06080105 CITY OF CUPERTINO t a•+ ��' /'W = �' "¢ '°"` `' cr
BUILDING DIVISION PERMIT kCIC1iRAC 'C/I2 TNkjUt.MATIUI , 4'
BUILDING ADDRESS: LARRY FU PERMITNO.0 6 0 H 010 5
11(
0731 JOHNSON
OWNER'S NAME: PERMIT ISSUEDATE
LARRY FU 06
NE: SANITARY NO. CONTROL NO.
ARCHI7ECTfENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION - IOI)DOSCTIpUOn
1 hereby affirm that 1 w licensed umks pmvislons of Chapter 9(mmmeming
with Section 70(X)of Division 3 of the Business and Professions Code,and my license is
i N in full force Andeffea DEMO GARAGE-REMODEL .GARAGE BEYOND ORIGINAL
'9--q o:muc°"' c maannr SCOPE OF WORK
7 ARCHITECT'S DECLARATION
A
WI understand my pit shall he stud u public rmmda / /
)dD
'u� LicermdPmfcssianal 2
OWNER-BUILDER DECLARATION e.G
i 0 1 hereby aRm on i am exempt from Um COntacnces License city
O for the
pO following ounce, emits 71Dstru B,alua. andrme,demolish.
Co de:Any dty ar roomy (J
%$
which requirenpermit recaresthealaebnprove,hermitt ore a sig any aunurt
�Zs pdarm itsissuance.c,alao require thovisios of forsuchpcfmi'ncile UW(Chapter
that he is licensed pursuant to Nc provisions o(Ihe Contractor's Liana fAw(CTapter9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Protest Code)or $12000
5. that he it exempt therafrem and the basis for the alkgnd wo mption.Any violadon of
Section 7031.5 by sly applicant fear a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not move man five hundred dollars($500).
❑Lasmarmof Neprepeny.or myunpioycea with wage uNe'v sok compemUon,
will do the work and the structure s nmtiumded or offered Waste(Sm.7044.Business Required Inspections
and Pmfessiom Code:The Commences License Law docs ant apply to owner of q P
properly who builda m improve thereon,and who does such work himsalf or through his
ownemployea,provided don such Improvemenu art net Intended aroffered for gab.If.
however,the building or improvement is sold within can year of completion.the owner.
Witter will have Um burden of proving that he did not Wild Or improve for purpose of
anic�).
tt]I,As owner of the prepeny,am aclusively contracting with licensed contramors an
construct Use project(See 7094,Business and Profoundness Code:)The Contractor's U.
terve dew dee not apply to an owner of property,who builds or improve Nemon.and,
who cones for such projects with a conceactorts)licensed pursuant mdse COntrmmes
License Law.
❑lam exempt a/9der Sec. B&P C for Ni moon
adg�weer GL�i._—s�--9
Data �f� .
WORKERS COMPENS ON ECLARATION
1 hereby afftm under penalty of perjury nes of The following declarations.
LJ 1 have And will maintain a Cersifsata of Consent to self-Ieum for Workers Compete-
nation,M provided for by Section 3700 of the Labor Code.for that performance of the
work for which this permit is Issued.
❑1 ban and will maintain Wohees Compensation Insurance,u required by Section
370D of Ne labor Code,for The performance of the work for which this permit is issued.
My WOrkees Compensation Issuance carrier and Polity number me:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(Thin shim hand notaccomplemd If the permit is(Drone hundred dollars(SIM)
or less.)
1 amity,that in the perfommncc of the work for which this permit is issued,l thall not
employ anyperson in my man bject to the Workeri Compereadm
Laws of Califo ice. ato
Applicant 9_Yru _
NOTICE TO APPUCA .IL a( r making this Certificate of Eaemptim,you should
became subject An the Wortees Compensation provisions of the labor Code,yen most
.,O forthwith comply with such provisions or this Permit atoll ne dmmnd molted.
z0 CONSTRUCTION LENDING AGENCY
F+ I bunchy afOrm that Vert is a com uction kndingapercy for the performance of
a> the work for which this mmtit is issued(Sec.3097,Civ.C.)
Q LeMces Name
Z)z Lenders Address
U O 1 certify that I have read this application and state Nu the above information Is
D.P cones I agree m comply with all city and county o umanco and stm laws relating in
0 building conmmction,and hereby authonte representative O(this city to enter upon the
[i1 above-meniuned property for inspection purposes.
0.
We)agree to eve,indemnify and keep bamlau the City of Cupertino against
rHr rA liabilities.judgments,toss and expense which may in any way warm against aid City
U z, in consequma of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURP REGULA70NS. "n��/
� &4i_1Re-roofs
S' um of ApplicatutOgfuncebor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicmt or future building occupant smre or handle hunNous maters)
All de0ned by the Cupertino Municipal Cade,Chapter 9.11.and the Health and Safety
COde.Section 25531()7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya t +u
Will the applicant or future building acupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit Incautious air contaminants As de0ded by the Bay Arta Air Quality Management all new materials for inspection.
Din ncR `
❑Ya No
I have mad the function,materials requiremcns under Chapter 6.95 of the Califon
nil Health&Safety Code,Sections 25505.15533 am125534.1 understand that if do building
dao not currently have•tenant,Nat it s my responsibility On notify flat occupant of Ne
be a swIt hmus hcmelprut miscue ren CeniR zer Oce
�� o / Signature of Applicant Date
L raumadP<duem Dae 0 All roof coverings to be Class"B"or better