07120241 CITY OF CUPERTINOxx.xkp �tTr� s�5 �=
BUILDING DIVISION PERMIT ��1�:J,.{l\tl�$'? Qaw. l'��N � l%N31
BUaQ�r(T9T9'hYANNISPORT DR TBD — TO BE DETERMINED PERMIT 07120241
7WNER'S rr NAME: PERMLSSUEDATB
MRS. CHENG 02/04/2008
HONE: SANITARY NO. CONTROL NO.
ARCHITECTENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
t� 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
F 1 hush, M.That 1 am licensed under provisions I of Chapter 9(commencing P
!E3 withSecdan7nf,0)ofDivision3ofNeBusinessardProfeatiomCode,andmyIkinmeis ADD GAME ROOM
- u in full forte and effect
2 Z Limm a Class Lk.4
Date onummi
Gan
ARCHITECTS
DECLARATION
e I understood my pletu shall W used an public mcmds
ya Licensed Professional
OWNER-BUILDER DECLARATION
s� 5 I hereby affirm that I am exempt from the Canoanor's License law for the
O O following mason.(Section 11131.3,Business and Pmfesai es Code:Any city m county
$ which responses a permit to emrwuct,alter improve.demklkih,kr repair any structure _
Zi prior to its iuusame.also requires the applicant for such permit in rile a signed smement
< mat he is licensed pun uan(to me provisions(the Conuacure License Law(Chapter 9 ' Sq.Ft. Floor Area Valuation
(commencing with Section 70DD)of Division 3 of the Business and Professions Code)or - $40000
5 that he is nempt therefrom and the bash for the alleged exemption.Any vuratfon of
Session 7031,5 by any applicant for a permit subjects the applicant to a civil penity ofNumber Occas
not mom than fin hundred dollars($5=. 3 5 613 04 6 A Y',p7� Occupancy Type
❑I,as owner of the property,or my employees with wlgn as their sale mmpenaiA.
will do tlrc wart.and theswctuu is out inteMedaraBered for ask(Sm.70N,Budmsa Required Inspections
and Pmmfead us Code:The Comanes Liceum Law does rot apply to an owner of q p
Pmpem whobuildskrimproveedumkn,andwho mnauchwmkhimselrn,tiuvugh his
awn emplayen,provided i Nmsmh Improvements am not ou of mpleemA the
instate.r.
Wilder the haw
building m improvement Is veld within one Seer of mproe for the kwnu-
builder .v01 Nve Bu Wrdcn of proving that he did not Wild or Improve far purpose of
rale.).
L as mwnr of the property,am exclutively conuaang with licensed cenvacdn,s to
mihwm the project(Sec.7044.Business and ProRW an Code:)The Conuame's U.
mea law docs an,apply as sus owner of property who build,or inspmsc theuon.and
who counters for such project,with a eoowctor(s)1lmned Freedom in the Contractors
Lison law.
if mtdmee isSBkPC fm thr Date s
WO 'S PENSATION DECLARATION
I herby afrtrm under f perjury ane of the fallowing declmnion:
I ham and will maintain a CeniEcemof Consent in self-ilium fm Workers Compeo-
sake,u provided for by Section 3700 of the labor Code.for W performance of the
work for which IMA permit is issued
❑I have slid will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code.fm the performance of du work fkrwhich this permit is Issued '
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy Na.: _
CERTIFICATE OF FXEMPTON FROM WORKERS'
COMPENSATION INSURANCE
Clhissectime toed wt he cmnpleted if the permit is formic huntheddo0in($100)
or less)
I minify that in the pmfmmence of the wort for which this permit Is Whim.I thali nm
nmployary pcwq%m any mannu er as become subjeett Workers'Corepeosaon .
Lawsaf Califamm . e
Applk.1 .._
NOfI 6Akfrv-H>•Ntr cert this CenifTuc m(Exemption,you shonW
become subject u me Worker's Compere t pmvrsions mf the Latin,Codo.you mute
.J 0 forthwith comply with such provision co i emit shall be deemed revoked.
'Z vj CONSTRUCTIONL TNG AGENCY
[-n I herby afford onto men h a consumeristlending agmey far one performarun of
E
.moi the wulc for which this permit is inucd(Sec.3097,Civ.C.)
Lf] Iandeh Name
-Z Landers Address
U 1 sonify our I ham rad Ws toolmaker and mote mm me amve information is
py ;••'.
commit-1 agree m comply with all city and county ardi .^"•and sou laws relating in
.0 rV^ building comutation,and hereby maborium mp=flULIvcs of this city m enter more the
above-mentiousd property fm inspection purposes
(y
(WO)agrte to save,indemnify and lump harmless the City of Cupertino!Saint
,,IIiabllidn,judgmengcnu as expenses which may in any way acesuc against mid City
U.Z in consequence of the granting of this Permit.
.. APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2-
SOUR LAnONS.U
Re-roofs
HAZARDOUS MATERI DISCLOSURE Date Type of Roof
Will site applicant or IMum bulldinguc p tnamorlumblehrasEaosmainal
as de0nad by the Content.Municipal Code. ter 9.12,and du Health sed Safety
mk.Scaan us32(.)7
❑Yrs All roofs shall be inspected prior to any roofing material being installed.
No
WIII the applicant or umm Wilding amupant use equipment or deHcca which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnardous air emnuminarn u de0nd by the Bay Area Air Quality Management all new materials for inspection.
Dimict7
❑Yes NO
I haw read the materi 'in scmcnu under .CTapurh.95ofdu Califon
McHnl"Seety Ca M. 25505,25533 u,425534.1.Mound mu If me Wilding
wrourly Aon,s tenlnk Net it h my meponihility m mtifY do oceupenr of the
n whkhmup =Lpioruissuanmofa Ccnlrcmcaf Occupancy
—'J'S ep�7 Signature Of Applicant Date
n mems t Dam. . All roof coverings to be Class"B"or better