06100054 CITY OF CUPERTINO a5'" z -"'`" ,aoc �"°'-" r•`'"'� -
BUILDING DIVISION PERMIT CoNTI2ACTCi12INFORMATION :
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: nnnnc PE U ATE
SZU CHEN LEE _ 396 SOUTH 'BASCOM AVE 01/02/2007
E; SANITARY NO. CONTROL NO.
(408) 977-1003
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT' PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION
i F I hereby affirm Nes 1 am lienee under provisions of Chapter Y(commencing Job Description
1<i with Section]IXIU)urDivision3of@cBusiness and Professions Code,and mylicense is REPLACING ALL WINDOWS (16) 2 OF THOSE WINDOWS
in full fare and effect.
;iqi u"ehxClazs Lm.x WILL BE CHANGED TO BAY WINDOWS
'Fp Dam Convacmr
to ARCHITECT'S DECLARATION
1 z a 1 understand my plans shall he used as public records
>yU
su.t, Licensed Professional
a0 OWNER-BUILDER DECLARATION
fo
f I hereby affirm Nal 1 am exempt from she Contractor's License Law for the
p O following mason.(Section 703 1.5,Business and Professions Code:Any city or county
m which requires a permit m c...tract.eller,improve,demolish,m repair any structure -
�¢i prior to its issuance.also requires the applicant for such permit to rile a signed statement
ss< that he is licensedpursuanttotheProvisionsOftheContractorsLiccnsclaw(Chapter9 Sq.Ft, Floor AreaValuation
Fro (commencing with Section 7000)of Division 3 of the Business and Professinns $20000
2000
`<9 than he is exempt shsmfrom and the basis for On alleged eaamptim,Any violation of
Section 7031.5 by any applicant for a Permit subjccta the applicant to a civil penalty of �,plal Number
Out Type
t more than Ave hundred dollars(5500). 3 2 6 rJ rJ 0 3 6:U CJ
I,m owner of the Property,or my employers with wages as their auto compensation,
will do the work.and the structure is not ntended or offered for sale(Sm'.7 4.Business - -Required Inspections.and Professions Cade:The Continuities License Law does not apply to an owner of - -�_.._.. ----^----'-""' q p, ----— -------- -----
propiny wba builds or imprrow"sloon,and who does.uch work himse f or through hul 1
own employees;provided thm such im us..or intended moBered for We.lf.j s��t°."":')' 1s ,-)�'� r r4' • �
however,ill have-dia e r improvemanl is sit he7dhin one tbuild of romo-ve fo,are owner l I
r builaei,wolf baveihe burden of� � Nat he aid not boob ter im ovc for�u oP - _-_- --- - - --�� . -�------- - "i-•�•. -- -'--------'-- "- --'"-""--"" -
T,ast the
epoj Uc(Sec.704,1.
unesivnd confessions Cod:iTheeacohacam's m „L ,,--- - - ..
proving --- pr P thou I..::� 1 i.
wrssuLa does not
to an Business and ProfessionsCoda:)oriapn Convenor's Li' --- I^'�:r::' @.p'r: ------ -
icense Law sou nm apply to an owner m property who builds or improves Nere^n,and. - _
who convacufor such projects wiNaconuacmr(s)Iiccnua pursuam to Nc Convenor's -
I ❑lam eaCmpty Sec. .B&PCfor Nis rcssonr ''� " --- --
,...Owner �1 1V\AM�Dale
I C WORKERS COMPENSATION DECLARATION - f A:at'l!Nt.:':J.'..•i:'.; ,
Ihereb affirm under II of one of the following declarations: I Id.�"=" ��:'' fi!\�" _
Y Penally R1u0' B - ,
I nava dna will maintain eCa n 3700 of Cm Lati wCom,'sort for Worker's m od thei
smiom ssprovided fobhy Section eONe Libor Coac,'fac Nc perfonnance of the' •1' � - $Cfii`i','d<
.:: :' work fm.wbich the prmit is issued b.._.:.:<c d F1oAcsuu;C:d:.:"4:m;9cs•ns � .. • ::
❑II tiavc iu d' ll'riaiotain Worker's Compensation Insurance,az required by section
D7jWM1he labor Cadc;far Ne performSnce bfNe wdFk for which Nis annit iiiuuedj '
✓_" My Worker's Compensation lnsunnT s.hici and Policynumber em:-""-"'--
... ,: ..... j
Cartier^: nr•c.CERTIFICA:EOF EMPTION No.:d' t
CERTIFICATE OF COMPENSATION
ON FROM WORKEASI...._...__..
COMPENSATION ItiSURANCE
_.l ednotheco lit.'•untiedRAi.or
(this section need not he court if the permit is for one hundred dollen(II0111
r flus) s . 'rzt 1 u 1 '^'. y . :••' I
1 certify that the performance of 1h permits sed I shall'out
work which chs _ -
p y )pts in any mann rtes Ih cc9Pc tub)ccuo Ne WarkcLS Compcnsavon • ;q -fir,__
a L'iwi of Cal fomesP101
NOTICE TO APP_ ANT If after making Nu Cen fcala of Eirl
crouron,you should'_
b oma suhjca to sh Workers Comps sauon pm so s'ofN Loh C da Yn mon' y,•,`l :.y ,Ft; 11�.v -r)(•., :\ _ - --- - '
�O forthwithci ply 'shs ch brov'scorid the permit shall beds dre,nkcd
rq II 3:• ' k v I ;CONSTRUCTION LENNG DIAGENCY es l
-- -- -._.
. ,_v,l m
herehYeff lhil the.is.comwuinn lend gagencY lm in.pe form race G
_-.- .. .:1's " ,�;{•� .
34 ilm work furl h eh iNi permu s usmd(Scc.1097 C C) y les 11L,
r n -- - - -
y Lender's Nam 1 L - t ' `: a i•1
1 Lcpdcrs da
Zd us - :,r ..- it
.. .: _, . .
,J 0 ""I comfy that 1 Have rtad thisiPpllcitinn'ana sure Nat the above mf.".lh n'is
o I ricagrm of comply with all city ane county ordinancesand sea lo
laws routing •
V' uilEing conswction,and herebyauthorimaprcscntativcs of Nis cosy to coat Orion N";,
W ro :mcnt aned pldpcny fonnspcetion puipoua.c r,;, 's ,,.oe3:.1i
gy A c)agme to save,mdc r ify and limitlimitharmless the City of Cupc1% ill
atmsf.
J o
Z Iribilitlebjudgmc is,e68U and expenses which may In anyway see=against said City'
throstairm.c.of the grinning of this _ -
APPLICANT)UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: ' `• Date
SOU
�`EGyy;; ATIONS
I ;V' D+
- t���. D>._._..YzI.,y i Re-roofs'
Signature of Ap ren omranor Data .;,i<I
'
1 1 - HAZARDOUS MATERIALS DISCLOSURE ": " Type of Roof •r' _._,
2 L ,--Will the pplicant orftrcb 'Ithng melomawc or handl"haeardous maariaP -- - --- ---_- - - - -- ----_ - - _ - _ .__ ,.
�! <I-
J
az&flood by IM Cuyemn2 Mun c pal Code-Chapter 9.12 a d the Health and Safety
1 C-d c:Section 25532(.)+ "ul +' I. c..f .. l;J ''t.•.••. 1,;.'1
r"'�pYeaftc Ih1�N . . .:". - I All roofs shall be inspected prior to any roofing material being installed.
i
' ' If a roof is installed without first obtaining an inspection,I agree to remove
Y Will the or Future,building ac pan)use
. equipment o deg cu,,which
i1 haciNous-,it contaminants defined by the Bay Am.Air,Qaalrly Management
dct7 all new materials for inspection.
filv - az -"r�" "'r '. t.
I c:'❑Yes' r '_iffi Nu Iri, _ : _ � .
"f l hays read the haa5ldtme maadals reyuirementa under ChaNar6.95 ordm Callfor-I
his Health&Safay Code;SmmMrr25N15.25533 and 25534.1ndersand uthmif the building
does t"uric tly ha.¢a tenant th 1 t u y icspmu h 11Y to notify the meupanl of mc'
maul t h amr,-N et pnorw ssuance fa CcmfTfu of Occup y�
rr „ ,. Signature of Applicant Date
.. ._.__.
ow a tee aumor.<a es"nt 1 + h a _ Data ,. . i,`:All-roof coverings to be Class"B''or better ,
rig-n' '•1 e ,t -:�)� r+ :�1111. :e- '�'i 47 ' N:.. _.__.. .__-__.-.._ .. . . _ .__: . _... _ ._