01070123 CITY UILD NG DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: _ PERMIT NO.
10130 LOCKWOOD DR HOO STEPHEN T TRUSTEE & ET AL 01070123
OWNER'S NAME APPLICA ON SU DATE
IdkHOO STEPHEN T TRUSTEE & ET A 07/25/2001
]ONE: SANITARY NO. CONTROL NO.
u0 ZO ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
iE I I I L__J L__1
LICENSED CONTRACTOR'S DECLARATION
5 Job Descn tion
Z= I hereby affirm that 1 am licen.ud under provisions of Chapter 9(commencing pp
E,; with Section 700(fi fDivisionSofthe BminessandProfessionsCode,andmyIntense ADDITION 1527 . 27 SQ.FT.
M in full force and affect.
O U Lieenu Class Li,:.0
i 3 u,y
Data Contractor
ARCHITECT'S DECLARATION
O 1 underxmnd my plans shall Be used as public records
Co
i,O O Licaned Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from to,Commaor'a License Law for the
h?< following reason.(Section 703 1.5,Business and Professions Cade:Any city or count, $149010
rcF G which requires a permit to mmmact,.Iter,improve,demolish.or repair any structure
tare;$ priomoioissuanm.alsorcquims the applicant for such permit to flea signed statement - - - ____-_
,tial ht it licinGil por'suant to thC provisions of the Contractors License Law(Chapter'
pO
(commencing with Section 7W)of Division 3 of the Business and professions Code)) .l..a.'3 L2 Y1S T.at7,V'��..Y y ;'i;' Valuation
or that be ii exempt therefiomand the basis for the alleged exemption.Any violation
of Section 7031.5 by......licant faro permi,subjects Ne applicem m a civil panalty-
ofoutmoxmanfvehundreddonarsasro). 202APNNYStSRFLOOR P UMB'ING' Occupancy Type
01,as owner of the properly,ter my employees with wages as their sole compensation,
-will do the work..and the smucmm'is a.,intended"or'offered for sale(See.7614,'
Busin...and Professions Cod,:The Con,mnor's License Law does not apply to an 502 - FINAL PBd4AEe1INI9pdZNRRGY' ' "
awn,fof properly Who builds or improves thereon and who does inch work himself 507 — FINAL PLUMBING
or through his own employees,provided that such improvements arc not intended or _—
;c WmA for isle:IL hOWCVCF.the building a aver of pro n sold Within one Wild of -" .,1 'a'
complefon.the owner-W ildcr will have the Widen of proving that he did not build or '
im�
str ownerp t .pmpeny.4th exclusBusinivelyc Peodessfions licensedcontractorsComctoato
construct the project(Sec.7104 Business and Profession Code:)The vet trecto n,
License Inw does not apply to an ,,net of property who Wilds or improves thereon,
end.who.commas for.such,
projoem.with o lmaracmr(s)licensed pomuam to.the
Conwnofs License Law. st,
°lam exempt and Sec - B&PCfor this action
Owner te ' J
-WANK-E—W9 itoMPENSATION DECLARATION
I hereby affirm under penvhy of perjury one of the following declarations:
❑ 1 have and will maintain aCertificate of Content to self insure for Worker's C01
Compensation, provided for by Section 37W of the Labor Cade, far Ne
perfornanttof'hehit
ork for Which i., sued.
01 have and will manaminWorker's CorrIentation Inxaranxce,as rt9 red by Section
3700 of the Labor Cod for the perfirituromm of Ne work forwhich this pmmm'is
issued.My Worker's Conalonoition Inamouncecandle and Policy :
irk an,t
Policy No.:
"'CERTIFICATION OF EXEMPTION FROM WORKERS' ts
,- COMPENSATION INSURANCB' t
(Th's<n on 'sed makes.mDlned if the perrmt is f or ne hummed dollars —
ISI00),or 1 ) 2 _
Ic ofyy Om n,he perf nCe of th k( hich,h pe mt'x iasuJ I
shell n, mploy any person in tiny manner so t become s bje,t the Worker
z
_ me' .. .. /u, ._ .. ..
Com tion Lew,of C I f
APP(cw
-NOTICE TO APPLICANT If,after making this Certificate of Exemption.you should
becmne b en to,tie Wok C mpensot o p nsmnx of th Luber Code,you must
C forth th comply w p I -with Such Provisions or this Permit shall be deem d revoked,
` 91 1 f x 'CONSTRUCTION LENDING AGENCY. 'r '
�. - 1 hereby (firm that them is a c ns,m t n lending gebcy foriA performance
Qb!the Work for Which this Permit is tssoed'(Sec 3097 Co. .)
Lender'.Name.. r
O.I Z Lender's Address. .. ._ . .. . .. .. .... . .. .. _- - _ ..
0 ,, Icmify thwlhava
U read this vpplicaion and slam thanhe strove in(on,imion is
correct.1 agree to Comply with,411 city and county.orgiances and mate laws relating
0 m Wilding construction;and hereby auRlimae reprcomativis of this city to enter upon
;„ W ,he above-mentioned Property for inspection purpose,.
(.a 0., (We)eine ld save,indemnify and keep harmless the City of Cupertino against
4'y liabilities,judgments,costs and expenses whichmay in any way accrue against said
V � City in consequence of the graining of this pemut. '
APPLICANT NDERSTpNDf A'0 N'ILL COMPLY WITH ALLN ,-POI
soDg�cls a. ol4s: /�f'`'� Issued by: Date
L " � L' �L Re-roofs
Signature a ,ppl canr/C t iter - .Dine '
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or fretum Wilding ace pant sters or handle haurdors material Type of Roof. _ L/ :-.!•; ,z_ z.._�.-
as clefoed by the Cupertino Municipal Code Chapter 9.12.and the Health end Safety
❑Yes t\1 El No " ,''- I All.roofs shall be inspected.prior to any roofing.material being installed.
'Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtainingan'ins ection;Ica ree'to remove
mi,hazardous sur con mminanIsas'defined by the Boy Area Air Quality Management P g
mricla all new materials for inspection. Applicant understands,and will comply with
O•" a] hon source iegulations:.
ti 1 have reed,he haamdous materials requireinnts under Chep,cr 695 of the _
Cali(am,n Health&Safety Code,Sections 25505,-25533 and 25534:1 understand That
,bebuildi agdoes not cummly have a tenant,'that it is my responsibility to notify the'Occupoat re luirementK which mum he mei Priorissuance of a Cenificam ofj,f'
x Signature of Applicant . Date
Owneeora arixmagenf - 447 ate All roof coverings to be Class "B"or better
OFFICE
t )