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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
C.T. AND NANCY• CHENG
PERMIT N006050141
1(0038 JUDY AVE
OWNER'S NAME:
PERMIT ISSUE DATE
C.T. AND NANCY CHENG
9 7 12
NE:
SANITARY NO. CONTROL 340.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=
LICENSED CONTRACTOR'S DECLARATION
lb Description
oe P
I hereby afore that I am fico d under pr e,um n¢ of Chapter 9 (commencing
with Section 7000) of DMdon Sof the Business and Professions Code. and my Immune is
InflllfOmerdaffec.
RESTORE A NON-COMPLIANT ATTACHED 2ND DWELLING B
License Class Lk. Is
Date Contractor
TO ITS ORIGINAL CONFIGURATION -COUNTY LIEN-6Mt*8
DECLARATI
ARCHITECT'S ON
recordsON
1 understood my shall he used el
CONVERTED TO LIVING SPACE -TO BE PUT BACK TO �_
plena Comic
Fr -7177//y v`-//1
Licensed Pmfcemnal
DECLARATION
OWNER
-BUILDER
1 hereby i accept from the CanuanCo License Law for Me
. (ffiromS% m 1. uta Calc: Any city car county
meson. (Smuan ] Business and Proove.
construct, aper, improve, d. tere wuctuse
which requku •permit re c
which
h permit a sig ed
Prior wits issuance. also requires the spilled For wen permit w Rk a signed
ares ft
Ft. Floor Area
Valuation
(unement
this he is licensed pursuant to the provisions of Ne Conwcwr't Liansc law (Chaper9
Sq.
(commencing with Section 7000) of Division 3 of the Business and Pnfessiau Code) or
$1000
this he k exempt therefrom and the bells for the alleged eumpdnn. Any Wolatlon of
APN Number
Occupancy Type
Section 7071.7 by arty applicant fa a permit subjects the 9pPlicrm0 a civil penalty Of
net man thr five heudred dollars ($5(107.
❑ I. u mw of tk property, m my mploym wi h mlm u dwp tole mmpe=don,
375± 00
Required Inspections
will do the wart and use Mmum is matntended oraRered fsi(Sm. 7044, Badness
and Professions Cade: It. Comarmfs L' use dm mt .pply to an owner or
q P
property who buildsmimprovexO n,sed who doessuch work himselfcar Sunugh his
own employer, provided Natueh improvements Are net tevMW araRered for sale 11.
however, the building m improvement is mid within ane year ofcompleuon, the owner-
builder will have the buNrn of proving that he did net bald or improve for purpoa of
/ e
ssleJ.
^J
I, as Owner of the property. am exclusively contracting with liceued comacton in
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sums tie project (Sec. 7044. Business and Proleeadans Cade:) The Comactofs Li•
C/
octal law does mt apply m an owner of property who builds car imp. ft.. sed,
who convects far such projects with acenumor (s) licensed pursuant to the Convector's
Liranac Law.
❑ l am "c"9�S[_ �w P C (or du. mssm
Owner 2 L� 0
WORKERS PENSATION ATION
I hereby affirm under penalty of perjury nm of use fallowing declarations
I ham and will malmin aCeNOmm of Camni m ulf-blurt fm Wmkefs Campen-
_
arum, el provided fm by sruan $700 of Se labor Code, fm W arfomana of do
weds for which this pcmit ts issmd.
0 I have aud will maintain Worker's Compensation Insuranm, as required by Section
37M of the LaborCode, for the performance of the work forwhich this permit is issued.
My Worker's Compensation lnmrwa wrier and Polity number are;
Curie. Policy No_
CERTIFICATE OF EXEMPI70N FROM WORKERS
COMPENSATION INSURANCE
rlbu=ton need not bccomplewJ lithe permit is fm ane hundnAxBars ($100)
or kis)
1 certify that in the perf per ave of the work for which this permit is Wood. I shall not
cmployanypenaninany in7rAbject w Se Workers• Compensation
Laws of California. Dam Y
Applicant t T AAs `-'- -
NOTICE TO APP .NT: I , artir makiry VIA CeNRc ec of Facmption, you should
become subject to the Worker's Compenaadon provisions of Na labor Code, you most
forthwith comply with such provisions or this permit shall be dimmed minified.
CONSTRUCTION LENDING AGENCY
1 lenity am. this alert Is. comroctlem lending agency for Se perfmmarce of
Me work fur which this permit Is Wood (Sec. 3097, Civ. Cd
'
Landers Nune
l.cndeh Addmu
1 cenary Suit I have read this applkadon aud was Sec the above )promotion U
cancer. l agree in comply with all city and county oNinuu:es and sum laws relating to
Wilding construction. and hereby authofire rep,ocntarivu of Nis City w enter upon the
snow-mcmioned p.,,Iy for inspection pu,poma
(We) agme to elve, indemnify and kap harmless the City car Cupertino ag¢inst
liabilities, judgments, eats And eapen¢u which may in toy way amus against said City
In consequence of the growing of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE NU�
�� /�
7-m0,
Re-roofs
Type of Roof
Slgnaturc orApplcanUConv.cmr
HAZARDOUS MATERIALS DISCLOSURE
Will the spplkwtor f num building aauprtaton or handle hum ous maaial
As de0ned by the Cupe tim Municipal Code. Chapter 9.11. W ole Health and Safety
Code. Section25532(an
Yu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed Without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipmentm devices which
at huamnu air cmuromms As defined by the Bay Area Air Quality Mansgmc it
all new materials for inspection.
District? /
QYes '94
1 have mad the haraNmarmou lab requirements underompwrb.95ofthe Csllram
m Hul"SalmyCodc. Secxns25505.25533 and 25534.1 understand thulfde Wilding
dm net cunemly lure • Iran. that It u my rupmrdbility w notify the oaupmt of Se
ngmnmcnts sen IDI priarmissuwaofaccrti0c. rp
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Signature of Applicant Date
All roof coverings to be Class 'B" or better
'
Owner or Authorized agent Dale