05030012 CITY OF CUPERTINO 77777777• 7777,
PERMIT TORINFOAM
BUILDING DIVISION
BUILDING ADDRESS: SANFORD ELECT PUmMlrNO.05030012
902 GARDEN GATE DR
ER'S NAME: PERMIT MILE DATE
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IVINCENT LIU/WESTWOOD DEVEL)P20888 PROSPECT Rn OR /01 /2009;
S: SANITARY NO. CONTROL NO.
(408) 996-9797
"ChIDECTIENCINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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00 LICENSED CONTRACTOR'S DECLARATION Job Description
I justaby airme that I ma Emoted under provislou of Chapter 9(commencing
with
ot Ed Sm,twn 3.fft intnimussm!Pradrasslow Code,and my license is
in in I
L 11 to=and affect. SFDWL-2 STORY (4056.' LIVING)
wmanChas
LI.... Lk.
qa Be,
Dow
C.Ousecto, GARAGE 6871
-ARCHnECTS DECLARATION
I understood my plans"I be used an public mcords
W Licensed Professional
OWNER-BUILDER DECLARATION
nyy I hereby aMm that I am exempt from the Conuscon's License Law for the
CoO following moon.(Section 7031.5,Business and Professions Code:My city or county
Which acquires,a permit to consumer.War,improve, howlim.Or repair my muclum
polar in its issuance,also rcquinut do applicant forsuch Permit Us Ale..itrued tawment
Nm he is licensed pursuant in the pn�isiom Of thecontracuse,License law(Chaple,9 Sq.Ft. Floor Area Val"M000
(commencing with Secure,7000)of Division 3 ofthe Business,ral Professions Code)or
that he is exempt fludefrano and the but,far the alleged exterapdon.My violumat of
Smears
by any applicant far.permit subjetth,flus applicant in a civil mostly of AIN Number Occupancy Type
our a.thater the hundred dollars(M). 32630031 . 00
[3 I..owner.felle pmpmy.err.yemployes wiLhw.ftbcote campemo.,
.illdotMwork.odthemm..i.notinmndedorafferedfortak(S=.704"4.Busiread
and pradfamoorm,Code:The Conummor's Liscame lawdoes Out apply to an Owner of Required Inspections
property who WildscOmmormatiamem,ninal whodeasmchamokhmaxelf.,through his
own employees,provided thal such Imprommems am not intended crofferad forrals.It.
howsmr,the Wilding or Improvement Is mid within as year ofoompledon,the ember-
holder will ban the hadden of proving that he did not Wild or Improve for Purpose of
names of Use property.am=elusively contracting with licutand courtaxon,In
construct we project(Sea.70 ,Busionea ad Prowsame,Code:)The
Comusetter'S U.
cum,Law does not apply 0 in Owner of property who Wilds or Improve thrown.end,
who contracts for such pat
with a contrawrods)Reacted pursuant in the Contractors
Licuse Law.
ol..camps under sm. -.B&Pc(err Nia ream
I
Owner Dow
WORKER'S COMPENSAT10N DECLARATION
I hereby affiran under penalty of perjury am of the following dedarations:
I ham and will maintain a Certificate or consent to self-Insure for Workers;Compcn.
11.as provided to,by Section 3700 of the Labor Code,far the prifixonsea or the
"Uhn
work for which this permit is Leaned.
-.1
[31 have and will maintain Workers Compensation Insurance.45 mquircul by Section
C 1
7371 of the LAW,Code,for the insformance of the work for which this permit I,wanted.
'Y'A
My Worker'.Compensation Insurmus:carrier and Policy number am:
�adrl,
Carrier_Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not N completed IfIla:permit Is forms:hundred&It=($1011)
Or has.)
I cenify that In the performance of Ran work for which this pcool,is issued,I shell not
employ any person in any mum;7e—coaaeAlut to be Worked Compensation
Laws of California.Cars
Applicant
NOTICE TOAPP g�4
.Ir.7afL+7mkMrUd,Ocrilticato of Exemption,you should
become subjca to the Worker's Computation pmIsions of the Units Code,YOU MUSU
Z forthwith comply with such prandsons or this cordit Mall he deemed ranked.
0
CONSTRUCTION LENDING AGENCY
I thereby entire that them Is a consumman lending agency for the performance,or
> the work for which this Knoll Is issued(Sec.3097.Civ.C.)
s
Lndcees Namc
Lender's Adddmu
U Q 1 certify that I loom read this application and now that the above information Is
I,. ..met.I agree in comply with all City and county ordinances and sure,[.we totaling Ur
0 building construction,and hereby mehorins represcriustins of this city in enter own the
alsove-mentioned property for Inspection purposes.
(We)agme to an.indemnify and keep hardeleas due City orCupertinoagainst
rag liabilities,judgments,cents and expermems which may In my way seeatialonsaidChy
In consequence or the treating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date CF-1,6-j-
SOURCE R:ZIULA��S
Re-roofs
Sigramomal'ApplicarrulCmuncelor ^ Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or firshe building Occupant some or handle baccutious ramurfill
as defined by the Cunartirm Municipal Code.Chapter 9.12.and the Health and Safety
am.Section,25532(m)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu e(N. If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wildirt,Occupant use equipment as dcAces which
It Juixinka. I, ortantimums as defined by ft Say Area At,Quality Misestimate' all new materials for inspection.
II
Dinner?
ot
0yes Vil.
I inum metal the huirdws�daisrequim�m&rCUper6.95 afthe CalifDr.
cut cafth&SadclyCoelo,Soctims,2550.25533 vW25534.I understand!ftirft Instant
res
Idm Out comently ban a wrann,that It is my nusponswitity to badly the accuptan,of the
req.
nequi.w::Ix�ldch�� .CL ran Ismance err.Certificate of Occupancy. Signature of Applicant Date
Owner arm W z All roof coverings to be Class"B"or better
orized agent Dam