08010071 CITY OF CUPERTINOt° ��y* ��`'
BUILDING DIVISION PERNUT �C0NTRACT0'R INI+'O,RD'SATIONR
PERMIT NO.
BUILT8aVPb-UDY AVE OCCIDENTAL EXPRESS 08010071
OWNER'S NAME: '- PERMIT ISSUE DATE
STEPHEN CHEW 1019 HOWARD ST 03/06/2008
E. SANITARY NO. CONTROL N0.
(510) 676-7718
ARCHFIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
op LICENSED CONTRACTORS DECLARATION lob Description
FF I hN
emby affirm et 1 am licensed under provisions or Clupter 9(earmarking!za with Section 7")of Division3uftheBusinessandProfessionsCode.mdmyacenmu ADD 488 SQ BDRM,BATHRM & KTCHN,RE—ROOF(14
�y in full forte and effect
,qz— License Class Lie.8 SQ) INCLDED SANITARY IS SUNNYVALE' S JURISDICTION.
rpt Dan: Gnmese or
7W ARCIBIECI'S DECLARATION
< I understand my plans shall he used as public Memo
'yU
LL LjCenaCJ PN(Ce]Ianal
ty3
OWNER-BUILDER
mptfr DECLARATION
ContrON
C C I Mrcso alum Nal 1 1. ,Bumps from the Contractor's o IJecnm Taw for IW
pO following reason.(Section construct.
n1.5,Busier. and ve.dem l Com:Any city ormunry
which rtqujrcs a permit on ennsthe alter,nn prove,demolW,m repair any sbucterc
!zy prior..licensdpur omgo the Provislicant for smhpcmitro fila a,Us, ststmnmt
(but the uliecnmd pumuamroNe provisions of Nc Conummr'e t5mnm law(CNptm9 Sq.Ft. Floor Area Valuation
?F� (camencing with Section 7")o(Division 3 of the Business and Prefewdrns Com) �148�00
m
51 Nat he is exempt thcmfram and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
out mom than an hundred dollars(55003 �
3 7 510 0 0 2 N
❑Lobe wa and
property.o my ainsyea withwagsu Nevml.mm.Buri n,
and dalbcwons and Nc he Com bnotimeMW aortduce, askapply Ed an
areas Required Inspections
Proand arty who
Cade:The Contrsemfs Licenseilm law does rot apply m ut owner of q p
Own eny whe W ilds provided
Oatuh i mn,and who danouchwart himudfar duough hu
awn employcu,p ingor i Nat such mimpmvemmts art not intended mralfemd for oak.if.
however.ll Wilding orimProvemmtismid within al MM
mmpkdam the amof
builder wiB have Ila Wrden of proWng But K did rot Wild o improve for pagms of
ala.).
1,m awmr ar the property.am conclusively...CEkE.z with licensed connonms m _
construct the project(Sec.7014,Business and Professions Code:)The Cmtracwh U. '
canoe law daa not apply man owner orprapeny who Wilds or improtat themon.rod.
whoeoowcts for such projects withs emuanar(s)licensed pursant m Ik Canlractori
License Law.
❑Ice simpr under See .B d P C far this reason
r k G._r Date 4
gra q& 'S COMPENSATION DECIARATTON
I hereby affirm under penalty of perjury ane of the following declaroiaa:
❑I Imre and will andaudn a Certif mofCmtmnuomlRlnwrefmWalmesCmnpen-
atim,o provided far by Section 3700 of the labor Cade,far Ne pelfman.of Or
work for which this permit is jamd. -
1 have and will maintain Wortrfs Compensation Insurance,u required by Second
3700 of du Label Code,far Nc pm(omanm of Ne work fa which Nu permit is amed
My w.,sces Campematian lnmmce camia and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSADON INSURANCE
(Bas Mabon reed not M completed if the Permit Is forms hmchcd damn(Sim)
or th.)
I certify Not in the perfomanco of Inc.,it far which Nir permit a named,l shall not
employ any pawn in any mw mbemnm subject m the Workets'Compensation
Laws of Caliromia.Doc_
Applicant
NOTICE TO APPLICANT:If,after m 'ng this Cattiness:of Exemption,you should
become subject m the Worlect s Compmallan provisions of Nc lab..Code.you man
.J O forNwitn comply with men provisions or Nu permit shall W dmnud mated.
'Z CONSTRUCDON LENDING AGENCY
i hereby afTim Nat them is a construction landing agemy far the urfomasue of
D: >
the wurk for which this permit is issued(Sec.3097.Civ.C)
yQ Iandch Nork
z Tanciefs Address
U C) 1 certify Nat 1 have mad Nis application and sum Nat the aWve iNommma a
Ct. P comet.I agree to comply with all city and county ordinances and sum laws relating uE
O U building construction.and hereby amhorim repreamotives of this city m enter upon Or
a above-mentioned progeny for inspccum purposes.
(We)agree to can.indemnity and kmP hamlets the City of Cupertino againn
.F' N liabilities,jWgmcnY•Coco and c.,.which may in my waymErmagsiatmidCity
U Z in coaequmee of the grmung or Nu pemit Date
o/ �G
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR REGULATIONS.
Cy� 61ok' Re-roofs
Signmurgo liceami le
HAZA
HAL3ADOUDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne a Cuptct or future building mempane.Chapter
narem hmdh h ealdoa d Safety
u defined by the Cupertino Municipal Cak.Oupter 9.12.amt tW HaIN and Safely
site.Section 25532(x7 All roofs shall be inspected prior to any roofing material being installed.
C]You No
Will the applies..ar r are Wildin occupant use equipment or device witch If a roof is installed without first obtaining an inspection,I agree to remove
mil ba aa uminan Nnair ccaas deo by the Bay Area Air Quality Management all new materials for inspection.
Dimin7
❑Yes
1 ban mad the hazardous mamrialsrequircmom under Chapter6.95 oftneCalifor-
nix Health&SainyOode,Sccuuv25505.25533 am125534.I umlcrstmd thmi(Nc Wilding
does act currently hate a tenant Nat it Is my responsibility N Only tate acoPmt Of the
rc�.eata wniah mat memet�iaamm car I Certificate of Mey Signature of Applicant Date
owner ter aamarrzm stmt / f All roof coverings to be Class "B" or better