05070041 CITY OF CUPERTINO '� "- w
BUILDING DIVISIONPERMIT Cd)NTRACTOR INFORMATION
BUILDING ADDRESS: MARK CUNHA' S PAVING PEPM'r"005070041
10110 LEBANON
ERS NAME: PERMIT ISSUE DATE
ANDREW KO 2491 OTTAWA WA 07/29/2005
PHONE:
SANITARY NO. CONTROL NO.
(408) 866-0945
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT
t� PLUMB MECH
�n O D O
�Oo LICENSED CONTRACTOR'S DECLARATION s�
mF 1 hereby affirm Nat I am licensed under provisions of Chapter 9(commencing NR �b0}/es❑}npUonq, yqq
�Zty with Section 70DO)of Division Sof do Bananas and Professima Code,md my license is 9r'ri � s�
in full force and effect. DEMO (E) HOUSE
��Z Limnos Clan Like.N
=Fp Dalc Contractor
FFoy ARCHITEDEC
CTS LARATION
K� I undcrsunJ my plans shall he used as Public rtcnMs
J a U
o�, fI p yyy✓✓✓yyy���r��,
s Licensed Professional d p
S OWNER-BUILDER DECLARATION L Y■NfLow
lS I hereby afrom Wal 1 oro exempt fru.the Cah Lice
nuaetonse Law future
coo following reman.(Section 7(n 1.5.Business and Pafcssiors Cale:Any city or county
y Y. which re,dims a permit to eMSWc4 alter.impmK,demolish,or repair my structure $6400
_Z6 prior to its issumee.also requires the applicant(orsuch permit to file asigmdstarement
War he is licensed pursuant n the provisions of the Contractors Liccasc Law(Chapter 9 Sq. Ft. Floor Area Valuation
Y1-3 (commencing with Section 7000)of Division 3 of the Business and Pmfessiom Code)or
E R_ that M ta exampt therefrom and the basis for We alleged exemption.Any violation of
Semon 7031.5 by any applicanr for a permit subjects the applicant to a civil penalty Of ep Occupancy Type
nor mon than five hundred della.(5500).
0 h as owner of the pmpcay,or my employees with wages as Weir sole compensation,
will do the work,and Be,swore is not intended or offered for sale(Sm.7014,Business
and Professions Code:The ConuactoYs Electric law dos not apply to an owner of Required Inspections
Property who builds or imgoves themen.and who does such work himself or through his
Own employers,provided ars such improvements are not intended or offered forsale.IL
haven,the building or improvement is sold within one year of completion,the owner-
builder will have We burden of proving that he did not build or improve for purpose of
sale.).
L as ower of the property,am exclusively convening with Iians al contractors to
....I the project(Sec.7044,Business and Professions Cade:)The Contractor's W-
eems law does not apply w an owner of property who Wilds or improves thenen,and.
who contracts for such projects with a contractor(s)licensed pursuant in the Contractor's
License Law.
❑1oro caste t under Sec. .B&PC for this noon
oeW K O Dan � 0
lip WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the following declarations:
1 ham and will maintain a Cerni of Consent to self-insure for Workets Compcm
titian,as provided for by Section 3700 of and labor Code,fm the pcRonmana of de
.6 for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as squired by Section
37W of the Libor Code,for We performance of We work for which this permit is issued.
My Wmked Compensation Insuance carter and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not On completed If the permit is for one hundred dollars(SIM)
or tess.)
1 ani(y than in the performance of rhe work for which this permit is issued,l shall am
employanyperxontnanymeamrsass xuV UmrheWorked Conixamor
Laws mf califomia.Dan
Applicant M n
NOTICE '0 APP CANT:If.after makin Nis Ccniricate of Exemption,you shuuW -
become subject in are worker's Compensation provisions of On tabor Code,you most
J O forthwith comply with such provisions or this permit shall he doemed revoked.
Z' " CONSRIJUSON LENDING AGENCY
[—i I hereby affirm that Were is a construction lending agemy for On performance of
x the work fur'which Wu permit is issued(Sec.3M,Civ.C.)
Lander'.Name ,
= z lender's Address
U Q 1 certify that 1 have mad this application and sate that We abwe information is
ly F-' Goren.1 agree to comply with all city and county a divan es and suite laws relating to
U building construction.and hereby amhorin mprexnutives of this city to enter upon are
C alarm mentioned property for impecdon punned,
(We)agree to ma,indemnify and keep harmless the City of Cupertino again
Ff/j Ilaniides,Judgments,costs and expenses which may in any way&a=against mid City
U z NNAPPLICAu- RSTADS ortAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC G TIONS.
Re-roofs
Si...'a. fA,pIicmVC.mrxctor Dan '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will But,applicant or future building occupant store or handle ha tedous material
as dclined by Jn Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
a,Section 25532W7 - All roofs shall be inspected prior to any roofing material being installed.
❑Yes �(tu. '
Will the applicant or ftuun building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
DisViet?
❑Yes No
1 have mad the hazardous manri.1,re,mmcnuumocr Chapter6.95ofJn Calitoo-
nix Rtut kSafmy Cgqgqc,Secants 25505,25533aa125534.1undersand Watifine building
docanmrcuneWJ (kennanr,arae it is my napomihilitynnotily the mcupanwf the
myotome musthe metpnorw issuance nfaCcmncatcrety/aorpancy. Signature of Applicant Date
Date All roof coverings to be Class "B"or better
� Owner or authenxO aFcm