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04040193 CITY OF CUPERTINO - BUII DING DIVISION PERMIT 6CONTRAgTOR INPa©RMATIO i uari , P,.. BUIGIINSGN AVE LDINGADDRESS: PERMITNO. YQM CONSTRUCTION 04040193 N R' AM : - PERMIT ISSUE DATE -- E:PRN WANG 51:56 PRIBISOR AaE SANITARY OL NO. 2S7 '-�ra/? AR151-0) 661 CHITEC iENGINEER: BUILDING PERMIT INFO ` / BLDG ELECT PLUMB MECH LOp LICENSED CONTRACTOR'S DECLARATION fF"� U Ihereby affirm that lam liniment under provisions of Chapter 9(mmmencing _ - -. lob Deseriplion'r. - withSection7glU)ofDivision]ofd¢Bus3neu end Pmfessinu Code.and mYlicenx is d-Gt{�il' 1 R in full tote,and cffnt. 4 p M� License Clu� a Lie.a �'-3// SFDWL (1998 'LIVING SPACE) - -�- - -- - _ ro Data �`/ �coSDEWCr �ARAGE 434 SQ'. FT. qq_ ARCNI'IELTS DE LLA ATIO -' 1 tanJ my plans shall M used as politic records -- - .. Z/ •' ` ?0 LLa I Licensed Pmr O 0� 3 OWNER-BUILDER DECLARATION <22 1 hereby affirm Nat 1 am exempt four the Contractor's License Law for the p a following mason.(Second 7031.5.Business and Pro fessions Code:Any City or Money H'.m which form.a puna,w cfrowct.alar,improve,dcmnfuh,pr repair any structure '� yr prior in its issuance.also roquma the applicant forinch permit a File a signed statement < that he is licensed pursuant mthe previsions of the Common's Liccnu law(Chapter Sq.Ft. Floor Area - Va�uatlQpo O0 ad (commeacing with Section 7")of Division 3 ofthe Business and Professinvs Code)or l`c�j Uta ` that ha is ex,mpt Hetero.and the basis fm die allegeA exemption.Any violation of Section 7031.5 by any applicant for a permit subjects arc apPluml to a civil penalty of - APN Number - .. Occupancy Type . not more Nan five hundred dollars($500). ❑I,as esvner of tie psopmy,or my employers with wage u tkir sale compewoon, 37527006 . QO _ will do the work,and she motion,is not intended or offered for sale(See.7044,BusiM.. and Profession Code:The Contracto's License Law does not apply to an owner of Required Inspections propeny who buildsorimproves stations,andwhodoessuch work himselforNmugh his - ownemployee,provided Natwchimprovemnuartnotinwm oroff r formate If. however.Ne building or improvement is sold within one year of completion.hammer. builder will have One burden of proving that he did not build or improve for puryoe of _ sal..). ❑h is Owner of the prop,ny,am uclusively contracting with licensed contractors in contract the project(Sec.7W4,Business and Professions Cade:)no Contncar's Li- came law does not apply to an owner of,ampety who builds or improve thereon.and who nntracm for such projects with a contr icar(s)licensed pursuant to the Contractor's License law. I am exempt under Sec. - .B&P C for this reason Owhor Data WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury m¢of the following declarations: ..7[3]11.fthC have and will maintain a Catarina,of Convent to elf-insure far Worker's Comped-n,as provided for by Seem.37W of the laor Code,for the performance of the for which this permit is issued. have and will maintain Worker's Compmmoon Insurance.u reuired by Seems LaborCode,for the performance ofNe wort for which Nis permit is issued. Workek a Compcnsetfon Insurance Cartier end Policy number art: CERTIFICATEOFEXEMPTIOlOrInROMWORK& COMPENSATION INSURANCE anis section need not tecomplcred ifshe permit is for one hundred dollies(SIM) _ or Ito.) I,entry that in the Performance of the work for which this permit is issued.l shall not employ any person in any manner w m in become subject to the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Ccdifcate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must - ., foMwith comply with such provisions or this Permit shall be deemed revoked. - zo CONSTRUCTION LENDING AGENCY t-.H 1 hereby affa m that them is a construction lending agency[of the performance of CL 7 one work for which this permit is issued(Sec.3097,Civ.C.) LT.1 Iandcls Namc fY Lenders Address - - -- - Uz 1 Cetif Nat 1 have read this application d sea that Ne above infmotaiun is O Y an -�'"- Correct.I agree to comply wish all city and county ordinances and state laws rolating to pU building construction.and hereby amhodm mprearnallives of this city to mar upon the r W above-mentinncd property for inspcnion purposes. 04 —_\ E•' (We)agree to taw.indemnify and keep harmless Ne City Of CUNT0.0 against CL Liabilities.judgments,costs and expenses which may in any way amu,against wad City U Z APPCANTCof the Standing Of UNDERSTANDSt his Miami. LAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGO TIONS. Re-roofs Signature of App1,CmjEm_or Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar!inure building occupant store or handle hitarom s rommai a defined by the Cuper ino Municipal Code.Chapter 9.11.and the Health and Safety Code, yes �Nu 15533(4)? DAll roofs shall be inspected prior to any roofing material being installed. Yet 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 \ ..thanolous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. istrict? ❑Yes QNo 1 have mail the havaniouss materials requirements under Chapar6.95 of the Califor- niaHcalth&Safety Cads,Sections 25505.25533 and 15534.1 understand thatifthc Wilding dins not tunemty have a tenant Nu itis my re sonsibility a notify far daupam of the myu'rt ats.K.Ch he met poor to issuance or a Ccouliche of OCcapashey Signature ofApplicant Date der pr anmpfi> apem�_ Daft All roof coverings to be Class"B"or better