04020107 CI TY OF CUPERTINO "�'9^ a" au
BUILDING DIVISION PERMIT CONTRAC-TOR,INFORMA�TION
BUILDING ADDRESS: PERMIT NO,
FRANKIE KANYIN LAW 04020107
ER'S NAME: PERMIT ISSUE DATE
PANKIE
ONE:F SANITARY 0 OLNO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
I� t�
app LICENSED CONTRACTOR'S DECLARATION
1 hereby from that I am licensed under provisions of Chapter 9(commencing Job Description g�
with
Suction)deffect-
to
fecDivision 3of the Bulinus and Professions Code,and my license is A l� {rye®
n a 'n full forts and cflttt Ob/J��U P®yav fB{{i�s_—a
,q? in
Class Lie.as SFDWL-2 STORY LIVING 3 , 019 SQ F
—o Dal Conlracmr GARAGE 458 SQ FT
ARCHITECTS DECLARATION
I undomund my plans 0a11 W used as public mcmds NOV �5- 2004
�yU
GG Licensed Professional .
OWNER-BUILDER DECLARATION w
ip I hereby amrm tat I am exempt from he Contractor's License law for the ■' I
'0 following moon(Section 703 L5,Business and Professions Code:Any city or county
$ which requires a permit In construct,also, m
rimprove,demolish.nr rural,any strustructureMRetu
r Z> poor m its issuance,also mquims the applicant for such permit to file a signed statement
< tat he is licensed pursuant to the pmvisioms of the Conuacmrs lice.Law(CbmtOr 9 Sq. Ft.Floor Area VacI8 0 0 0
�H$ (commencing wit Section 7000)of Division 3 or the Business and Profusions Code)or v U
—
that he is exempt themfrom and to basis for fee alleged exemption.Any violation of
Section 7071.5 by airy applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than rim hmdrtd dollars(5500).
I,az owner of to property,m my cmployna wit wages u their sole eompcnsadon, 35918013 . 00
will do tM work,and to swclare u not intended o,offcred forsalc(See 7044.Business
and Pmfassiom Code:The Conrraccors limrue Law does not apply m an men of Required Inspections
property who builds m improves thereon,end w ho does suc h work himsel f or through his
own employees,provided that such improvements are notimmnded or offered for sure.If,
howevs,q to building or improvement Is sold within oto year of completion,the owner.
builder will have the burden of proving Wt he did not build er improve for happens,of
aisle.).
L 1,as owner of to property,am exclusively contacting with licensed commandos to
construct the project(Sec.7(144,Business and Professions Code:)The Contacror's Li-
cense law door not apply Is in owner of property who builds or improv feemon,and
who contracts for such projects with a conaactorfs)licensed pursuant on the Contractors
License law.
I am uempt117 Sec. .B&P C for Nis moan
Dau
/WORK ER'. C MPEN�S I IRA
1 hereby affum under pcnslty o(pepjury ore of to
to
tog dttluations:
1'17'y.
have and will for by Se Cern3um of the amtLab r Code.ford for Wooers ce of
on,as provided for by Section T]DD of the labor Code,for to performance of the
k for which his permit is issued.
I have and will maintain Workei s Compensation Instuanm,az required by Section
of the Labor Code,for she perfor once of to work for which tis permit is issued.
Workee.Cnmpcnsation Insunnm cartim and Puliry numMr am:
ier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not be completed Little Permit is Intent,hundred dollars(SIM)
or kis)
1 ccniry that in to Performance of be work for which this Permit is issued.I shall out
employ any person in any manner so az to become subject to the Workeri Compcnsadon
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Cenificalc of Exemption,you should
become subject ro use Worker's Corer mSetion provisions Of fee Labor Coda,you moa
�Z foMwife comply wit such provisions o,tis Permit shall ht,deemed revoked.
z O CONSTRUCTION LENDING AGENCY
'r. I Nochy elf ren Out fere I..consuuninn lending agency Int tc Performance of
y' dm work for which his permit is issued(Sec.509],Civ.C.)
fA 25 lander$Name
V. Lt,ndels Address
U C) P moody that I have read this application and sum tat the above information is
0 t—' corona I agree ro comely With all tory and county rdinamrea mW sou laws r upon t e
�U building cniumoctpmKand Moody aufeoorereoses. tis of this city menmruPmn dm
W ahovcmention agree
to now.
for indmnify an keep ha.
(~ f1 liabilities.Wt,)agme to save,indemnify and keep ay inm the City of Cupcnsts against
rq in
uencea thecmuand esp..which may in any way ettme against said City
C.1 z m PLICAcpme of togranting of tis Permit
APPLICA ERSfAN ILL COMPLY WITH ALL NON-POINT Issued by: Date �0D
SOURC LATION
b- Re-roofs
yrappu �A� Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantstore or handle haterdous mamdal
az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
e.Sccties 2ss5z(a)]
Ye All roofs shall be inspected prior to any roofing material being installed.
❑
7Will be applicant or fumro wilding occupant use,equipment or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmit hazardous air contaminants as defined by to Bay Area Ai,Quality Management all new materials for inspection.
trict]
❑Yes
I have mal fee by nusmaleriaH mquirements underChapter695 of the Califor.
ltealt&SorryCode.Scedom25505.2s555aN25554.1und mwdtuliffee building
cs no fly haze a dTbla it u my mspomibiliry m noddy ns,acupem mf me me ire tpri issuanmerrcemnerceorOccupancy. Signature of Applicant Date
e set _ ase Da� All roof coverings[o be Class"B"or better