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05020089 CITY OF CUPERTINO �' x°£�✓r �vtLx+�"�"� N BUILDING DIVISION PERMIT , CUN'TRACTURINFURMATIO BUILDING ADDRESS: PERMIT NO. THANH HA CONSTRUCTION 05020089 N R' AM TREBfi�iPERMIT ISSUE DATE E SANITARY O�gtL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p aLOij LICENSED CONTRACTOR'S DECLARATION lob Description td 1 hereby affirm that L am licensed under provision,of Chapter 9(commencing with Salton 7004 of Division 3 ofthe Business and Profession,Code,and my license Is ^� in full fora MdC9jCL SEE IJansaclw Lin• ADD 708 ' (640 ' -2ND UNIT) /REROOF Da &trae'ar BATHROOM 18 ' /GARAGE 50 ' A ITECrs DEcua DN y 1 understood my plana shall be used u public reemda 3 sed Licensed Pmfeedmnal OWNER-BUILDER DECLARATION I hereby affirm that 11. exempt s an the Contractors Licence Law for the p o which re moon. Panni t R13IA.Business and Professions Coda:Any can or county which mgdru•permit re ennnnws Wee Improve,demolish.or repair sig any urtucwm F Z to Win to its i licensed portion,rho requires thevision of for�oh panait LNe ce La(rtaumem (commis licensedSectiorock of Division of of the Business lucvclaw(Chapter Sq.Ft.Floor Area Valuation $ thammcacinewith Section ad of bull for rth alleged eosM Professions vi Code)or � — olation of r) Seance 7031.5 by any applicant far as pamtl subject,thea Pant to a civilipenalty of net mom than five hundred dmlloa($500). APN Number Occupancy Type ❑L o ,hare of the proprny,army rnimmides with weds r Neo mc.cornpa ecomes will Palk work and the The Cor b Coruscate, ed La erect tonawpply in an owntur or 3 16 3 1011 . 0 0 Required Inspections and Prty who ns Code:The C,nuacme,Uttnse law Pau nal apply lf an owner of q P am ertywha s.proorimproKa thermnand who daaaahwork indeh wallowselfor s for own employva,provided thesueh(mprowmanto in not lorded moRered for tole.If. however.was WildingorImproKmmnlamid within oft year or mprove for theowrcr. builder will have the When of proving that k cid not Wild or Improve far purpose of uwd. ❑1.as ower of the property,am inclusively contracting with licensed contractors to construct the project(See.7044,Business and Professmns Code:)The Con ncmr'a U. cense law does act apply to in aware of property who builds or improves thereon.and. who convects for soh pmjecu with a eomummu(s)licensed pursuant to the Communes License Law. ❑I am mempl under Sec. .B h P C for thin moon owner Dau WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury as of the following declarations: have and will maintain a Certificate ofCamenl Ire self-lasum fm Worker's Camper- audit,u provided for by Section 3700 of the tabes Code.fm the performance of the work for which this permti is issued. ❑I haw and will maintain Worker's Compensation Insurance,o required by Section 3700 of the labor Code.far the performance attic work forwhich this permit is laced. My Warkefs Con pansat n annnce rtim and Policy number Co. Polity Nm.:1D�.�?� CE FI A •OF EXEMPTION PROM WORKERS' COMPENSATION INSURANCE (Thh section need net becomPlewd lithe permit is formic hundmddellos($100) or leu) 1 unify mm in we performamc or the work for which this Permit is Issued.I shall not employ any person in any intention u to became subject to the Wmrkari Compenudon Laws of Califomu.Dau Applicant NOTICE 7O APPLICANT:If,spur making this Certificate of EsemMion,you should became subject in the Workers Compensation provisions of the LaM Code,you muse O forthwith comply with each provisions or this permit shall be deemra ed nked. z► CONSTRUCTION LENDING AGENCY [ti Ikmby ninon that there is a commandant lending agency,for the Performance of CYi.7 to work for which this permit is load(Sec.3097.Civ.C.) WQ lender,Name landowes Address V C 1 certify that 1 haw read this application am sore thin the show Infmtmmlon I$ U,t comm I agree m comply with all city and county ordinances and show Ism mhtin{m G Wilding conmucdon.and hereby authoda reNesenhotiwa of this city to enter upon the W akw-mentioned property for inspection purposes G (Wes)agree to an,indemnify and keep harmless Loc City of Carolina,against rA Iiabilitio,judgmcau,core and expenses which may In any way acme against told City V Z in consequence of the{liming of this permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. ' rt� �," ©4—4 Re-roofs Signature of App icantlC,nuactor Dow Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding=upset atom orhardlo hasardoes material as carred by the Calcium Municipal Code.Chapter 9.11.and the Health and Safety Code.Section 15532(x)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑Nu Will the applicant or future Wilding occupant us:equipment in device which If a toot is installed without firs[obtaining an inspection,I agree to remove haudou,air cwitarrinanu as dcOrmd by the Bay Area Air Quality Management all new materials for inspection. istrict7 ❑Yes ON. 1 kw mad the h57sawu materials requirements underChap er 6,95 of the Califor- hisHealth&SawtyCode.Sections 25505.25533 and 25534.1 understand that iflhe Wilding dose trot currently haw a knot.that It is my mapomihility in reify the msupanl of the requirements which must Wm '— tP'pg wan i,nuecmfa Cenificto ff0c ans. Signature of Applicant Date t::Ep /n/�f/ (V T� All roof coverings to be Class"B"or better Owner hr anthomcd agent Dow C