04040176 CITY OF CUPERTINO '�' °'••� °"
BUILDING DIVISION PERMIT ,C,ONTRACTORINEU A'TIO
BUILDINGADDRESS: RICHARD SHWE PERMITNcb 4 04 0 17 6
21840 HERMOSA AV
OWNER'S NAME: PERMIT ISSUE DATE
AhL RICHARD SHWE
IPPE; SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC14
net,
LICENSED CONTRACTOR'S DECLARATION
ZJob Description
wF 1 hereby af0rm dust 1 sm licmnsNMo
u
cr provisions of Chapter 9(commmeing p
ty with tion OW)of Division 3o(thc BuLnev aM Rofrssinns Codc,and mylicc�iz
Jaz nIfull f ffen. tierr� Q � aI r�d DEMOLITION OF HOUSE
5
n f Dao: Contractor
pp ARCH SC6ptt9YION
Ky k< I undcnland my pie hall m9 nhl' rods
Da,U
C� Licensed Professional
OWNER-BUILDER DECLARATI N
1 hcrchy affirm Nal I n ss License law for Nc
o o following mason.fSZ... 31.5,evsinus and RoreW .Code:Any city or County
m which mquims a peonil to conduct, her.improve.demolish.or minor any svuou e
FZ< prior ht its inane...h.mquions Ncapplicanl for such Permit m Wzu
file a sign ¢rNm
Bad he is llcenud pursuant to the provisi...f N.Convector's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
'rn (commencing with Section 7000)of Division Sof the Buaincas and Professions Cook)or 6000
y $
dust he s exempt therefrom and the bass for the alleged exemption.Any violation of
Section 7031.5 by anyapplicam fora permit subjects On applicant o a civil penalty of APN Number Occupancy Type
not mom Nan fine hundred dollars(8500).
❑1.asawtter of rhe propeny,mmy employtns with vngssu Heir sok compensation,
will do Ne work.end Nessrvclum is not inonded Oronered for snit(Sec.]OCA,Business
and Professions Cousde:The Conone,License laoes w dnot apply to an owner of Required Inspections 7
property who builds or imprpwa Nemon,andwho doesauch work himself or through his
nemployms,pmvidcdthatsmchimp�menuamnotinkndedwoffemdfmWe.If.
hpwevcn Ne Wildog m improwmem i,roti within one yens of camPl.tion,the owner 7/
Wilder
will handle burden of proving thas he did not build or improve far purpose of
sal..). c\ IT
C]1.as owner of the property.am exclusively contracting with licensed romracws to v s
cunswcl the project(Sec,7044,Businevs and Professions Code:)The Contractors Li. \ e`
ceam Law docs not apply to an owner of Property who Wilds or improves thmon,and v
who CCOUNU for such projects with a contractor(s)licensed pureasat w the Contractors
L` nY ave.
• am eaemPt undo Sec. BkPCfordusreason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penally of perjury one of the following dedantions:
brae and will maintain a Ccrsiftcak of Consent osel6insure for Worlur sCom Na-
7c,
n,az provided for by Section 3700 of ire Labor Code.for the perform of Nc
for which this permit is issued.
have and will maintain Workers Compensation Insurance,as rapt red by Section
mf Ne tabor Cade.fn Nc performanaof the work for which Nis permit iz issued.
Wm Ione,Compensation Insurance carrier and Polity numberam:
ier. Policy No.: '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section reed trot W completed if the permit is form hundred dollars(SIM)
nr kis.)
I cert,that in On per0amascc of On work far w h Ihii Po it is issued.I shall not
employanypezm an an BgT ensure orae jectla NC Workcri Compensation
Lawsof CalifomiDi
PpImanl ��.�.
CrICE TO APPLICANT:111 ukr fine of Etemption.you should
on subject to IN Worker's fcnsalioo provisions of the labor Code,you miser
wJZ forOwilh comply wit such provisions or this permit shall W deemed mwked.
Z O CONSTRUCTION LENDING AGENCY .
LQ I hereby ichthi Net Nem is s ed(See.30 lending agency for tM perturmance of V
y the w rk for which this permit s issued strut.mt le Civ.C.) --
W tarsiers Name
=z Lender,Address
U Q 1 certify that I have mad this application and sum Nat the show information is
LL .room,I agme to comply with all city and county ordinances and sum laws misting to
0(J building construction.eto saw.
aifyandac reprnenms,tenS this ciryocmeruTaaflit
U show-amationed property for inspection purlwses
4. (We)agree to saw,indemnify and keep hay in an w City of Cupertino ed City
fA inst
liabilitiesuenec o Ban osuand.apensespermit. may in any way attroe againslssid City
CJ z APPLI ANT of UNDERSTANDS
1pg of lAFNWit. Date:ew:
^� APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULONS. /1 O
— l Q n
IJ a Re-roofs
Elgn c of Applt an omra �- Dem
HATARDOUS MATERIALS DISCLOSURE�V Type of Roof
Will Nc applicant tar(more Wilding occupant a'..or handle hvudous mascrial
sw Zinc!by the Cupertino Municipal Code.Chapter 9.12,and IN Health and Safety
colk,Section 25532(a)a �� All roofs shall be inspected prior to any roofing material being installed.
❑Y
Will the applicant or future building=upanl use equipment or devices which If a roof is installed without first obtaining an inspection,] agree to remove
I hvardous air em tsmi...a as defined by dte Bay Area Air Quality Management all new materials for inspection.
isuict7
C3 Yea 0
1hawmadthedCSC materialsrequiren255under Chapter6.95 of the Califon
ilia HcalN de SafcryCode,Sc 'ons25X15,25577 and 25534.1 understand thvirthc Wilding
dors not cane by how a¢ an Out itis my mapomihiliry o nmtily Int occupant of the
"Ulm iehanPriorIn.,vancor.c.,Z!ttleofaCyPUNY SignatureofApplicant Date
All roof coverings to be Class"B" or better
0 er or an no - Dao