05060172 CITYOFCUPERTINO ` t' ft
BUILDING DIVISION PERMIT CONTRA.GTORVEOTtMATIQN "
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BUILDING ADDRESS: CUPERTINO CONSTRUCTION IN "Rm"NG'O5060172
22299 JAN
OWNER'S NAME: PERMIT ISSUE DATE
DANNY LEE 10079 SAICH WAY OR/02/9005
E, SANITARY NO. CONTROL NO.
(408) 253-9000
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO PLO MEOCH
3OC LICENSED CONTRACLOWSDECLARATION Job Description
1 lemby affirm Wt 1 am licensed under provisions of Chapter 9(commencing
with Section TOW)of DivWon 3 of Propositions Business and Propouns Code.and my license is
in tall tons and effect. ADD COVERED PORCH (11551 )
25� fxeaw chis Lk.N
Dam Conlnclm
ARCHITECTS DECLARATION
I understand my plans"I be used u public recoods
y C Licensed Pmfmainnal
OWNER-BUILDER DECLARATION
I I hereby affirm mm 1 am exempt from the Contractor's License Law for the
p o following moron.(Section 7031.5,Business and Professions Code:Any city or corny
$ which requires a permit to construct.alter..improv,demolish.or repair any structure
'
prior its issuance.aim tortillas the applicant fmauch peull to file asigncd statement
- �
G that he is licensed pursuant to the provisions of the Conaatrnri License Law(Chapter 9 Sq.Ft. Floor Area Valuation
�$ (commencing with Section 7000)of Division 3 of the Business and professions Code)or $100QO
.•
that W Is exempt enpt therefore and the buss for the alleged exemption.My violation of
Section 7031.5 by any applicant Ins a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not tome than Eft hundred dollars(5500).
❑1,anownerof Nepmpmy,mmyemploymwithmgrsudmhsole=mp on,
wllldodevro,L.dite umismtimmdednoRnmdfornm(Sm.7OM,Budmas
tib Protewana cads,The coatec ^�^^ m umes m' law doat apply to an owner of Required Inspections
property who bulldsoriulthal tMmomandwho dmauchworkhimWtodNmugh bf. FINAL
�®
awn employer,provided prover tmproftm wt alane year dedfC or offered for nm.If. L
however,the building or improvement u told within one Yw of c prove for
the owmr-
buildu will lust On WNan of proving Out he did not build m Improv fm purpose of
sa ').
1,u owner of the property,am exclusively contracting with licensed contncmns to MAY 't — 2006
c mtmet the pmlem(Sec.7094,Business and Professions Cade:)The Contractors Li.
cane law docs not apply 0 an owner of property who Wilds or Improve thereon,and
who convects far such projects wimacnnuactor(s)IiansedpunuanttotW Conuactar's �w, aa�st RB� ��
License taw. ■U■ LpV�
❑I am exempt under ,B d P C/ltar this mann
net � � Dam P- • �o
WORKERS COMPENS) ON DECLARATION
hF I hereby of our under penalty of pu jory arc of de following declantions:
I hast aM w11I maintain aCW 0mm of Covent to self-boom for Worker's Comfort-
0
sadom As provided for by Section 37M of the labor Code.for the peformana of the
work for which this permit is issued.
❑1 haft and will maintain Workers Compensation Wurnam,As required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and!Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mrs suction need rot bu complete BIW permit Is form hundmddollam(21010
or leu.)
I cenify,Not In the performance of the work for which this permit is issued,)shall not
employ any persen in my manner so u to Wmme mbjmt to tie workere Compereatiun
Laws of California.CamIP
Applicant '>'
NOTICE TO APPLICANT:IL after making thls NOmmTof Exemption.you slmutd
become subject m the Workers Compensation provisions of the labor Code.you moa
0 0 forthwith comply with such provisions or this permit shall W deemed revoked.
y^ CONSTRUCTION LENDING AGENCY
[-+ IWmby affirm that dem sea construction lerningagency for the performance of
lYi> tits work for which this permit Is ismd(Sec.3097,Civ.C.) '
QLenders Name
z Lender's Adders
t,) 1 tally that 1 have and this application and sum Nn the me ft informal.Is
F corms 1 Agnostic
ger m comply wIN all city and county oNinances end tum Iowa raising m
O V building construction,ad Wrathy mNarim representatives of Nu city m cost upon the
W a Wv-mentioned property for inspection purposes
(Ws,)Agro to oft,indemnify and keep harmless the City of Cepenimo against
wwy Iiablltficajudgmems.emu and exporters which may In my my accve agaimt said City
L)7 in consequence of the panting of this Permit.
a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date --or
SOURCEvRFATIONS. x
PC- �L - Re-roofs
Signature of pplicaMConuac Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ns,applium or future building Occupant stare or handle haurdous material
As dcOnsd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yrs fnRra
Will the applicant or future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hauNous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
iatrict7
C]Yes
I have read the heesNom materials namilaments under Chapter 6.95 of the Califer.
nit Nallh B Safety Cade,Sections 25505.25533 and 25334.I underNnN that ifthe Wilding
dm Out currently have a tenant.that it 4 my responsibility to ratify the occupant of the
requirements whit aW met prior to issuance ox Certi0case of Occupancy. Signature of Applicant Date
00_) -e'r All roof coverings to be Class"B"or better
Owner or authorixed agent Data