07090157 CITY OF CUPERTINO $s as sBUILDING 11 11v1s1GN - PERMIT Cm IT] .0 (1Yi IN1'+46RMt�.TION
x,., n .
PERMITNO.
BUaDTc619"Fs ENEY CREEK PL TBD - TO BE DETERMINED 07090157
OWNER'S NAME:. - - PERMIT ISSUE DAIS
LAI ERIC H AND JULIA TRUSTEE - 01/04/2008
PHONE: - SANITARY NO. CONTROL NO.
NITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
op LICENSED CONTRACTOR'S DECLARATION - - fOb D05CilptlOn
(U I hereby affirm Nal 1 are limned umkr provisions of Chapter 9(conumm ng
with Section 7000)of Division 3 of the Business sold Professions Cade,and my lkemmis ENCLOSE A BALCNY TO PRVD A CLOSET.
s in full(ores and effect
Lima.Class Liu.P
a DaM Contractor
ARCHITECTS DECLARATION
i z.�< 1 understand my plans shall he used as public meords
jos
G(n Licensed Profcssimmil
<S OWNER-BUILDERexemptDE DECLARATION
� 1 hereby affirm Not 1 1. exempt form the Contractors Co License Law for the
p O following mason.(Suction 71D 1.5,Business and Rvfcmi.0 Code:Any city or county ..
�i which requires a Permit to construct.alter,improve,demolish,or repair any anemone
prior to its ismame,also requires the applicant far such Permit to file a signed statement
Valuation
-xx< that he islbarmedpursuantI.thepre iM.mofthcCommcturSLims.Low(Chaptm9 Sq.Ft. Floor Area [•
[l•� (commencing with Section 7")of Division 3 of the Businessand Nefasinm Code)ur $10000
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by try applicant for a Permit hubjCcu the apPlicmuo a civil penalty of App��77 Number Occupancy Type
net mom than five hondmd dollars(5500). 3 4 2 4 8 0 31 .v V
Luownerof old pmpeny, emYemtramda withwagesuthe(Se.7W.Beat.
will doom work and no Contractor,Lt..
Law
apply TOH,Bu.of Required Inspections
end Professions Codc The ves tvecmrs License Law does rot apply to en owner of q p
properlywhobuildsori ithenuthimprovements
anhwho dasombwoek himalf edIlwugh hu
own employees,eba divided dot such improvements tie not ear ofc reoffered Al If.
however,the building or improvement is hath within ata year ofimproe for the ewmr-
builder will have Ota burden of proving that he did twt build or improve for purpose of
sale,).
❑1,as owner of the Portnoy,am exclusively...starting with licensed aanowaors m
c.mtnmt the project(Sec.7044,Business and Professions Code:)The Cmtrarhar•s U.
cametaw docs not apply m an owner of Property who builds or improves moment,land.
who contracts for such pmjecu with a como.ror(s)licensed porous,to the Coamamrs
License Law. /•
❑Ism exempt muff a ,B h PC for this win
Owner Due—4I—"a
W9 I ER'S COMPENSATION DECLARATION -"
I hereby affirm under penalty of perjury am of the following declaruWm:
1 have am will mninuin a Cusifim¢of Co...Ho self-insure far Workers coupon.
Me,as provided far by Section 3700 of the Labor Code.for the pnrfonaana of she
Fir for which this permit is issued.
❑I have and will maintain Workers Compensation Insursnce,as required by Seetian
3700 of the Labor Code.for the performance of the work for which this permit is issued '
My Worker's Compensation Insurance artier and Polity number are:
Carrier: Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thin section need not becompkted if the permit is foram hundecdhollars(5100)
nr less.) ..
1 cenifY that in the performance of the work for which this Permit is issued.I shall not
employanypermninany manmrso as tofT4 )f�_ be Wmkeri Camw
pedon
Laws of Califomig.� ( ( G$
Applicant J�t7�L
NOTICE '0 AP I.ICANT:If,after making this Certifeam of Escapable,le,you should
become subjecVo the Worker's Compensation provisions or the labor Coote yen moa
O forthwith comply with such provisions or this permit shall he deemed revoked. +
,Zv tr CONSTRUCTION LENDING AGENCY
F-t.�. 1 hereby affirm that there is a construction boding army for the perfomams of
athe work for which this permit is issued(Sec.3097,Civ.C.)
W 0 Lender's Name
Zl Z Lenders Address
U 0 1 certify Nu I have read Nis application and sum that Ne be.for o..me is
ry H correct.1 agree to comply with all city and county mdinsmes and sum laws mladng an
0 U building convection,and hereby authorize reprcantativcs of Nis city to enter upon the
W shove-recd i.ned p.,,,y for inspemian purposes.
fy (Wc)agree m save,indemnify and kap harmless de City of Cupertino against
to Iiabilitics.juhgments,comsend expenses which may in my way memo againslmid City
U 2 in conmgmnce of thN
ing oftld p"mit.
r•a APPLICANT UNANDS AND WILL COMPLY WITH ALL NO Issued by: Date
SOURCE
��G��Oa Re-roofs
Sigmwrc of Appl' ✓Contractor^ Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ocapentuorc orhandl.havm bore mmmial
as defend by the Cupertino Municipal Cade.Chapter 9.13.and the Ha1N wad Safety
Codc,Section 25531(a)?
Oyer ON. All roofs shall be inspected prior to any roofing material being installed.
Wilt the applicant or future building occupant use equipment or devices which 'If a roof is installed without first obtaining an inspection,,I agree to remove
mil hazardous air contaminants as defined by the Bay Area Air Quality Managmnem all new materials for inspection.
uict?
71 Yet 0 N
I havemad thehma c)usmaerialsmquimmen6umkr Chopmr6.95ofd Uifor-
nialkalth&Safety ode,$ecdom35M5.25533and25534.1und..=dNuifft building -
docs not currently aft L Na It is my mspomihility m mdfy oe oaupant a the
mquiremcnawhih at at poor loisurance of.Certificate ofSignature of Applicant Date
P o8
Q.. .,aruhfWda,rt m' All roof coverings to be Class"B"or better