05110023 CITY OF CUPERTINO sF>4sab � 'wwra ` ', r-¢: z�
BUILDING DIVISION PERMIT %NTRACTOR RORMATI A
x, t'x` 1!aT?^ s.Av»," d° . 7 Y-,r",m
BUILDING ADDRESS: LYNN "CHING PERMIT NO.05110023
264 LOCKWOOD DR
OWNER'S NAME: PERMIT ISSUE DATE
LYNN CHING 01/06/2006
E: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
eLDrO ELECT O PLUMB MECH
O O
30p LICENSED CONTRACTOR'S DECLARATION lob Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing IT
with Section 71(10)of DiMalon 3of the Buse.and Pmfeasium Code.and my license is
in full force and effm REVISION-TRUESS CALL.
jp2 LlannClass Li,
Dak Contractorg NO NEW PERMIT ISSUED/ORIG. #05050152
j ARCNIIECi'S DECLAR _ATON
1 understand my plans mail he used As public mcords
G Licensed Prulmdonal
OWNER-BUILDER DECLARATION
M 1 hereby affirm that I am"craft from the Convenor's License Law far the
Z C o following won.(Section 70313.Business and Professions Code:Any City or county ,
(L which requires a permit to camaneL aha impound,demolish,a repair any armtum
—�S^A Pdmm its issuance,a)surequires theapplieant forsuch permilmfilc asignedstakment
5< That he is licensed puraammthe pmvisiomaflhe Commetais License Law(Chapter9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Profession.Code)or
dist he 4 exempt therefrom and the basis for the alleged exemption.Any vlolallon of
Session 7031.3 by any applicant far.permit subjects the applicant to a cidl penalty of APN Number Occupancy
notmmethanfiwbndreddallar.(5500). . 34214037 . 00 Type
❑I.as want of the property,or my employma with wages U they sole compensation,
will do the wad[,and the swclum is not intended or offered for sale(Sec.701,Business
and Prefesaona Code:The Condamine,Licimm Law does let apply to in owner of Required Inspections
propenywho builds or improwa thereon,andwhodoa.uch worthintsel(ortlwuglm his
own employcos,provided Out such Imprevemenu art sal immak l reoffered for tale If.
however,the building or improwment is sold within arc year of campledon.ft owner.
Wilder will law the burden of proving that k did nm build As improv fm purpose of w
ale.).
I,As owner of the property,am exclusively contracting with licensed conaacmra Is \
Lown,La the project(Sal.]041,Bualneu and HokW as Code:)The Cmtnekea U-
anowhoc!cawdatanotapplyroam with
oftracurty.whebuildsmimdtonda Cmtt orb
who contsacu for cord pmjem with a emuxmr(S)licensed pursuant b time Canuanaea
License Law. \^
[3I am eampl un et sea. ,B&P for Ice mrason v
neo Dak w
WOK SCOM SA DECLARATION
I hereby allied under penalty of perjlsy arc of one following declaruionc
I haw and will maintain a CeniOcate of Consent kselbinsure fm Worlum.Camper.
sasion,u provided for by Sation 3700 of the Labor Cade,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Laurance,a required by Section
3100 of the labor Code,fm the performance of the wart fm which this permit is issued.
My Worker's Compensation Instarsme carrier and Policy number are:
Canis Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Lillis section mked mtbe comptekd if the permit 4forme hundred&It=(5100)
or leas)
I modify that in oo performance of the wart for which Nis permit is issued,I shall nm
employ any person in any manner an u to became subject te the Workers'Cmnpensssim
Laws of California.Data
Applicant
NOTICE TO APPLICANT,IL after maklog this Ceniflcam of Eumption.you should
become Subject u,the Worle s Compensation provisions of the labor Cade,you moa
.J O foMwith comply with such provisions m this Permit Nall bN cooked
.z
do mo .
'Z�5CONSTRUCTION LENDING AGENCY
I berehy a07rm that Vert iso tonstnetlnn lending agency fro thperfurmaac of
fYr 7 the work for which this peri
QLender'.Name fs/IV 1.-- /-L
z lender's Address
U O 1 certify that I haw read this application and cute that the now informations is
C✓ co rt T agree to comply with all city and county dolmans,and sok law relating te
U building concoction.and hereby suthosim oepreSenmiwa of this city he cow upon the
[let above-mendoned progeny for inspection purposes.
Ly,pL (We)agree to saw,indcmnily and keep harmku the City of Cupertino against
Tq 146ilida.Judgmenu.cam andexpeaa which may in any way accrue against said City
U z In consequence of the grantingo this Permit �J
'-" APPLIC NT UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date of
SOURC REGULATIONS. I G O
Re-roofs G
Signaum of ppliesHAZAnclor alk
HAZARDOUS MA IAIS DISCLOSURE Type of Roof
Will the applicant or fMuni Wilding e.Owpo store or hawk IuaNaa material
sa nn.Sac a the Cupertino Municipal Cade.Chapter 9.13.and the HcalN and Safety
Code,Section 25532(x)7 1
❑res fl Na All roofs shall be inspected prior to any roofing material being installed.
!T\ If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or forum building occupant use equipment at devices which pon, g
7d=
ha'sardous Air contaminants ss defined by the Bay Ares Air Quality Management all new materials for inspection.
ict?
❑Yes No
I haw read the hummou.mamdals requirements under Chapter 6.95 of the Califor-
ealth&Safety Code,SeNme 35505,35533 And 25334,1 understand that irthe building
not curmpsiy haw a tenant,that k is my oupo rallo ily m notify the occupanl of the
lremAms which on be ktsae neem1)eak or P"7- Signature of Applicant Date
��p I i JA G
owmmarathmrodagent ionic All roof coverings to be Class"B"or better