04080229 CrfY OF CUPERTINO
BUILDING DIVISION PERMIT CONTERACTOR�INFORMATION
BUILDING ADDRESS: PERMIT Ng.4
082 HUNTERSTON PL
OWNER'S NAME: PERMIT ISSUE DATE
.111111111s, WEI-GRAN HSU 10/12/2004
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
iso LICENSED COPTRACTOR'S DECLARATION O O O
U P 1 hereby arum that I am licensed made,provisions or Chamer 9(commencing Job Description
=N
with Section 7("B of Division 3 Orri,Beca,sa and Promaxions Carl and my license is
m son rmce a.ne«er. REMODEL/ADD 490 SQ. FT. (LIVING ROOM)
p DIA? License Class Li,.N
n=o Dam N.varur
�C ARCHITECTS DECLARATION
y a,V 1 understand my plans shall be used as public records /
a. b" Licensed Pmfcssional j
mpg OWNER-BUILDER DECLARATION
a,a— 1 hereby affifm that 1 am exempt from dm Contractor's License Law for the
a n o Billnwing reason.(Scrim.703 1.5,Business and Pmfasinns Code:Any coy or county
1.mwhich requires a Permit to construct,alter,improve,demolish,or repair any svucwm $7 0 0 0 0
.`Z` priono its issuance.also requires the applicant forsuchpermit to lilcasignedentemenl
Valuation
.o that heisficensedromanDothe povism^s Of the Contractor's La
sLicens, w(Chapter9 Sq. Ft. Floor Area
,P$ (commencing with Seninn 70)0)al Division Sof the B usineaa and Profasimaa Code)or
w.3 Nat he is exempt thcafrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by may applica^Ifor ape.it subjects the applies.(I.a civil pc.air,of bC ccu anC O -Type
Omore than five hundred dollars(S51% Occupancy YP
❑ I,az owner of the property,or my employees with wages az their sole compensa(ion,
will do the work,and the eouctme is not intended or offered for sale(Sec.70,44,Business
and Pmm,taimus Code:The Cmhmacmr's License Law does not apply to an owner of Required Inspections
property who builds or Impoves thereon,and who does such work himself Of hrough his
n employees,provided that such improvements are not intended or offered for ass.If.
however.Ne building or improvement is sold within one year of coo fiction.the owner-
huiHer will have the burden of roving that he did not build Or improve for purpose of
salve.).
pd t,as awar, f,he property,am exclusively contracting with licensed contractors to
outsmart he project(Sec.7(M4,Business and professions Cade:)The Conuacter's Li.
cost Law docs not apply to an owner of property who builds or improves Ihemun,and
who contracts for such projects i(haconractor(s)licensed pursuanuothe C^nraror's
Llccnse Law.
❑lam eamft un Se ,Bk PC phis mazon
Owner Date
KE COMPENSATION DECLARATION
I hereby affifm under Penalty of Perjury one of the following decimations:
it have and will nuinwin a Campeau of Conseil(sot sclr-insure for Worker's Cumpen.
sa,ion,as provided for by Section 37M Of the labor Cole,for the performance of the
sok for which(his permit is issued.
I have and will maintain Worker's Compensation Insurance,az required by Section
3700 of the Libor Code,for Ne performance Of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier Policy NO.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This soon need not tecomplemd Bum Permit is form¢hundred dollars fS100)
nr lass)
1 sonify(.hat in the Irerrmmance of the work for which this permit is Issued.1 shall not
cntpiny any person in any manner sit as m becmmc Subject o(be Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.o,,making this Cant lieme of Eaemprion,you should
became suhjcr to the Worker's Compwroa im provisions or the Labor Code,you mus(
�Q ronhwi th comply with such provisions or this farm i i shall be deemed revoked.. ..
Z�
CONS'rRUC ION LENDING AGENCY
I hereby affirm Nat Ne re is a construction lendi ng agency Ior the performance of
a the work for which this permit is issued(Sec.3W7,Civ.C.)
fi3 Q Lender's Name
a Leader's Address
az
U 1 ecnify that 1 have read this application and sum that fire above information is
ly ,� cored.I agree to comply with all city and county ordinances and sum laws relating to
building eonamurion and hereby au(horiveo ceinm(ives(if this cit
C:)U pr y(aenter upon the
j a ahmc(We)amedare in arysave for inspection emipurposes.
(We)agree m save,ind sonify and kith harmless the y act of Cupertino against
f' liabilities,judgmcn¢,eosts an xpcnacs which may in any way seethe against said City
U in copse pence Of ,gran-rte [this Permit.
^ APPLI NT DER 'AN S AND WILL COMPLY WITH ALL 'ON-POINT Issued by: Da
SOURC TI N
Re-roofs
amara
p ser Dam
IIA'I OUS MATERIALS DISCLOS Type of Roof
Will the applicant ser lure building aeupam surto ser hanJlc harallous material
as defncd by the Cumnina Municipal Code,Chapter 9.12,and the Health and Safely
Code.Section 25532(a)"
E]Yea la< All roofs shall be inspected prior to any roofing material being installed.
Will the, scan(or future building If a roof is installed without first obtaining an inspection,I agree to remove
pp g Occupant y A ea Air
of devices which g
i(harardnus air Contaminants as dclincJ by the Bay Arca Air Quality Management all new materials for inspection.
blrict?
E]Yea ®1q
I have readthc hO diode serials requirements under Chapter 6.95 o(dm Cali for
ria Hcalih65Z,C ,)trod
drcscgms irngu ts 5505.25533nd25534.1undcrsudthlfthchuilding
currently ate 0! ditisynespmmilityn
Signature of Applicant
DateIwh Gmuc �
OF-
94,r
ser,d6hdi age All roof coverings to be Class "B"or better