmmin a tis pefmit.
^ APPLICANT UNDER AND WILL OMPLY WITH ALL NON-POINT Issued by: Date 7—/2— I-
SOURCEREGULATION
Re-roofs ✓iii�G
Signature of Applican o mann etc
AZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will IW app mum or future building occupant store or ha dIc hazurtu s material
as defined by to Cupenino Municipal Code.Chapter 9.12,and the Haalt and Safety
Code.section 2553x.)+ - All roofs shall be inspected prior to any roofing material being installed.
❑re P1�a.
Will to applicant or future building occupant are equipment or device whim If a roof is installed without first obtaining an inspection,I agree to remove
emit b t.mous air contaminants as dcfincd by the Bay Area Air Quality Management all new materials for inspection.
DiatricO ' �
❑Yes ,�Nu
I have mad the Wvallous mamdals coq uranor a under Chapter 695 of the Califor-
niaFkaltkSafnyC ..t2 5,MS33ar 25534.lundcrstandthmiflW Wilding
doe nal curremly IOvol Nat it is my pato nibility noufy do occupant or dm
myaimmcnu which 9` n ` rwissumc ora Ccnifica¢of am parrry. Signature of Applicant Date
Owueruraut i agmn/ Date All roof coverings to be Class"B"or better C