06040152 CITY OF CUPERTINOr
BUILDING DIVISION PERNUT
BUILDING ADDRESS: MARK CUNHA' S PAVING PERMRN0.06040152
10387 MIRA VISTA AV
aR'S NAME: PERMITISSUBDATE
MARTHA KANG 2491 OTTAWA WAY 05/18/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 866-0945
ARCHMC17ENGINEER: BLDG BUELECT PER PLUMB
MECH
;op LICENSED CONTRACTOR'S DECLARATION Job Description
1I hereby"".that
1 am licensed under provisions of Chapmr 9(commencing
+� with Section 70M)of Division 3 of the Buainm and Professions Cade.and my Ilam is
in full form and elect. �?�.1!(. SFDWL DEMO
a p z Ucene Cl L.ie.M
Dau ,(y_Comruwr
1/ ARCHRECI.3 DECLARA ION
[ undersand my plans Nall be used a public mentis
ya Licensed Pmfcummal
a OWNER-cartel RDE DECLARATION
1 hereby a1Rm an 11. exempt from the Cssion C a Ueense Law for the
p o following mason. panda t ?co mm,comment,
mars and Profession C.or Any cloy or et.. $10000
S$(V which as nus apeho recansuatplotimpmw,MmnIW.ars a sig my edu M=l
than he asname, rex WaPionsO for such permit m Rle as U.(Chlcment Valuation
IhathetalkolmN penuat to the of DipmuafWConusiness Lice=Prormiio(,Code)9 Sq.Ft.Floor Area
(co he is my with Section Md the Division r the
the Alleged
Business Md on.Any vi lagan of
e $ Nei Section
ta 31.5 b rang from and or Itata it be cts the esempaan Any violation of
not on 7 then l ve airy red dont roil Pennll Objects W applkal N a civil penally Of r Occupancy Type
not mom Nan Rw hundred dollen(5500).
D 1,as Maar of the property,a my=plays=With"tea u del,sale almpeluetion,
will do the work.mi Ne aura a Own Intended or offered far mile(Sea.704,4.Bminea Required Inspections
and Pmfadaw Cade:Thmm
e Commences License Law tis nat appy 0 a owner or q P
property who builds wimprova Nermn,and whodaassuch weak himvlfa Waugh his
Own employm,prvided Nur such Improm al are at inmrlded aaReand for axle If,
hawew,the building or improvement is mid within ons year of mmpledon.be Owner-
builder MB haw des bard"of proving that he did Out bold or impra<for impar'of
ale.).
D 1,as owlet of Ne pmpeny.as exclusively contracting with licensed mnuactors to
cansmcl the Partial.(Sec.70x4.Business and Profusions Cada:)The Commences U.
cc.Law dos not apply m a owar of property who Italian or impmmn ham.sed,
who comment for such pmjecu with a contracmr(U licensed pursuant m the Committees
License Law.
D lin exempt aria Bee .B&P C fa the recon
Dau
WORKER'S COMPENSATION DECLARATION
I hereby anise unMr Pea1ty,of perjury ane of Ne following mismomons:
D I haw and will maintain•CWOtau of Coacm an aelfdavm fa Worker'!Campn-
auim,an provided far by Sagan 3700 of W Labor Can,for W perfomlanm of W
wart for which this Permit is Inued.
D I haw and win maintain Wormer Compossmon Ircmnas,as required by Section .
3700 of the Labs COM,for the PeRamutee of rile wwrk for which this permit is Ivwd
My Worker's CampeaNa Iminna urriur ad Policy mumbo use:
Carrier.�? f"�,sr 'm J`J PolicyNO.: 1533 LO
iCHICATEOFF EMPnON FROM WORKERS'
COMPENSATION INSURANCE v
(This session and at be completed if Ile perch is form huntlrtCMlles(5100)
or Ica)
1 certify that I.the pashron a of W work for which Nb permit a ivued.I Nall nus
employ any person in any matter u an became abject as the Wartru'Campaatim
Laws of Califamia.Dau
Applicaa
NOTICE TO APPLICANT:If,after meting this Cerubate of Exemption,you should
biome subject m the Worker's Coreper adon provisions of the Later Code,you must
.70 forthwith comply with such provisions or Nu permit shall W doomed rewkca.
„zt v~y., CONSTRUCTION LENDING AGENCY
[r Ianchy ammo that Nen Is.coavuctinn lending agency far W Perfamamuf -
(Y tie weak fur which duns Permit is arced(Sec.3097.Civ.C.)
QLatices Name
c, L ruler's Address
f,Q I certify that 1 have wad his application and state that the Mmw infeamNen is
comet.I agree in comply with all city mal county ordinates and sum laws reining in
C) building construction,and hereby atharire mpresenulivea of Nis city to enter Upon[be
W shave-mentiencd property for inspection purposes.
(Wc)agree to saw.indemnify ad keep h males W City of Cupnino against
paq Itabilida.judgmmmu,cove ad expenses which may in any way same against said City
V Z in APPLIICCANr UNDERuarox of the`MSfANDS AIN WLL1 COMPLY WITH ALL NON-POINT Issued by: Date _P/jlUZ
SOURRULA77 B.
p� Re-roofs
Sign p HAZARDOUS MATERIALS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future building decupatuom at hassle hazardous material
a stRMd by the Cupertino Municipal CUM.Chapter 9.13,ad the Health ad Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Dyes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicat or furore Imidiag ommpaa use equipment a devices which
emit bastions air commetnanu a MOad by the Bay Am.Air Quality Management all new materials for inspection.
District?
DYa Nu
1 haw mad Ne hassrdaa mammals mquinmc ns under Chapter 6.95 of the Caller.
ilia Health&Surety Cast,Seems 25SD5,25533 ad 25534.1 unstmund that if tic building
des nus currently haw a tenant WI it u my mapoalhility an my W aecupat Of W
mgommcnu wt' be met prior to ivanm of a Cath of CC Signature of Applicant Date
` All roof coverings to be Class"B"or better
a
Owner or I m