07120117z..
a�
�z
UO
aJU
Fa
�z
CTTY OF CUPERTINO
3
f
o
tea
y
9
—
Oforthwith
h
p,� • ;'•_ F r;;3a. " wl""
BUILDING DI VISION PERMIT
TWAgQ����`^,
BUILDNggA DRESS:
PERMITNO.
�U1D21 PASADENA AVE LOT 2
TBD - TO BE DETERMINED
07120117
NER'S NAME:
PERMIT ISSUE DATE
JYAN—PING LILY CHANG
05/20/2008
ONE
SANITARY NO. CONTROL NO.
ARCHITSCrIENGINEER:
BUILDING PERMITINFO
BLDG ELER PLUMB MECH
0 � 0
LICENSED CONTRACTOR'S DECLARATION
licensed! Chapter 9
Job Description
1 botchy M. that 1 am under previsions of (commencing
with Section 7") of Divimm 3 ofthe Business and Profossiom Cod=,and my license is
NEW 2 STORY SFDW
in full force sed.fleet.
License Class Lk. a
Dan Canusnor
ARCHITECT'S DECLARATION
I undemand my Plan alWl W used u public records
-
Licensed professional -
OWNER -BUILDER DECLARATION
1 Wreby affirm that I am exempt from the Contacar's Uccna Law for the
following mason. (Section 7931.5, Business and Professions Cork: Any city or county
which requires a permit m combract, alar, impmce, demolish. m repair any ametum
prior N isimance.tlw requires de applicant for such permit to file a signed sanmrot
that W is licensed the of the Conuactori Licas Law(Chapter9
Sq. Ft. Floor Area
Valuation
pursuant provision
(commencing with Section 7000) a DiviSon 3 of the Rusnas and Pmfeaimu Codc)or
$1200(]00
that he u exempt tWrefmm and Lt. buss for the alleged exemption. Any violation of
student 701IS by My appuant fm a permit subjects on appllemt n a civil penalty of
ppw* dumber
Occupancy Type
ore seam than five hundred dollars (SM.
35717045•T.�CJ'1'L'
P Y yP
1,nownerofthepmpety,amyemploymwi0mgnudnirwkco Madan,
will do the work ants the swaue u wtknnded or oQeW forsak (S.c.ION. Business
and Pmfesslon Code The commences cense law doe at apply man owner of
Required Inspections
property who builds or improves thereon, and who does web wort himself err through his
own employee, pmHded W, such impmwmans as not intended oralle ed foraale If.
however, the building or imprewmea is mid within one year of completion, the owner -
Wilder will law the burden of proving that he did at laid or imprew for balance of
1, u Owner of the prep.", am cecluo,,aly connected, with licensed aonuaaors to
coustrtnt the pmjea (Sec. 70a, Business ad Prefeadons Code:) The Cabana's W -
cense Law does at apply m an owner of property who Wilds or improves themon, and
who conmc,s for such projects with a causco (s) licensed pursuant m the Comosomes
License law.
plan.aanp, rad c ,BRPCf Nis wan
I
ncr Dan
WORKER COMzz P SAnON DECLARATION
I hereby ar hm under pcally of perjury one of dan following dcelarWon[
❑ I ham and will maintain aCertifica a of Can ted to self-insum for Wo mos Compcn-
sakn, u provided for by Sceuon 3700 of the labor Code, forthe pato ore m n a NO
work for which this permit is Wood.
❑ 1 haw Nd will maintain Workers Compensation Insurance, u required by Semon
3700 of de labor Code. for the performarnre ofthe work for which Nu permit u issues
'
MY fth-COmpemation lecon. curie end Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPITON FROM WORKERS'
COMPENSATION INSURANCE
(This acaat need not W completed if tW permit Isforonehundred dollars ($I00)
or lai)
1 «rdfY that in the p=rfornmen of thin work for which this permit u ivued, l flan am
employ any person in any manrerw u a bm�oe amt to the WorkeY Cmnite"th n
Laws of Califomin Dan
Applicant en or
NOTICE TO ApP11��5 akin] this C 4fncan of Exemption. you should
M<omc wbject4pjpacN.1kis's Compensation pmvisnom of the Iahnr Code, you mesa
comply with such provision or this permit shall W discmed mvked.
CONSTRUCTION LENDING AGENCY
I hereby wM- the Ncrt 4. roxMMx,m n lending agency for the performance of
Nin went fur which this pami, B issued (Sec. 3097, Civ. C.)
Landers Nare
Landers Addw
I certify Out I haw mW this application and state d u Ne aWw information is
correct 1 agree to comply with all city and county ordinasu and sea laws mlating in
Wilding cawrucuoa and hereby authorise
1
representatives of this city an ennrupnn the
cny
purposi
aWw-menuoncdpx. fond
(Win) agree n use, indemnify and keep harmless the City of Cupertino against
core expenses which a
cuts, coreand Of tenerwhich may in any way acave against aid City
%V�(70
incxiueNmaxn
in consequence of the granting of this permis
APPLICANT UNDERSTANDS AyyyBBB'''WILL COMPLY WI ALL NON -POINT
SO{utCE REGIcJ�4y.T1ONS
Issued b y Date [�/ -p
11
Re -roofs
M um 911wPlinsour nuacmrI Dan
HAZARDOUssURE
Type of Roof
dl tW applicant m future Wilding atcom nt Mom mhandlc lineations; material
u defined by the Cupeanm Municipal Code. Chapter 9.13, and f Health ad Safety
.Section2ss33(a)7
❑Yrs
Oy.❑ N.
All roofs shall be inspected prior to any roofing material being installed.
Will the apphieant or forum Wilding oceupant um cquipmcot or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
Drsmc hardness tar contaminants u defined by ft Say Area Air Quality Management
all new materials for inspection.
Oyes ON.
I haw real the h»ardausmanr a s requiremmusumaxonman6.95ofde Cilifar-
ni. HOaJd&SafeyCad=, Secvmu25505.25533 and25534. I undsmand Nuifthe Wilding
does not cunend hue a tenant It iv mY responsibility to amity the oauM m of pillm
re irero mtn,W artaiaaane=ancenor. = araap.n.y.
Signature of Applicant Date
S �0 0
All roof coverings to be Class's :s' or better
0 1 authodac cut f sen