06020145 CITY'OF CUPERTINO
BUILDING DIVISION PERMITC0 rjUCT0RB.�I�1VI. ,';URMAT„Id
BUILDING ADDRESS: ALL SEASONS REMODELING PEaMITND.06020145
10410 IMPERIAL AV
NEWS NAME: PERMIT ISSUE DATE
CHAMPION & CINDY CHEN 219 DEMPSEY RD - 02/24/2006
ONE: SANITARY NO. CONTROL NO.
(408) 946-4744
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLO
30� LICENSED CONfRAMIUSDECLARATION Job Description
I hominy aHim that 1 am licensed under provim.of Chapter 9(mmnme.i.g
with Scmdon Talo)of Division 3 of the Busi.s,and Professions Cade.and my license,u Post n, T'—
nzOfinfull farnand effm Lleg PATIO ENCLOUSRE //0232 '' W//ELECT.
L7 Z Lieenu Clue d e( `las( ?
3
Dam 1 �TSDE7or Ga yE
ARCHITECTS DECLARATION
' 1 understand my plans shell he used u public meards q/ cep
50 LicensedProf,ssianal t a�> 2006
py OWNER-BUILDER DECLARATION
4 i I hcmhy aRrm that 1 em exempt from ft Contractors License Law for the �� �: 1,
COO following mason.(Section 7(D I!,Business and ProfeWom;Cade:Any city or county [[ (7 tp $49733
$ which requires a permit Or convect.alter,improve,demolish.m structure try scture J)l i f) ,• ff i7�
prior to its issuance.also requires the applicant for such permit to rile a signed statementSq.Ft.Floor Aida7— esu •�
< ave W u licensed pursuant m Ne,provisions of the Committees Lice.Law(Clupmr9 Valuation
zC8 (commencing with SOdon 7000)of Division 3 of the Business and Prnfnsaiom Cado)on
3 that he is exempt tMaefram and du:basis fa the alleged exemption.My violation of
nodi dome Non five any
narcplicti , IS=.
erit subjects the applicant m a civil penalty of r Occupancy Type
0 1,u owner of the pmpmy.or,my employ.with cages as their auto compenandon,
will do the work.and the srucrom is act Intendedoruacred for tee(SM.70th,Buircas Required Inspections
and Prof.iom
as Code:The Concurs Llmue . m Law dnot apply an owner W q P
property w ho bui I da or im proves thereon,and who doeauch work himself or through his
Own employ..provided doo mch ImProvemenu are net mended croRered for,title IL
boxamm.the building or improvement is sold within am year of complo ion,the owner
builder will ban the burden of proving that he did out Wild or improve for purpose or
ate.).
0 1.u Owner of the property am exclusively contracting with licensed conraron to
consumer the Project(Sec.7040,Business and Profession Code:)The Cou mutces Li-
coma law does not apply to an owner of propeny.who Wilda or improves thereon,and,
who contracts fee such projects with a contracu (l)fiwued pummu to the Contseux's
License Law.
O l am exempt under See .B At P C for this rescue,
ser Date
W ORKPR'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury can of the following aeclanrhmu:
1 Mvc end will maintain aCmi0neof ConscmmselGiaum Tor Workeea Compose
nation.u provided for by Section 37M of the Labor Code.for the pmfonnsnce of Ne
mark for which this permit is hand.
0 l have and will maintain Worker's Compensation Insurance,as mt ired by Section
3700 of the labor Cade,for the performance of the work for which this permit u Issued.
My Werkees Compensation Insurance carrier and Policy number am: '
timer. 1r.� f�Wa Policy No.:,M- 1-00/p
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Data section need not be completed If due permit Is forono hundmddollan(SI00)
or less)
I canify that in the,perfarmaen of the,work for which this permit is lamed,I tall not
employ any person in any manner an as to because subject Or the WorkcW Compensation
Law,of California.Dae
Applicant
NOTICE TO APPLICANT:IL after making this Cenhficatc of Exemption,you should
became subject to the Workeri Compensation provisions of elm Labor Code.you mum
vJO forthwith nmplywuh such provisions or thupermir dol W doomed revoked.'�y rNn CONSTRUCTION LENDING AGENCY
[.. 1 hereby am.tet them la a nnswedon ending agency for the porfumomm of
Gv the murk for which ria permit is issued(Sec.3097,Co.C.)
GQ Lanese,Name
7 Z Lender',Address
V O 1 cenhfy,dust 1 have read this application and state that the aWve infomudw u
r+ correct,I agme In comply with all city and county ordinances and auto laws relating to
O SIJ Wildingconstruction,and hereby autoriu mParmsenutly of this city m enur upon due,
W move-mentioned pmpeny for hnspection purposes
(We) S.m ave,,indemnify and keep harmless the City of Cupcnino agaimt
rA Iubilitia.judgmuu,cenM ts aeapenxce,which may in any way seem,Maim said Cit
1113 rmit.
V 4
APPLICANT UNDERSfANDSomfing Of tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z- 7-5-r0 2
souR EcuLpno 4m - ,6
�fY� Re-roofs
Sigridurt ofAPPllunmC nu,cmr - Date,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant tom or handle haamon,material
as defined by Oe Cupertino Municipal Code,Chapter 9.12,and to Health and Safety
sen,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
0Yes 217�u
Will the,applicant or future building Occupant me equipment or devices,which If a roof is installed without first obtaining an inspection,I agree to remove
emit h lAmOm,air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Distrier7
0Yes $Tiro
[have
mad the hmar.ms materials requirements underCMper A95of the 0difor,
cola Heal"SafetyCo ic.Sedum 2350.5.25333 a 125534.1 moseruond that lithe Wilding
does rot currently have•mnu4 that It u my mspomibility m notify,the occupant of the
requi c which or manceuilcenifaaearOccuumy. Signature of Applicant Date
vin All roof coverings to be Class"B"or better
wooer or authorised sgon ate