06070117 CITY OF CUPERTINO
BUILDING DIVISION PERMIT COL�iTRAC'1'QR`[PIFO.RIVIA'rI=�
BUILDING ADDRESS: TIM n LUI PERMIT N0.06070117
20960 GARDEN GATE DR
R'S NAME: PERMIT ISSUE DATE
TIM LUI
..HONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
OELECT PLO MEOCH
Op
LICENSED Ddunder
DECLARATION - Job DBSCOP000
l�iu 1 beinbY u0IC this 1 am CONTRACTOR'S
under DEC ro DECLARATION
9(comeeedeing
i< with Scene.lIXp)of Division Softhe Busammaed Poloauoro Code,And my hcenau
❑y mfull
ucons,And errtt DEMO 1 STORY HOUSE
in? Dan Ctua Lk.N IC
Dam Con7rS DECr
ARCHTIF.CTS DECLARATION y
� I understand my plain shall W used u public records
O/
e G_ Licensed Pmlctsioesl
'y� OWNEmconemDER DECLARATION
ConumON
i n Ihentity
Maso .corm that
11. exempt rrom the Cwers Code:s Lke y c Law for the
p o following rerun.(Section 1011.1 BatldeR and ve.waoro h.mrMy city or county
S$ which inquiet a permit or air a the uta,improve,h permit
t or sepur any momstatement prior lo its issuance,also inquires me applicant for such permin m tilt a signet stsmmem
that IMU licensed pursuant in that prorAshurs;of duce Comment'.Lj=.I..(Chapter 9 Sq.Ft, FloorArea Valuation
B (commencing with Section 7000)of Division Sof the Business ark Profession.,Code)or
that he u exempt nherefrom and the bub for the alleged exemption.My violation of
Section 7031.5 by any Applicant for a Permit Subjects the applicant to a civil penalty of r u u Occupancy Type
not mom dun firs hundred dollars ISM
❑1.As owner orate property,or my employcsa with wagro As chair tots campensadon,
will do the work,and the =lure Is rot intended or offered for nk(See.1094,Business Required Inspections
and Profau(ou Cade:The Cooractofs License law don set set apply m an owrcr e ns of q P
property who Wilds orimprov.Neseon.and whodoessuchworkhimselfer through his
awnempleyen,pmided thatmch improvements art hmtimended anoRered mrmle.If.
hewem.the Wilding or Improvement is mid within ane year of compledon.0e owner.
builds wild have ee burden of proving that M did int Wild or improve for purpose of
Fsok
An
I, awmer of the property.am exclusively contracting wWm
h licensed nuunom
s
FIto
the pmjm(Sec.7044,Business aM Professions Cade:)7be Coouaam's U.
ccnsa Law does not apply a an owner of property who Wilda or improves thereon.Md.
who contracts for such projects with a coma cmr(s)licensed MMW t in We CanuacmYs
License law.
❑lama pt un Sec ,BkPC rthu recon
r °I N ai�1 Doha /
v
WORKERS COMPEN ATION DECLARATION
n I hereby affirm under penally of perjury nue of the following declaration:
Q I ham and will mountain a Certificate,of Cement 1.MIN"Me for WorkelsCanpen-
sstian,ss pmvidcd for by Section 37M of the labor Code.for the performance of the
work for which this permit u issued.
❑1 haw eM will mumarm Worka9 Compensation Inmrmtm.u inquired by Scnion
3700 of t e Labor Code,for the pesfmmance of the work for which this permit is issued
My Workees Compensation I=.artier and Policy number art: ,
Canim, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU section wed tet W completed ifthe permit IS;forow hundred dellasa($I00)
less)
1 amity that in d e parormeses of tie work for which Nis permit is issued,)shat not
employ Lawsfnyp1..is. any manwrmut li 'rguag Workers'Comperadon
Lawn of California.Data
Applicant L44
NOTICE TO APPLICANT:If.after m ng u Cenffeae of emMio.,you should
become subject m me Woher's Compensation provisions of the Labor Cede,you most
,JO forthwith comply with such pmvisioro amu permitahal be dcemed invoked.
,zvy CONSTRUCTION LENDING AGENCY
,4 I hereby am.that cert ts a construction lending agency for due performance of
pv, de wish for which this permit it inwd(Sce.7091,Ci,C.)
A ISMch Nano
a z lattice Add.
U0 I certify that I have rad this application and sum that the above informal.is
U,(y' cminct.l agme to comply wim all city and county ordinanm and mha laws misting e
OU building eonsuuction,and hereby aummim xpresenxtivn of this city to enter urn[he
�LT1 show-rwm.cd property for inspection purposes.
(We)agree to save,indemnify and keep harmless de City o(Cupcnino agunsr
eF'—e cn liabilitin,judlimcnul custs and expenses which may In any way Ammo against mid City
U,z in consequence of the gelling of this permit /� //
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NQN-PORK Issued by: Date -/!f
SOURCE CRUION� O
6,ULL.,/t//l — �F/� b Re-roofs Py
Sigestm,of Applicams'C ndinscum Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
dcflZWIII the appliaw or future building aeupanutom whandlc haven ons materia
by Un Cupertino Municipal Code.Chapter 9.11.and the Heath and Safety
Sdetiw Is531()7 1,. All roofs shall be inspected prior to any roofing material being installed.
❑Yes yfh No
Will the applicant or/m`t'um Wilding occupant use equipment or device which
If a roof is installed without firs[obtaining an inspection,I agree to remove
emit luan udw,aI,conumomants see derided by the Bay Area Air Quality Management all new materials for inspection.
District?
Dy" Ir NO
I have,mad the haardour materials mquircm arm under Oupter6.95of the Califor.
nix Heal"Safety Code.Sodom 25505.25533 and 25534.1umkrnnnd thxifem Wilding ,
Jena wt c...ify how A tenant that in IS my map uddhany Is wiry Me recupant or the
myulinmentshichmus m pooreismanceof.Ceniftcamof cep Signature of Applicant Date
owderormtWmsd gal Dam' All roof coverings to be Class"B"or better
i