04050133 CITY OF CUPERTINO ""•a-T �`•' '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .,.
. ,. . ..,,.t. ,. .
BUILDING ADDRESS: ALL SEASONS REMODELING PERMIT NO
OWNER'S NAME: PERMIT ISSUE DATE
HUANG-CHEN
tlE: SANITARY N0. CONTROL NO.
(408) 946-4744
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
u0o LICENSED CONTRACTOR'S DECLARATION Job Description
e u C
]be b firm that 1 am lirenud wander pfovisions of Chapter Y(commcneing
c with See Bur Division Sof NC Bu c d Professions Cndc,antl my license isD
? = in full force derfen. PATIO ENCLOSURE (160 SQ. FT. ) If'-tj tf\\Il(%-+
License LIc.X
n�,❑ Dam CunvaCarl
qq ARCHITECTS OBCI,p$6 ON
2 1 undefa W y plans shall he used.puhli rtcnrds u U N 2 P 2004
Gyu
aH Licensed Pmlesslenal
iDa OWNER-BUILDER DECLARATION nII II�n ���t�n//.l_
.�<S 1 hereby from that 1 oro exempt from the Cnmmnor's License Law for the CUl VA a� �J 2
i c CO following mason.(Section 7131.5,Business and Professions Code:Any city m county
K y Y, which requires a permit to cnnsWcl,ri m.improve,demolish,or rtpoll any nrucmm
u—�am poorIn its issuance,also requires the applicant for such permit to BIC a signed statement
— that heislicensed pursuanunthe pmvisiortsoftheContractor'sLawnsalawlChapler9 Sq.Ft.Floor Area Valuation
X,Q (commencing with Section 7")of Division 3 of the Business and Professions Code)or
ar
i that he is exempt thcrafrom and the basis for dm alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit Subjects Ne applicant o a civil penalty of 3(31XIN3JO18 cr00 Occupancy Type
not roam Nan Ban hundred dollars Word.
❑1,uowner ofthe property,army employees with waitress theiraolecomformation,
will do the work and she sumcture is nm intended or offered forsale(Sec.70,14,Business
and Profusions Codc:The Contractor's License Law does not apply m an owner of Required Inspections
propeny who builds or improves thereon,and who does such workbimselferfl rough his
Own employcea,provided thatsuch improvements arc not intended oroffered firsale.IL
however,Ne building or improvement is sold within one year of completion,too owner
builder will have she burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
consumer the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such prejecta with a contractor(s)licensed pursuant in the Contractor's
License law.
❑1 am exempt under Sec. .B&P C for this reason
caner Dat
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury one of the fallowing declarations:
1 hove and will for b in eCCNhcem of du Labor
farerrorma ce of the
vwakf r hick this
for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by station
37W of the Labor Code,far the performance of the work for which Nis permit is issued.
My rkers Comparison.on,nsu ce carrom and Policy number are:
Caqt Policy o. 'QU
CERTIFICATEOF E%EMPI'10 R MWORKERS'
COMPENSATION, U ANCE
rfM1issemion need not be complemJr nail is forma,hundred dellausti it
less.)
I cenify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to became subject to the Workerd Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Carl festa of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Codc,you must
Z forthwith comply with such previsions or this permit shall be deemed revektd.
zCONSTRUCTION LENDING AGENCY
[rte ,hereby affirm that there is a Conswction lending agency for the performance of
p:> the work for which this permit is issued(Sce.3097,Civ.C.)
W Q Lender's Name
az Lender's Address
U Q 1 cenify that I have read this application and stale that the above information is
W H correct.I agree to comply with all city and county ordinances and sure laws mlming Int
OU building construction,and hereby authorim repruenlatives of this city to enter upon the
W shove-mee)agree
farinspection keep In.
gy
(We)agme to save,Inde expenses
and keep harmless w City of Cupcnsts against /�
UZ liabilities judgments,costs and ex this Farm
it, may in any wayaccmc against said City Il/
U z 'tAnPPLuyucnccof the grami ng UNDERSTAN of this Trott COMPLY WITH ALL NON-POINT Issued by: Date
SOU CE EGULATIO S,
Re-roofs
gn ofApplrc HAZA r OUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to an roofingmaterial beingInstalled.❑Yea �
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yca
I have mail the havnrears materials requirements under Chapter 6.95 of the Califer
nix Health&Safety Code,Section,25N15,25533 and 255341 understand that if the Wilding
does not avncm a mnent,drat it is my rc iM1d. In nntily Ibc osupant of dc
V ��
r,yuirem iah unbcmmprio aceni0eammr pantr. Signature of Applicant Date
ownerarauthicniola,,Of Data All roof coverings to be Class "B"or better