06030071 CITY,OF CUPERTINO �'• >'^ ^�' �''" �"'
BUILDING DIVISION PERMIT C�NT.RA-CQR INFO,;ILMA"CTON .
BUILDING ADDRESS: PERMIT N0.06030071
10726 LINDA VISTA DR
NER'S NAME: - PERMrr ISSUEDATa
WILLIAM CHAN4 26 2006
NE: SANITARY NO. CONTROL NO.
ARCHTIECT/ENGINBER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MFLH
LICENSED CONTRACTOR'S DECLARATION Job Description heW
1 hereby aBlrm t 1 am lianeed under pmm visioArchaism (mm
mcesing
+'1
with Section 7000)of DW
lvon 3afthe Business asmd Professions Code,and my Reagan u in full force And erteca ADDITION 308 ' –BEDROOM & FULL BATH
LicenseClass Connector ADD LIGHTS & SMOKE DETECTOR HARDWARE
q Dam ARCHITECTS
f7W ARmailW=it
� I undrnunJ my plan!a1Wl W sed u public rtmrdf
a Licensed Pmfovion.l
OWNER-BUILDER DECLARATION
aC i hereby!(Sem that 11. exempt form P1 Gomrsela o License Taw for the
O O following reason.(Saito 703 1.5,Business and sae.da ors Coda:My oily m ceu en
3$ which requires n permit re eaves the alma Mpmw,de permit
t ore a3ir any anumure
prior m its Wvapursuante,also W the the applicant o for such)actor's ice se Law(Chas em
<
that he is Ikcnntd pursuant m the provisions of Na Contractor's Ll:Fmse law(Chapmr 9 Sq.Ft.Floor Area VaID 616 0 2 5
9 (commencing with Sudan lDBD)of Division 3 of the Businas and Pmfection,Cook)or
— dw he u aaempt Ib urtnum and the India for the alleged evmpdan.My violadon of
Saxon 7031.5 by cry applicant for a permit subjects the APPlleant An a civil PevhY ofpp/Y�,7�r5��1�1mber Occupancy Type
am mom dun five bundmd dollars(3500). 3 5 O V 6 u 19 . 0 0
❑Las ower of tiie pospmty,Or my=plays"with wages As deb sale compensation,
will profession,
ndc,The ConvookimeMWaraRetdWi apply
t1,Bager of [y � a nS ections
aM property
who
Cade'The Cagpunce, adman Law dam aal him! lf rt PYgh is �1, �I® P
manenYwbes.pr000,LmPmvv thueogaedwW M hasiteneL Mmsalandfor for is h1. i 1(Alr*-3\t\l
ownanplay Wilding
Nm sohimpmwmanuinant intended ofoaraQemd far manse.
bows rr.One Wilding wake of ement,sand within one Yen of mprove in,the manse.
Wilder will have Jane W rden of)saving dot W did sat hdW m improve for purpose of
ole.,.
}}pp I,a owner of the Property,.Business si nd comratlins with:)TheC ce menses i- t
Fvmet the Project(Sec.As An wnOfand Professiray mean Cade)The Commences Li-
cave law dov..(apply m is owner of Property who Wilds ra Impmsn therm.,and
wbeemLarefor suchpmjecuwithacantralor(OlipaandpvrmuetmmheConvacmh
0 lam Law.
❑lam vempt undy Sec BBPC for this moan
ne. 171M - _ ('� —Dacey 060
WORKER'S COMPENSATION DECLARATION
1 hereby same under penalty of pmjury,ago of the fallowing decla d=
Thaw and will malnWnaCeNficem of Covanlmanlf-imurt(or Workar's Campers
union,as provided for by Section 37M of site Labor Code,foo,the performance of de
wort for which this permit is intend.
❑1 hoe and will mainam Workers Compensation Inmwten,an enquired by Section
37W often labor Code,fm the performance of the work for which this permit is Wand.
My Worker's Compensation msurince artier and Policy number w:
Cartier. Posey No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE r
(This sada.gad nothe completed If the permit uforam hundred Wflars($I00)
or kat)
I certify shot In the performance of thus work for which this Permit is in"I shall nm
employ any person in any manncrmum o e��ttblL'�tccIJo the WasiuWCompemation
Laws of CalifomWi � ��+�t�-•
Appnunt Appy/ •1—
NGfICE TO APn the :t'AfterCom making this Certificate of m Exemption,aboC you sham
bccane subject y the Workm'g Compensation permit
provisions of the labor Cade,you nue
'JQ forthwith comply with dais pmv(siam Or this permit lhallbe dcomW invoked.
Z y CONS'T'RUCTION LENDING AGENCY
l:+ thereby affirm shin dem u a construction sanding agency ran the performance of
iY. the work fm which this permit is issued(Seo.3097,Civ.C.)
WM Q Lenders Name
7 z Lenders Add.
U0 1 certify that I Mw read this AppliWion and mm thin the&bete inflammation h
U, !" "rem I agme to comply with all city and county onlinances and me lam relating in
O LSJ^ building construction,and hereby submire rtprvenusivv ort is city as enter upon the
W shove-an,out ned property for inspection purposes.
0. (We)Agree to an.indemnify and lost,harmless the City of Cupertino agaimt
W fiabilidetludgmenu.eosuandexpenor which may in anywsyaccaeslciMssiiCity
U Z in eonsequanm of the grsnting of this PmmiL /L
m•^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.P01N Issued by: Date
SOURCE RE (tLATIONS//
d2� �— (. D�i�/� Re-roofs
Si uceo AppliarwComrMar base
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Aga applicant or future building acupar uman or lamok hareem aulantild
as defined by the Cupertino Municipal Cade.Chapmr 9.12.and the Health and Safety
tale,section 25532(,)1Alt roofs shall be inspected prior to any roofing material being installed.
[3 yes 1pNo
Will tie applicant or forum building Occupant use equipment m Jovkv which If a roof is installed without first obtaining an inspection,I agree to remove
emit hayao,dnv air conuminants As donned by the Bay Ams Air Quality Management all new materials for inspection.
District?
oym ON.
I ban mW the herardaus maerWsraquirm enn undcrChape ti.95 ofthe fabler.
nuHulthkSafety Code.Swdom25%5.25533md25534.lunden dUtaifum Wilding
docs sat cmrentiy hew a mnant,shat it u my mupnmibility m notify the occuMnt of the
mq�uisrc/mcnswhichmutthe tpdarusWaanceof,cen;rcateofOra Signature of Applicant Date
own"cr ororvad.enta~ � � All roof coverings to be Class"B"or better