08030119 CITY OF CUPERTINO ..� - 3
BUILDING DIVISION PERMIT ORIR
BUILDINGADDRESS: PERMIT NO.
21115 FREEDOM DR MARVIN DAVIS CONSTRUCTION 08030119
OWNER'S NAME: PERMITISSUEDATE
HUNG TANG 1450 KOLL CIR 03/21/2008
- ONE: SANITARY NO, CONTROL NO.
(408) 975-0200
ARCHITECT/ENGINEER: BLDG BUILDING PERELECT P F LUMB MECH
0 0 0 0
°oa LICENSED CONTRACTOR'S DECLARATION IObD05Cr1 hon
V 1 hereby affirm dm 1 am licensed under Pmvuions of Chapter 9(comm.ncing p
with Section 70(10 of Division 3aIt.Businesv and Pro(eturkma Cade,and. m license is MIS in fullfameandeffeet B Z y BTHRM & DEN TO CONVERT TO BEDROOM
j LlgE Llcensc Class Lie N
r q DamConn.
ON7W AACNffELTg DECIA ON
6
U I undersmnJ my plana shill be used u puhiic menrJe
oLicensed Professional
g OWNER-BUILDER DECLARATION
9 i f I hereby affirm that I am exempt from Use Contractor's License Law for to
D O following mason.(Section 703 1.5,Business and Professions Code:Any city or county
m which acquires a permit to ennswca,alms kpm o,demolish,or repair any structure -
zy
pd.,1.is ismarmc.ain.ramd.the applicant for such permit o file a signedsmument
that be 1.licensed puranumt to the provisions of te@nuacluh License Law Metric,9 Sq.Ft. Floor Area Valuation
at (co
m $7500
mencing wish Section]000)of Division 3 of Ne Business and Professions CMe)ur
t R$E fret he u exempt tMmfrom and to basis for to alleged a notion.Any vialafon of
Section 7031.5 by any applicant for a Permit subjecs de applicant Or a civil Penalty of Ap�j Number Occas
not mon Iran five hundred dollars(5500). - 32653031 . UU Occupancy Type
❑I,u owner of the pmpmy,m my employcm wit wages o their mle compensadon,'
will do the work,and the srmmum is nothmnthd or offend formic(Sec.7044,Business Required Inspections
and Poefessiaru Cade:The Communor's License e Law dors Int apply b an owner of q p
property who builds m improves f tenon,and who does such wark himself or through his
own emplayees,provided Nm such imprommens tie notinsnded maRcled for sal.If.
however.the building or improvement is sold within mm year of compledon,fie owner- . ..
builder wiB love the burden of proving that he did at build or improve far purpose of ,
role.).
❑I,es mvncr of Ne property,em exclusively contracting with littered...means in-
construct me project(Sec.7014,Business and Profesions Cade:)The Comommes Li-
cane Law does net apply o an owoer of property who builds or improves demon,and
who contracts for such projecs wit a comracinds)licensed pumuanl la the Cantremes
License Law.
❑I am exempt under See. ,B At P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afRrro under penalty of perjury nnc of me fallowing dedanlmon
I h:v�md will maintain a CerfBcate of Consent in self-Inmm for WorkclsCompen-
f..ax provided far by Section 3700 of me Labor Cade.far me pedom ace of the '
work for which this permit is asued.
❑1 have and will maintain Worker's Compensation Insurance,as;rox Bred by Section
3700 of NC labor Cade,for to performance of ma work for which this permit is Issued. '
My Works a Compensation Insurance canis and Policy nu abet
Cartier. t PoliryNo.://9/-7/I_m
CERTIFICATE OF EXE P IQN FROM WORKERS'
COMPENSATION INSURANCE
(Thu section reed nal be completed if the permit is forma hundred dollars(SI W)
car los)
I certify tat in me performance of to work for which this Permit is loved.l shall not
employ any person in any mannerm as 0 became subject o me Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.efm making this Cmdricate of Exemption,you should
become subject o the Workers Compensation provisions of me labor Cede,you must
.J O foMwilh comply wit such provisions or mu permit shall he deemed revoked.
Z,I a"" CONSTRUCnON LENDING AGENCY
1mody affirm that sort is a consuucunn lending agency for me Performance of
CL to work for which this permit Is issued(Sec.3097,Civ.C.)
W�Q Lender's Name
Q.� Leoice,Add.
V Q 1 cenify tat 1 have read this application and m l mel to above information is
Uy;: cmncL l agree to comply wire all city and county ordinances usd sum laws nesting to
0 C building conuwction,and hereby mutation mpmentauves of this city in enter upon me
W shove-mcmioned property,for Impaction purpoea
gy (We)agree to ova,indemnify and keep motion to City of Cupertino against
a.t rA liabilides,judgmees,eastt and expenses which may in any way ecru.against said Glly
(�'z in caneequenca of do granting o(tis Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON DINT Issued by:9 Date
SOURCERE ULATIONS.
Re-roofs -- ---
Signmu o ppl'an a tar Dam
DOUS MATERIALS DISCLOSUR Type of Roof
ill me applicant or famm,building Occupant son or handle ha>amous manorial
as dclIm d by the Cupertino Municipal Cade.Chapter 9.12.and to Health and Safety
Cole,Schon 255320)?
❑Yrs )LINu(((``` All roofs shall be inspected prior to any roofing material being installed.
-
Will to applicant or fu\lure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
itair caroti. anti ha'rardnus o Jefncd by Lou Bay Area Air Quality Management all new materials for inspection.
uicr7
C3 Yet,
No
I haw nod!fie mammas mamdals requirements under Chaptar6.95ofdeCalifor-
maHan"Satiety Cade,Sections 25505,7593 and 25534.1 mommtsed tmifte building
does not currently have a nrent,out it is my muPandbuity in nadry the Occupant of de
nquirenc which muss mel 'r issuance.(.Ccmfeam.f� puny.
"/' Signature of Applicant Date
ow araam eat Dan All roof coverings to be Class"B"or better