05050152 CITY OF CUPERTINO �y : ,'P• ,wa-r.r: ,�.+n; �^ K'"`:%e ��"*I �`':t.
BUILDING DIVISION PERMIT s' CON TRACTORANEORMAT�ON
8UILDING ADDRESS: LYNN M. CHING PERMIT NO.05050152
10264 LOCKWOOD DR
all's NAME: PERMIT LSSIIB DATE
LYNN M. CHING 09/30/2005
E: SANITARY NO. CONTROLNO.
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
400 LICENSED CONTRACTOR'S DECLARATION Job Description
rd dF9� I hereby Affirm that 1 Am Ilmescd under provWons of Chapter 9(commencing
-�Gwith Sectwo TODD)of Division 3 of the Business and Professions Code,and my licenser
me
in full ToAM cffem. NEW 2-STORY SFDWL (4483 ' -LIVING)
L/en a ClestLic.8
Dare Cr GARAGE-8 3 2 '
S
u�S ARCHITERSDECLARATION
S I understand my plan shall Ise mad As public accords
56
g
Licensed Pmfesaionel
g Oat I am would
fr DECLARATION
9<q 1 moure amrm eel 1 1. exempt from the Conic nCode:Any c taw co the
0 o following acamn. arnall t 7413 Ld, t.Business and sae,damll Any oily or county
$e' which its requires;n e,em re cnnstme, silo,Improve,dcmch mrh,or e a sig any mortician,
_ZS^^ mPrior ad WI,u iuumro,elsurcq the theision soats ve oloradlilmfienseiLaw(Chned apnc^l
< (commuliamcdpunuanr in the provisions m du Comnness ruevclsw(CMplor9 Sq.Ft. Floor Area Val O
$ (commencingwie Sudan 7000)ad of basis I"
of the Business Vpikun.dl Myvilaade)m
Nat he r exempt taemrrom and the aper far be cgs the Amman to Any violation of
Semon LIMA
w my applicanlfar a m($500miuubJocts the Applicant a evil pcnsiry of A N r}y�Tkl�l7 . Occupancy Type
not more Nan five hundrtd dalrn(f300). 3 4�14 V j"� . O O
❑I.As owner of be properly,or my employees with wages u their colo compensation,
will do the work end the swncore is not intended or offered for sale(Sec.7044,Business Required Inspections
Add Proposed.Cade:The Containers LLt..Uv does not apply u e an owner of q P
propeny who builds ver improves dtamon,and who does such wort himself or decough his
ownemploym,provided we Inch Improvements Am not Intended aro@red for,sale,IL
however.the Wilding or improvement Is said within are year of completion.the owner
builder will have dm burden of proving the he did mal Wild or improve for purpose of
sale.).
1,as owner of site property.am exclusively contracting with Removed contracmn to
construct the project(Sec.7044,Bwiness and Professions Code:)The Commune,Lb
cove Law does not apply m an owner of property who Wilds or improve desmon,and
who condi for such projum wild•contraclode limned pursuant u the Contracmh
Lw also u
❑I maze plunder Se .Bd PC o�r Nqi retvyn
r Dale Ir AVM,
N RKERS C iMP 4SATTON DECLARATION
1 hemby a ren under penalty of perjury am of the following declatemes:
I have and will maintain a Cerdlicale of Consent to mlRlasure for Wmkcra Camper.
sa0on,As provided for by Section 37W of the Labor Code,fm the performance of Nc
wart for which this Pelmit is issued.
❑1 haw and will maintain Workers Compensation Insurance,As required by Sedan
3700 of the Latour Code,fm the performance of she wart for which Nis permit is issued.
My Wmi Compertsetion Ivururm emu and Policy number am:
Carrier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not bocomple¢d Ktk permit Is fmonebundreddellan(SIM)
or sass)
1 unity that In Ne performance of the.,it for whit Nie emit r issued.I NN not
cmployanrIscowninany anuersossubct i ' 4"`WorkerYCampewtion r
Laws of Celifomia.Dam
Applicant
NOTICE TO APPUCA . Lcr making this Cen r ale of Exemption,you Abould
become aobject to the Waher's ompusation provisions of the Labor Calle,you must
0 0 forthwith comply with such provisions m this Permit met W dcem el revoked.
Z y CONSTRUCTION LENDING AGENCY
(ti (botchy a I..use Nero r•eonnrecdnn undingagenry l'ar Nc perfmmencAd
rL > dm work for which this permit Is lured(Sec.3097,Civ.C.) '
fU Q Ienkes Name
Z Lenders Address
U 0 1 certify that 1 haw mad was application and sou due the above information Is
D.V comers,1 agree to comply with all city and county ordinances and mu laws admin{to
0 building construction,and hereby suthodm representatives of this city to color upon the
above-menlioncd property fm Inspection purports.
(We)agree in save,indemnify and krep harmless the City of Cupertino against
o-„y Ilabilitin,Judgments,costs And expenses which may In any way am=against aid City
V In consent cc of the granting ofyhis permit. _
APPLIC UNDERSTAND AND WILL COMPLY WITH ALL ON-PINT Issued by: Date
SOURCE EGULATIONS
�1 Re-roofs
sigwum ofAPPdavc.mncmr V Dea Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
8411 the applicant or future building occupant slam or handle hazardous matede
Ifined by tiro Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section 23533(a)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or f w Wilding occupant core equipment m devims which If a roof is installed without first obtaining an inspection,I agree to remove
hvsrdnm Air conumimnes u dcOred by the Bay Area Air Qu lity Management all new materials for inspection.
ict?
❑Yes t�7u
I saemadNehunrdnmmelorialsmquimmenuunderCNplor6.95oftheCelifnreal SarctyCmw,SudonAZ50 25533and25534.1undentsndthstifNa Wilding
rwt nandyhamaunanlthat amyrespovlMlilyunoulytheoccupantof the
arm tswichmumbe 'owissuance oracdcreauofOmu Y`� Signature of Applicant Date
Owner or 0thon agent alo All roof coverings to be Class"B"or better t:1