05020114 CITY OF CUPERTINo -^ t s a „i
]BUILDING DIVISION PERMIT CON�TfRACT.®R INFN
BUILDING ADDRESS: PERMIT N10 5 0 2 0 114
7437 FALLENLEAF LN
OWNER'S NAME: PERMIT ISSUE DATE
ERIC CHANG 02Z16/2005
INE: SANITARY NO. CONTROL N0.
ARCHITEC(ENGINEER: �±y.'v BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±oo LICENSED CONTRACnOrprovi Cons of CON- Description a,
u C I ion? ))orm that 1 am fthe Bu under provisions ofChapterCode, 9 commencing Job I�eSCriptl�l0n
,z ser with Seaton 7IXllgofDivision3 of Ne Business and Profession Code,and mylicense is ,g n�
�
c. rfall ecava. KITCHEN REMODEL MY? License Class
Class LIC..
;F,o Dale COmranur V/may) O
pp ARCHITECTS DECLARATION ®� S
ry U I unticrsuu
nd my plana shall he used as public records Qsya UNG shy
Licensed Professional /J��.�l/gJ;J s7p A'
7 Chat Ire extort from
DECLARATION
2 a y 1 hereby affirm that I am exempt from the Comnnors Liccnu law for(be �GJJ
O O following mason.(Section 7031.5.Business and Profession Code:Any city or county
m which requires a fermi!In Consumer.alter,improve,demolish,or repair any structure $30000
priormiuissuance.also requires the applicant for such fermi)to rile asigneJ.nalenenl
'.¢p that he islicensed pursuanuothe pmvismosorlhcComract.1'.URnuLaw(Chapter 9 Sq.Ft. Floor Area Valuation
[� (commencing with Section 7")of Division 3 of the Business and Professions Code)or
Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to.civil penally of
Ml more than five hundred dnuars($50). a Occupancy Type
❑ 1.as owner of the pmpeny,or my employcu with wages as their sole compenemion,
will do the work.and Ne swaum is not intended or offered for sale(Sec.70M,Business
and Professions Code:The Contractor's License Law dors not apply to an owner of Required Inspections
properly who builds or improves thereon,and who does such work himself or through his
awn employcer.provided that such improvements sure not intended or offered for sale.It.
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did no,build or improve for pm,ou of
sale J.
j1111.M owner of the pmpeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7054,Business and Profusions Cale:)The Contractor's Li- _
se law docs not apply o m owner of proprny who Wilds or improves themoo,and
who contracts for such projects with a contractor(s)licensed Pursuant to the Comredor's
License law.
0 l am exempt under Sec. .Bh PCfm this a
Z O
Owner / Date '
WORKER COM ' TIO7 ECLARATION '
1 hereby aRrm under penally of perjury One of the following declarations:
❑1 have and will maintain a CatiRcale of COnsCnl to self-insure for Worker's Compon-
ution,az provided for by Section 37W of the Ichor Cade,for the performance of the
work for which this Permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cama: Policy Nu.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thoscaiom recd not tic completed if the Permit is fortune hundred dollars($1(x))
or less.)
1 Crotty that in the verrommoroc of the work for which this Permit u issued.l shall not
employany peninmanymaggc/.wd�iMmnle subject m IN,Worla, Compcnation
Law.of CalifwrData �I15 y
Applicant 11 Ca-fA
NOTICE TO APPLICANT.If,a0cr making this Certificate Or Exemption,you should
become subject to the Worker's Compensation provisions of the labor CMB,you most
�Z fonhwi lh comply with such provisions or this Permit shall W deemed stinker.
OCONSTRUCTION LENDING AGENCY
1 hereby affirm thatthew iso ed(So,.3 lending agency Ire the Performance of
3a the work for which this pcnnit is issuM ISce.JOffI,Civ.CJ
])0 4ndcr' Name
2 Lenders Aadmss
J 1� 1 certify Nat 1 have read this city
and county
and sum that da above information is
:F. U cording 1 agree m comply with all city and ceposy oNi vesOf and seam laws relating e
3C.) ahowngeotioned Construction,and herebyoinspetionprposesemalivesofNiscityocnmrupon the
W ahnvc(We)are Properly for inspection Purposes.
y r, (We)agree to save,indemnify and kap harmless w City scenic
Cupertino against
Z incoisequer ,of the
tsang of this Smit. may in any way accrvc against said City
J z in ctunuqucncc of the graining of this Permit.
^-t
APPLICAN7,VNDERSTANDS ANP W L COMPLY WITH ALL ON-POINT Issued by: Date
SOURC LATIONS.
Re-roofs
Signature of Ap,1iC.nVC.o rhm - Da
HAZARDOUS ATERIALS CLOSURE Type of Roof
Will the applicant or future building Occupant store or handle l000mous material
M dconed by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.SecCyYcs on zss3z25332(a)? All roofs shall be inspected prior to any roofing material being installed.
f,
Will the applicant or furore Willing Occupant esu equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Will
dour air contaminants as defirod by the Bay Arca Air Quality Management
Owner? all new materials for inspection.
�u
clRe ! to
I have and the Womb ua materials myuiamenrs under Chapter 6.95OHhe Calif.,
nia Health Jk Svfety Cale,Secuon 25515,25533 and 25534.1 unJersmnd mnifdw Wilding
docs nm curunly hoc uma�l,that it is my responsihilitY lO nnuly lW a'cupant of Ne
norpii5a,1516 uswmeh :jmetprior OrissuananraccoieeatcofGO -arcy. Signature of Applicant Date
Owner or authorized a DC, All roof coverings to be Class"B" or better