05060182 CITY OF CUPERTINO
BUILDING DIVISIONPl;t
RMI"P CON=TItACTnRINFORM�ATd 0
BUILDING ADDRESS: K & M DEVELOPMENT INC PERMIT NO.05060182
OWNER'S NAME: PEILMEIESUEDATE
RAYMOND LIU 1060 FST HILL CT 09/02/2005
E: SANITARY NO, CONTROL NO.
(408) 253-9787
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
E00 LICENSED CONTRACTORS DECLARATION I Job Description
U U1 hcmby affirm Nal I am limned under provisions of Chapter 9(commencing P
widt Section 7")of Division 3 of ac Business and Professions Code,and my license is
;;� iard[If amaeff ¢jN//-1 SFDWL-2 STORY (2090 ! -LIV. )
Liccnm r Lic.p
Fn Date connector -✓ GARAGE-458 '
ARCHITECTS DECLCRA ION .a✓G
¢< I undcrsund my plans aha d As podlis mmrds
;yU
�� LiceMKaesiesta
OWNER. IL �RDECLARA ION
.�<I 1 hereby affirm that l am exec t from the Cn car's License Law for the
-C 0 following reason.(Section 703 LS,Burin .ssiuns Cole:Any city or county
K m i which requires a permit to corturuct.eller,improve,demolish.or mp.ir any ahactare
u-m prior to its Issuance,also requins the applicant for such permit to rile aligned statement
=s0 that he pursuant
is licensed to the prons visioof We Contractor's LicenseLAW(Chapter 9 Sq.Ft, Floor Area Val$' 016200
yl- (commencing with Section 7000)of Division 3 of We B usinev and Professions Code)or
A,
$ Nat he u exempt therefrom and the basis for We alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects We applicant to a civil penalty of APN Number OType
not mem man 0).raw hundred dollars(550 - Occupancy Y YP
❑Lasowner
work.meproperty,a my employees with wages rmic(Sce. (AA.B miner
35716128 . 00
will do Ne work and dm swaumid not trendedc Law do sante(Sec.loan,owner
of
and Professions Code:The Conductors License law does not apply ff an mugh of Required Inspections
property,who buildsvided Oat suchicon,and who Amsauch work himulf offered
his
own employees,provided pr suchimprovementswitsamnot ear of or completion.
for Late.If,
however,the building or improvement is sold within one year of completion,the ro
builder will have the burden of proving Nat he did nm build or improv for purposeom of of
sale.).
1,As owner of the property.am exclusively contracting with licensed contractors in
construct the project(Sec.7064,Business and Professions Cade:)The Contractors Li-
mom Law does not apply to an owner of pmmny who builds or improves thereon,and
who contracts for such projects with a contractor(a)licensed pursuant to the Condacmra
Limem Law.
❑ 1 am exempt under Sec. B&P C for a reason
Owner Date
'40 1WORKER'S COMP SATION DECLARATION
I hereby am.under penalty of perjury one of the following deerature.:
❑ Ihxveand will maintain a CenlBmre of Consent to self-insumfor WorkersCompen-
sation,ss provided fm by Section 3700 of Be Labor Com,for the performance of the
work for which this Pcnnit is issued.
O 1 have and will maintain Worker's Compensation Irmuunm,As mquimd by Section
3700 of the Labor Code,for the performance of We work for which ads permit is issued.
My Worker's Compensation Insurance carrier and Policy numher am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mos section card not bcromplemd it the permit is fmone hundred dollars(510(0
or less.)
I ccmfv Oat in ac performance of the work for which this permit is issued.1 shall not
c.rarm ny person in any..tiesaazmbe ygib (She Workcri Compensation
Laws of California.Da¢
A%1ann
NOTICE TO A ,a _ is Ccaifca¢of Exemption,you should
become subject axi
w Nd Worker's oro nron provisions of We tabor Cade,you must
.,Z foMwlth comply with such provisions or cis Permit shall be deemed awaked.
Z OCONSfRUCfION LENDING AGENCY
F+� Ihembyaliirm cat cert isaco.,arm kndingagccay for dre perfofmanm of
z trm work fur which this permit Is aimed(Scc.3097,Civ.C.)
la1 Q Lender.Name
7 Z Lender's Addri
U C) 1 certify an I have read Unix application end stale cat the above information is
14, f coral.1 agree to comply with all city and county ordinances and stare laws relating to
0 building construction,and hereby ardurimrepresentativ¢s of Bis city to enter upon Unc
F y .hove-mentioned progeny for inspection purposes
(We)agree to save,indemnify and kale harmless the City of Cupertino against
y liabilities,judgments.costs and expenses which may in any way ethane against mid City
U in coasequcom of We gaming of this Permit. G
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (-2 -O 'r
SOURCE REGULATIONS.
12
7 Re-roofs
H C ROOD IAIS DISCLOSURE ata Type of Roof
Will the applicamor utu ildin ctiparturrecrhandlehanAous mnmrol
As dcfincd by We Cupmino M nicipal C ,Chapter 9.12,and We Health and Safety
Calc.cetion 25532(.)1
Yea All roofs shall be inspected prior to any roofing material being installed.
Will Bic applicant or fund building occupant tau equipment or dcviw which If a roof is installed without first obtaining an inspection,I agree to remove
-,cit havardoua air contaminants ss dcfincd by We Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes Po
I have bead the h.rdoo,a ials requimancnu underchap,r 6.95 of Bie Calder.
.is Health&SafetyCodc.Section,25505.25533 and 25534.1 understand 0.1 if Be Wilding
does not currently have a¢nano Oat it u my responsibility An notify tiv ecedpant of the
requarri which mu prior In issuance of•Cemfieaa ejaculatory. Signature Of Applicant Date
owne < rag „p All roof coverings to be Class"B"or better q/