06050053CITY OF CUPE RTINO
BUILDING DIVf ION PERMA
BUILDING ADDRESS: SAM AND D IANA HU PERMIT NO' 0 6 0 5 0 0 5 3
10026 ORANGE AV
OWNER'S NAME: PERMIT ISSUE DATE
: SANITARY NO. CONTROL NO.
ARCHI7ECTIENGINEER:
la
JOO
iu
aE
'a
cLL�
So
7y
Zcoo
44m
Y"N
0z
z°
W;
1. 0
�z
UO
V. F.
O U
t'r W
►-� V1
Uz
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
rith Section 7000) of Division 3 of the Business and Professions Code, and my license is
t full force and effect.
.Icense Class Lic. 0
)ate Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
,icensed Professional
OWNER -BUILDER DECLARATION
I herchy'affiirm that 1 am exempt from the Contractors License Law for the
ollowing reason. (Section 7031.5, Business and Professions Code: Any city or county
vhich requires a permit to construct, alter, improve, demolish, or repair any structure
irior to its issuance, also requires the applicant for such permit to file a signed statement
hat he is licensed pursuant to the provisions of the Contractor's Ckcaso Law (Chapter 9
commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
hat he is exempt therefrom and the basis for the alleged exemption. Any violation of
iecion 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
tot more than five hundred dollars (S500).
] 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7D44, Business
end Professions Code The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements arc not intended or offered for sale. If,
however, the building or Improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
21. as owner of the property, am exclusively contracting with Bcensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Coouwwe3 Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exgmp4undFgSec B & P C for this reason
Date
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars (S100)
or less.)
1 certify that to the performs e f the Rork for which this permit is issued. 1 shall not
employ any person in any m nt sou be o c eet to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making th' ertifical of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihcmby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
I certify that I have read tads application and state that the above infornadon is
correct. I agree to comply with all city and County ordinances and state laws relating to
building construction. and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit
APPLICANT NDERST9'NDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE R
HAZARDOUS ATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.17. and the Health and Safety
Code, Section 25532(a)7
❑ Yes 1100
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yee n4.
HOUSE DEMO
Sq. Ft. Floor Area
umber
Issued by:
Re -roofs
Type of Roof
Job Description
Required Inspections
BUILDING PERMITINFO
ELECT PLUMB
Date
$8500
Type
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
1 have read the hamrdous materials requirements under Chaprar6.95 of the Ca)ifor-
nia Health & SafctyCode, Sections 25505.25533 and 25534.1 understand that if the building
does not cu nil ve a tenant that it is my responsibility to notify the occupant of the
require en
Signature of Applicant Date
All roof coverings to be Class "B" or better