08090013 CITY OF CUPERTINO 'x-�
BUILDING DIVISION PERMIT ,kCONTRACTORANFOIt1bIAtTION '
BUILDING ADDRESS: PERMIT NO.
11535 MURANO CIR AMERICAN BRANDS CONSTRUCTIO 08090013
NER'S NAME: PERMIT L4iUE DATE
PERRY LUO 1029 BLOSSOM HILL RD STE 3 09/24/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
ADD PATIO COVR ENCLSED ON III= OELECT
PO MECH
O
go o LICENSED CONfRAC ORS DECLARATION
U
C I literary affirm Wt 1 am lion d under provisions of Chapter 9(commencing lob Description
with Section 70M ofDivisian]ofdo Rucimsr and Pmfessioru code,and my license is
Is in fanm an
ford errecV
j%R- Luenam Clan Lu.
n s,� Dau Canuaaar
q A Hr1ECTSDECLA 1 N
WU I understand my plans stW I x used ss Public records
a O In Licensed Professional -
3 OWNER-BUILDER DECLARATION
�E 1 hereby aRrra Nat 1 sen tempt from the Camnnors License law for the
D O following mason.(Section 7f13Id,Business and Rvfutiom Cade:Any city or county
S$F which inquires a Permit m construct.Aur,improve,demnluh,or inPan any strumme
prior to its issuance,also,mquies the applicant for such permit to file a signed suumeal
-t< that he is licensed pursuant totrc provisions of the Com.cmrs Limns,Lao,(Chapter 9 Sq.Ft. Floor Area Valuation
Y�3 (commencing with Section 7000)of Division 3 of the Busi•e.•era Pour mm Coca)or
r3.. that he is exempt therefrom and the haste fm the alleged uunption.Any violation of
Section 7031.5 by any applicant for a permit mbjccu the applicant to a civil penalty of APN Number Occupancy
col mart dun ane fere hummed dollars(M). P Y Type
❑I.as owner of the property,or my employees with wage a their sok confrontation,
will do the wad,and me suuttum ta an(Marmot or offered for aide(Sco.7014.Business
and Prorassimts Code:The Chrmosme,License Law doe Out apply to an owner of Required Inspections
property who Wilds orimproves Neuron,andwho doessuchwork himselfor through his
own employee.provided th usech improvements am not intended Or offered forsale If.
however.me Wilding or improvement is cold within oast your of completion.the owmu-
builder will have the Widen of proving that W did not Wild or improve far purpose of
sale.).
❑1.ss owner of the property,am exelusively contracting with licensed contractors in
construct me project(Sec.7W.Buse.and Profesimu Cade:)The Co moncmrs t.4
tense law doe oat apply man awns of proton who Wilds or improve;liberation,ead.
who contracts fu such pojeces with a conwcmr(s)licensed postal in me Conuacmrs
Lien.law.
❑Imn emnpt undo Sec ,B&PC fm mannas'
knot,
u Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Pendry of perjury arts of the following decimation:
❑Ihs+e and willmidnuinaCenifiem olCortsemmsclf--imam fa Wartcrs Compere
radon,as provided for by Section 3700 of the labor Cade.far the pitf tom.of the -
work for which this permit is issued.
1 have and will maintain Workefs Compemation Insurance,as required by Section
3700 ofthe labor Code,for the performance afore wart fu which this permit is issued. '
My Workers Compensation Wed.carrier and Policy number ale: 'fes
Carrier: 12YcL V tlrLtQ✓C+-yEEliry No.: AO QS-6--75'Vb '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihusectlan coed not W camplcmd If me permit is faros,hundred matin(SIM)
or less).
1 certify mat in me performance of the work for which this Permit is issued.I that not
employ any person in any mannerso as to became mbjcot to the Workers Compmntion
taws of California.Dau
Applicant
NOTICE To APPLICANT:If,aper making this Cenificam of Exemption,you should
become subject to 0th Watch Compensation provisions of the labor Code you a"
.J z foMwith comply with such pmvisinm of this permit shall W domed revoked.
Z C7 CONSTRUCTION LENDING AGENCY
[r I hereby arfmrm that the.iaa comtrurelm.lending agency for the oftron.of
a w�. me.,it far which Thu Permit u issued(Sec.3097,Civ.C)
W 0 Landers None
z Until Address,
U C) I canify that 1 have eat this application not sum that th,aWw,ormanstiun is
Lx. Ecosset.1 ogee m comply with all city and county antitumor and sum laws elating to
O Wilding construction.and hereby aumosie representatives of this city m enter opera the
r W above-mentam ed property for inspection purposes
I,y 4 (We)again to save,indemnify and kcep harmless the City of Cup:nino against
(A liabilities,Judgments,Costs and casement which may in any way accrue agaimt said City
U Z in communicate,of the grand,of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -2
sOURf.F�GULATIQNS.
(�� J
Smgnuurcof ApplicaHAZARDmr pain Re-roofs
IIAv,RDous MATERIALS DlsaosuaE Type of Roof
Will the afePlicanl01 future Wilding occupant stale or handle hmardom material
46
defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
M.section zss3x(a>7
❑Yet No All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future Wilding oavpont tau equipment or Jerkin which If a roof is installed without first obtaining an inspection,I agree to remove
emithtT�om air contaminants m dcrincd by the Bay Asa Air Quality Management all new materials for inspection.
DistC]Y. El No
I have read the hmantwu materials mquimmen a under Chapter 6.95 of deo Califor-
niaHWtrkSalayCodeSectimu25505.25533 that 253N.l unduammd mat ifthe building
dues ant currently have a scram,mat It u my responsibility re of,one occupant of the
require hnous,Wmatpool lea afacenili rocmpine, Signature of Applicant Date
Owner or antharlved agent Dam' All roof coverings to be Class'n!i'or better