04040199 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �iiCONTRACTQR INFORMATION
BUILDING ADDRESS: ALL SEASONS REMODELING PER MITNo04040199
859 HYDE AV
OWNER'S NAME: PERMIT ISSUE DATE
dmk FUK CHEUNG 219 DEMPS
E: SANITARY NO. CONTROL NO.
(408) 946-4744
ARCHITECrYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ipp
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm Nal l Am licensed under pro 'siou of Chapter 9(commencing
with S.ti..7IXMnaf D!visi.n3of Ne Businessm ofessima Cor andmylicenxis
nom!
in murm Anderr 2 PATIO ENCLOSURE (121 SQ. FT -� ❑2 SQFT. )
MLicense Lk.a sf*yf .� vss'L EM
M
Daley n, Contractor W/ELECTI CEL ON CONCRETE IYA IYI\\VylA aiJL'1ti\l lVls-
ARCHnECTSDtLtARAL
1 urtdel rs v my plans.hell be toed a public'
3r u, Licensed Professional JUN 7 - 2004
s'O OWNER-BUILDER DECLARATION
if I hereby affirm Nat I am exempt from the Convector's Lieenx Law for the
00 fallowing mason.(Section 7031.5,Business and Professions Code:Any city or county
K Q which Imports a Permit to construct.alter.Improve,demolish,m repair Any a
tmcLum BUILDING
v�M prior 0 its issuance.also inquires the applicant for such Permit I.file A signed suumem
=?-e Our im is licensed pursturn to the provisions of the,Conimclor's Litonac Law(Chapter 9 Sq.Ft. Floor Area Valu$QPE475
(commencing with Schon 7")of Division 3 of the Business and Professions Code)or
'� .. Nat M is exempt therefrom and the buss for the alleged assumption.My violation of
Section 7071.5 by any applicant for a permit subjects the Applicant to a civil penalty of APN Number Occupancy Type
not mal than fin hundred dollars(,Soo). 37541002 . 00
❑I.as owner of the Proprny,mmY cmPloyees with waguutimir axle compensation.
will do the work And the suuchme is not intended ar aReted for sale(Sec.7011,Business Required Inspections
And Professions Code:The Contractor. ss na
License law dol apply In An owner of q P
property,who buildsmi it..thereon,end whodoessuchwork himselfuthrough his
awn employees,provided that such improvements are not intended moRered fmsals,If.
however.the Wilding or improvement is mid within one year of completion.Ne ownmr-
Wilder will have the burden of proving that W did not build or improve far p o cam or
sale.).
❑1.AS Owner of the Property.Am uclusim,cantering with licensed rontr .to
construct the project(Sec.7001,Business and Professms,Cade:)The Contractor's Li-
SmAn law does not Apply to an owner of property who builds or improve thereon,and
who contracts for such projects with a contem, s)licensed pursuant to the Commetrr's
License Law.
I am exempt under Sec .B&PC for Nu—A
Owner Dale
WORKERS COMPENSATION DECLARATION
I hereby arRnn under Penalty of perjury au of ILA following decimations:
ham and will maintain a Certificate of Consent to self-MI.M for Workefs Compere
103113'1'01
,u provided for by Section 37M of the labor Code,for the performance of the
for which this Permit is issued.
ave and will maintain Workers Compensation Insurance,a reuired by Section
of the labor Code,for the performance of Oat wit fm which this permit is issued.
orker's Compensation�lnaunnce ceniu and P I mother am:
er.R4li�N5.:00/OLPL
CERTIFICAOfE FE%E1T/PIONFROMWORKERS'
COMPENSATION INSURANCE
(Thbxction need not beeomplemd If the Permit is fortune huedmddollars($I00)
or Ass.)
I certify Nat in the performance of the work for which this Permit is issmd.I shall not
employ any permn in any manner An AS to become subject to the WarluenCompewtion
laws Of California.DAM
Applicant
NOTICE TO APPLICANT:IL after making this CcnifioM of Exemption,yen should
become subject I.the Weakch Cw.Knawdma provisions of Ne labor Code.You must
.J O forthwith comply wit such provisions m mi
this pert shall be deemed Nuked.
Z CONSTRUCTION LENDING AGENCY
[-. 1 Wrehy affirm that them is•convroctm.Iending.,mey for the,perfo rr anco of
Ci> the work for which this permit is issued(Sec.3097,Civ.C.)
n1 Q Lcndets Name
11 Lender.Add..
U O 1 certify that I have read Wa application mi SUM that the AIMW information is
I,- M.I.1 agree to comply with all city and county ordinances and sum laws mlating to
Authi ,Wsvuction,and Wmby Imemive representatives of this city to enter upon We
r L17
above-mentioxd property for inspection P OPOAAL
(We).,me to Ann.indemnify and keep harmless the City of Cupertino against
Ft,, labilitie.judgments.costs and expense which may in Any any ami agNtatsaid City
U Z in conx, c of the granting of this permit.
^' APPLI UNDERSTAN SAN ILL COMPLY WITH ALL NON-POINT Issued by: Da
(i
OUR ER ULATIONS
` Re-roofs
gneture of Appli VC 1.01 HAZARDOUS MATERIALS DISCLOSURE D Type of Roof
Will dM applium or future Wilding occupant no.orhandlc hvndous material
AS defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ye Nu
meIf a roof is installed without firs[obtaining an inspection,I agree to remove
Will the applicant or f.,.m building up...use Aqui,mAmt or dcvi=which
I Wvardoe air contaminants u dcrined by the Bay Area Air Quality Management all new materials for inspection.
Turin?
❑Yes
1 have read the hauudm a ma¢rids mquimments under Chapter 6.95 of thc Califon
nia Hculth&Safely Code,Sections 25505,25533 and25531.1 understand tAnifdM Wilding
does not d,he.A Mn Nati y re"..1hilitym nn.1. the cup of the
to
ui to which most t oameaf.Cemficate0recou Signature of Applicant Date
Owner Or aptnarixed.sen DataAll roof coverings to be Class"B"or better