06030093 CITY OF CUPERTINO
BUILDING DIVISION PE IT INF�URMATION -
BUILDING ADDRESS: RONALD ONG PERMITNO.06030093
10213 S PORTAL AV
OWNER'S NAME: PERMIT ISSUE DATE
ANRONALD ONG 2006
E: SANITARY NO. CONTROL NO.
ARCHITECTfENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
i 1 hereby affirm that 1 am licensed under provi9ns oof Chapter 9(cemmencing P
,ZW with Section'IM(Yuf DivW'an3ofta 8usinrss and Profebriom Code,and myliceueis
'.=T infullforccandcffm KITCHEN REMODEL-MINOR STRUCTURAL
)EJz Licenac Class Llc.Y
�t:Q Dow Contractor
ARCHITECTS DECLARATION
1 w U I understand my plans shall W=it u public records
>N
T Licensed Professional
5 OWNER-BUILDER DECLARATION
3 s I Wrehy affirm that I am exempt from the Contractors License Law for the
EO following moon.(Section 7031.5,Business and Prefessiou Code:Any city or county
3 m which ayuias a permit to mnmu after,improve,demolish,or repair any mine=
9 prior in its issuance also,requires the applicant for such permit in rile a signed statement
fsG that he is licensed Fursuant1.the rovisionscifthe ConuacmrsU..uhw(Chapter 9 Sq.Ft. Floor Area Valuation
i~$ (commencing with Sudan 7000)of Division3oftheBusinrmandProfeciansCode)or $50000
that he is exempt therefrom and tW basis fa the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than Five hundred dollars($5110).
El 1,u Owmr of the property,a my employcu with wage in their solo compensation.
will do the work.and the smanrm u mol intended or offered for safe(Sec.]1Hd,Business _. Required Inspections
and Professions Code:The Canonicals License Law does mat apply m e an owner of q
properly who builds in improv duccon,and who doessuch work himselfothrough his
own employrrs,provided also such improvements art an,intended aoQered fmrsale If.
however,Ne building or improvement is sold within one year of completion.the owner,
builder will have the burden of proving that the did not build a improve for purpose of
s�o/kJ
Sa'.as Owner mf the property,am ecluavely convening with licensed convacaus to
construct the project(See.n an Business of and property
who
CadeI The Cs thromn.an
d. sRrl� ,s//[//t�{� �h���t
cense Law gas rot apply je an owner of properly who Wilds or improves Norton.and }I\�QVt@tJ�ff�*at x
whocontneti for such projects wiNaeonuactoo(s)Iiunsed purwantmthe Convacmfs Pl p 19111��� p�P
License law.
Q I am exempt tint/n�be� B A PITC for this rtsson
Owner f !J/./�L�S{ Data
ft ERS comPERsAtIoNlorckkRATION
I heaby drum under pealty of perjury oto of alk following doelummuse [g �{ffyy 1t� (O
ham and will far by a CeNf37M of due Labor
Combe,sum far Workman ce of the
BI }g�Ls ��� ,g
n u provided tar by Becton 3]00 of Ua labor Cade,for the performance of the ) ((/G/)I7 Ifs{T� g�tt\\\\vWftylt f[(r/``yl,''hG�GP�Y_
W
far which this permit u abroad. '
❑1 have and will maintain Workcas Compensation Insurance,u minimal by Section
3]00 of Ne Latus Code.far the pcRarmance of Ne work for which this permit is issued '
My Wokeas Compensation Insurance carrier and Policy number art:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section rand not W completed if the permit is forme hundred dollars(SIM)
or loss.)
I certify Nat in the perfrrmanee of the walk for which this permit u issued.l shall Out
employ any person in any mannersouaYyeet to the Workeri Compensation
Lswaof California.Dam .'1
Applicant
NQIICE T)APPA ANI:IL after mfg 09:etiftificatc of Exemption.you should
become subject to thc Worker's Compensation provisions of the Labor Code.you must
.,z foMwith comply with such provisions of this Format shall W deemed revoked.
z OCONSTRUCTION LENDING AGENCY
�-. 1 hereby aRrm the there is a construction lending agency for the Fcrfarmaue of
14oho wort far which this permil'u issued(Sec.3097,Civ.C.)
1 Q Lendcas Name
a z Lender's Address
V C) I comfy Nat 1 have bed this application and sum and the move infomutiun is
U.P: contest.I agree in comply with all city and county ordinances and some laws rtlating to
0U building construction,and hereby amhorim represemmivu of this city m emer upon the
T 14hovctmcmioncd nu.cny for inspectors purposes.
F 0. (We)agree to save,indemnify and kap harmless the City of Cupenmo again"
liaemserl...C.of Orgranting oranting f this "which may in any way acctvc against said City
() z hAnPP`ICyANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOVR GVunfy�NS��.��
/� 2r� - `>�/`3/4i Re-roofs
Sign3Cua of Apolicaundepaincloror Oaa
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fumes building acupapt stow or handle Health and Sariml
u de.Sed Section
25 Cupertino Municipal Codc.Chapter 9.12,and the Health and affiry
Code.Barden zss3z(a]
❑rga [�Na 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 fuwrc Wilding Occupant us equipment o device which g
I havngoua air conuminulB u termed by the Bay Area Air Quality Management all new materials for inspection.
nc0
❑Yes RINo
I have mail Use haardont materials rsyvimme as under CTapter6.95 of the Califor-
nia Health dal Safety Code,Seetans 35505.25533 and 8534.1 uadcO.d this irate building
docs not canamily have•ananx Nat it h my mspomibilily to mal,the aeor.,or the
ayuiam
jq. mhichm W t ' rwissuana ofa CertiWaa of OccuFancy. Date
9 c,"' ` Signature of Applicant
owner or aamrrhned seg D,re. All roof coverings to be Class "B"or better