05070021CITY OF CUPERTINO-
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BUILDING DIVISION PERMIT
,�CdNTRAC'�TaOR=INORMATIdN
`HOOPER
BUILDING ADDRESS:
R J CONSTRUCTION
PERMIT NO. 05070021
10090 PASADENA
NAME:
PERMIT ISSUE DATE
CHRISTINE CHANG
996 MINNESOTA AVE 4002
11 10411200c;
PR'S
NE:
SANITARY NO. CONTROL NO.
(408)298-2994
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
.
Job Description
1 hereby alliin that 1 an lisnxd under Ptevuims of Chapter 9 (commencing
p
wiNS.e .70W)a w on3oftheE.ncssai frsnmu Cade•aM myliccnxu
nbIforceime((
CONVERT ATTIC TO LOFT (1821) &
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Uee,a.e Lk.N L,
Da¢ G Contractor
DECLARATION
ADD 2 WINDOWS
ARCHITECTS
1 understand my plans shall be uwd as public rtemds
Licensed oriel
OWNER -BUILDER DECLARATION
1 hereby adirm Nal 1 am cacmpl from the Conumm Law for the
hereby
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FIis � ®
Cods::Any
following mason. (Section 70J I.S. Bus'.... and Rofeasiom Cade: Any city ar county
m,
which mgmins a permit to coati alter, improw, demollsh, or raw toy slruetum
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prior m its iuuance. aim requima the applicant for such permit to file a signed statement
Nal he is licensed pursuant to the provisions of the Contractor's LJccme Law (Chapter 9
Sq. Ft. Floor Area fg At 1OQ6
Valua$idiS 000
(commencing with Section 7") of Division 1af the Buchims am PrOfusios Code) Or
Nat he u exempt Ncmfmm and tic basis for the alleged evmplion. Any violation of
5�ap.,N Nun: 6r qj ' kt V '+} eF
3D 005
qr Occupancy Type
rd
Section 7031.5 by any applicant for a permit subjects the appllcanuo a civil penally of
rot morn than fiw hundred dollars (M).
❑I.asawneroft pmpmy.ormYmnployeuwiNma udsirmlccompeumon,
/1%08CJ1 k A'y
)vac",-fo i+ It --/if
1!
Required Inspections
will da the work and Neswetom k notinxndcd oroRwd forsaen (See.7W. Business
and Professions Cade: The conmcaors Urea=x Law risen rot apply to an owner of
property wW Wildsmimgows thmmn. and whodoessuchwart himselfmthrough his
own employees, provided that inch impromimenu are not intended oroBerm for.sale. If.
however. the building or improwmem u told within aro year of mmplcdm. the Owner -
builder win haw the bones of proving Nat he did ml build m impmw for prison, of
tok.).
❑ 1, u owner Of the pmpenY• am eacduively contracting with licensed contramors m
mutmm the project (Sec. 7W. Busmen adi Pretensions Cont The Conuacmrs U.
cc= law does not apply m an owner of property who Wilds or improws them.. and
who contracts for such project/ with a CamYmrs) licensed puramin to Ne Comment's
IXenx Law.
I am naampl under See . B & P C for this mown
Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury nae of the following dcclarWons:
1 hart and will msimai. aCertifimteof Cmuent to self -hour fm Workers COmpeo-
cation, u provided for by Scedon 3700 of the Labor Coda. for On perfman. of the
work for which this permit is Issued.
❑ I haw and will maintain Workers Compensation I., u required by Section
37M.f On labs Coo, fm On performance ofthe work for which this permit is iuuad.
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My Worke s C .pen Once In umnec ca ec and Policy number am
Cartier. / PolkyN".:q�(J�7 I
CERTIFICATE Ol' E7EMPIION FRO W RKERM C S'
COMPENSATION INSURANCE
,
(lTumnien need rot W completed If t e permit u fame humboddaBars (SIM)
nr loss)
1 mnify Nat in tW pmform. of the wart for which this pe.I, u banned. I shall not
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cmpd.y any person in any mannerw u to became subject to Ne WmM Compeauadan
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making Nu Certificate of Esemptian, yon should
become Subject be tW Workers Compensation provision of Ne Labor Cmc, yam or"
forthwith comply with catch pmviai.m n Nin permit shall be deemed rewind.
LENDINGAGENCY
I hereby of iren Nat them u a comerectian lending agency for the performance of
On work for which this permit is issecd (see. 3097. Civ. C.)
Lenders Name
Lenders Add.
T cmtify Nat I have lead this application am nuke Nat the aWw, information u
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cortecL I agree to comply with all city am county Ordinances, and suis laws misting to
Wild' tiOn. and hereby auNnice mP.M1dvu of this city to enter upon the
e-menlioat pCrlY for inspection pmfpaaea.
(We) agree to w. iadc y trop hamtky the City of Cupertino against
rtabihiu.jmgmcnu,c used peau iehm In anywayameme, agaitutsaid City
60
incontons
"AN
APPL CANT"UNDEg SANDing L PLY LL NON -POINT
Issued by: Date
SOUR REG NS.
Re -roofs
SignmurtplioDataHAZARDOAznRDous MATERIALSt
osuE
Type of Roof
Will the applicant mrMuni Wilding core
vacor handle anmaterial
az defined by dm Cupertino Municipal Cmc Oupter 9.13. and the Health and Safety
n. Chapter Health
Section25531(x)7 _ /
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
Will the applicant or fumm in occupant tax equipment or devices which
emit hazardous air mnuminants rind by the Bay Area Air Quality Management
Divriet7
s No
all new materials for inspection.
Ihawm the ardhps materia4mquimmmesundcrChapw6.95ofOteCalifor-
0 Health&Sof ty fide, Se u25f 5,25533 am 25 dons dons the Wilding
d net cu dy awn¢ pWt u my mapawhility to mtif the pmtnr
on, Who maµ 11 fl if tato...( (:emOcate N
r"'1 A"'� y�
Signature of Applicant Date
Owner or amhamed agentI ,to
_ All roof coverings to be Class "B" or better