05050151 CITY OF CUPERTINO �' <•w .� '^" �?
. BUILDING DIVISION PERMIT CON`TRACTOR INFORMATIO
BUILDING ADDRESS: EDWARD YU PERMITN005050151
OWNER'S NAME: PERMIT ISSUE DATE
E: 1ANITA1Y0. CONTROL NO.
ARCHMICTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 � 0
tee, LICENSED CONTRACTOR'S DECLARATION lob Description
w 1 Wmby affirm Nal 1 em liaacd under provisions of Chapter 9(commencing p
�u with Scdlon7011U)of Division Sof Nc Business and Professions Code,and myliccnx is
;
in full fere.and cfrem' fNl L qi
License Class LK.Y ADDITION 450 ' -FAMILY ROOM
^ � Date Contractor
ARCHITECTS DECLARATION
tee Iundersandmyplans shall he used as public records 2pj0v5
J y UU
0 G Licensed Professional
of
OWNER-BUILDER DECLARATION nnl r�
I I hcrehy IT,.Nm I am damps from dm Cmureclora License Law for the I *.Y
00 following mason.(Section 7031.5.Butdoess and Pmfcsninns Code:Any city er county \
3 r-.
K m_ which requires a permit car construct,a1Nr.improve,demolish,or repair any structurelvil �
u z_i Incisor its issuance,also mquifrs the applicant formch permit lofle asigned salemtnl -
<
that he is licensed fromentso the provisions of the ¢m
Conlsri se Law(Cheeriest; Sq.FL Floor Area Valu Uon
i€$ (commencing with Section 7")of Division 3 of NC Busindsand Profusions Coac)ur
.. Nal he is exempt therefrom and the bass for the alleged exemption.Any voided on of
Section 7031.5 by any applicant far a permit subjects the applieant to a civil penally of 3.i'�AT6'b+�IhGr00 Occupancy Type
or oro Nan five WMmd dally.(5500).
as owner of the pmpeny,army employed with wage as their sole compensation,
(Ili 1 do Ne work.and Ne structureis not intended or offered far sale(Sec.7W.Bulinus
and Proreasiod Cade:The contractor,License Law dons not apply m an owner of Required Inspections
property who builds or improves thereon,and who ducssuch work himselfor through his
own employed.provided Nat such improvements are nm intended m offered retail..If.
however,the building or improvement is sold within one year of comidedon,the owner.
builder will have the burden of proving than he did wt Wild ar improve for purpose of
sale J.
❑I,as owner of Ne property,am exlusively contracting with licensed contraction to
construct the project(Sec.7(144,Business and Professions Code:)The Comnemrs Li-
mrom law dors nor apply to an owner of property who Wilds or improves thereon,and
who contracts for ochpmKcssun on"clor(s)limnmdpumuammdr Convectors
License law. /
❑1 am ex. pt un er Sec. .B h C far Nis mason
Owner Deas ds
WO KEIT S COMPENSATION DECLARATION
I hereby affirm/under penalty of perjury ow,of IM following declarations:
1 ham and will maintain aCertiOcate of Consent to self-insum for Worker's Compete
station,as provided for by Section 3700 of the Labor Codc,for the performance of the
weh for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Code,for Ne Performance of the work for which this permit is issued.
My Workers Compensation Inxmece carrier and Policy number arc: '
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W complcwd Ilion fifeth is foram hundred dollars(SIM)
or Ices)
I Cerrito fact in Nc pri forma of Nc work for which Nis permit is issued,1 shall not
employ any'pc in any in ren to Wsubjcc t�yM Workr4'Compensation
Laws of Cal' rn . m Da¢ 41S
Applicant r
mommNO'nCEsubject 1 M:I.after making n pr Cisions o of Exemption,you should
forfucop to N such
ro Coons or tis provisions of the re Wr Code,you mull
.J z foMwiN comply with aucg pmviaind or this permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
E+� Ihereby alrnm that Here iso codvuctinn lending agency for the perfurmancc of
ai Ne work fur which Nis permit is issued(Sec.3(197,Civ.C.)
W Q Lender's Namc
=z lender's Add.
t)C) 1 certify that I have read this application and SUM Nat the above information is
ty correct 1 agree to comply with all city and county ordinances and suite lows totaling to
O V Wilding convection,and hereby aithorim reprrsenmives of this city to enter upon the
r� above-mentiuncd property for inspection purposes.
(Witt agent to save,indemnify and trap harmless the City of Cupertino against
fa^y liabilities.judgments,costs it txpe which may in any way acerae against said City
U z in conxqucnc f Nc gami o yrs�pa(p t. s
"" APPLICANT NATIO JAN ANP(WILL COMPLY WI. ALL NON-POINT Issued by: Date `7�
SOURCE 1rG LATI/
jr-
-s'Re-roofs +.,.
Signature of Applica DemTDaDataAZARDODOUS MATERIALS DISCLOSURE Type of Roof
Will Nee Cupertino
future ipal Coe.Chaptatomor MMIC heamous lth anmaterial
C de.Sed Section
the Cupertino Municipal Code.Chapter 9.12,and IW Health and Safety
Code.Se❑con 25532(4)? n All roofs shall be inspected prior to any roofing material being installed.
Will the appnanl or future building Occupant use equipment ormntd which If a roof is installed without first obtaining an inspection,I agree to remove
11 h00Mdh.- n+
Snti defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑ N
lots[maleria requirements under Chapter6Y5 ofdc Glifon
nice Health dns 25505 25533 and2553C,l umkrsund therif NC Wilding
dons not et Nm' s my msponsibiliry I otil'yy the rccupant of Nc
Ipriortuiatuaw,cor Cenire er tpn,ns §g All
of Applicant Date
al` aAll roof coverings to be Class"B"or better
Owner urwhori' dagenl Date
Z'