06060132 CITY OF CUPERTINO ,t'NRy°'AY' �' a"`` ^"° �BUILDING DIVISION PERMIT CUI�ITR:A.C�'TORI�SF�,O.,.RMAT,I ' N
rd '?as„e ea^«PPr °�
BUILDING ADDRESS: v PERMIT NO. 06060132 ,
7698 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE
HENRY CHAN
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDINO PERMIT INFO
O PO MECH
C=
loo
LICENSED CONTRAC70RIDECLARATION Job Description
I hemby affirm deal 1 am licensed under provisions of Chapter 9(mmmracing
with Section 700M of Division 3 of the Business and Pmfeuium Code,and MY limas is
in full fame and affect. ADD 1, 231 ' -DEN/LIVING RM/FOYER/STAIRCASE
8g
Licse Lm.
Damic. sur GARAGE 513 ' —REMODEL THROUGHOUT 1, 630 '
Da
ARCHITECTS DECLARATION
i 0 I undemmd my plans shall be used u public records
i
•va
Licensed Preform anal
OWNER-BUILDER DEIN Com arc
5T ON
1 hereby aim en 1 1. exempt from the Camncmfs License Any c Law co the
O o following mann,(Smtiun 71W L4 Business and Pmfcainu Code:Any city or county
S$ which requires a pmnit in cnnmunn WWI.Improve,Newark,err-PAlr any slmdum
prior An its issuance.ALSO requires the applicat formch permit to file a signed summcniValuation
that be is licensed introvert m the pro
(commencing
Connector's Lim.law(ChaPm9 Sq.Ft. Floor Area
[� (commencing with Scauon 7000)of Division 3 of the Business and Pmfeneas Calc)or $428681
JO that w u emmpm therefrom OW the bub for the aMged @-Mellon My violation of
Section 70315 by any applicant for a permit subjccu the applicant W a civil penalty of APN Number Occupancy Type
not mom Nan five hundred doll.(3500).
❑L,As owner aftim pmpeny.m my employees with wages in their sale compeommon,
winaaupwad .nameAwawm+amtmm cads artemdrartae(s«.7ou.Ba
aid Pmfeames code:The Committer,License law dare at apply m a owner or Required Inspections
property,who wild,or imprawthereon•and who doessuch wark WrNI(er through his
own employees,provided dui such ireprowmenY are Amt inmrWd araRssed for Ola If-
however,
Lhowever,the wilding or impmvement 4 mid within ON year of compinim.the owner.
builder will have the burden of proving that an did Out bold o improve for pmpose of
sale
1,As mune,or the property,am exclusively commuting with licensed conummn to
consumer the pmjea(Sea 70ae,Business AM Profession Code)The Cmuacmts U-
ceme taw does not apply in a owner of property who Wilda or+mpmva thawn.and,
who,..meta for such pmjem with a mnuumr()Iiunad Pura m m tier ContranoYs
License law.
❑tom excrept tagat8 . B&P f ��/on
D.m G�
er �
WORT R•S COM ENSATION DECLARATION
1 hereby aR)m under penalty of perjury am of the fallowing dulamlou:
I haw and will maintain a CctiBata of Consent to self-Wum far workers Compa.
swan,a provided fm by Section 3700 of the labor Code,fm We perfomana of tx
work for which this permit is ima d.
❑I have and will maintain Wormea Compevulon Insurance.As required by Secure
37W of me Laher Code,far the performance of We wok for which this panni,is iuund.
My Warkees Comiu m ban Insurance artier and Policy number arc:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mix Women need an,N completed if the permit is foram hundred dollen(SIM)
or len.)
I cenify tient In theperformance of We work for which this permit Is issued,I,hail nm
employ any permit In mymaners c e bjent o the Worked'Compensation
lamorcAlifa a.
Appli e L
NOTICE TO APPLICANT:If,f—,making this Cenifiam of Exemption.you should
become subject to the Wurkors Compe owdon pmvblms of the later Coda you mom
,J O forthwith comply with such provisions m this permit shall be deemed rebuked.
,z,A� CONSTRUCTION LENDING AGENCY
[—t Ihembyallim drinW.i..coutrutlne lenift.geney for the Pnnswonv f .
CL> the work far which this permit is bound(Su.3097•Civ.C)
W Q Loam.Name
IY Landce.Addrea
U 0 I mnify that I haw read this application and sum Nu the above infometiun Is
torten.I qme m comply with all city ad county on inaues and sum laws relating to
�U building conservation,and hereby authorise representatives of this city to enter upon the
W .hove-mentioned pmperty for inspection purposes.
(We)agree m save,indemnify ad keep homeless the City of Cupertino against
wF.t y liabilities,judgmenu,creta ad espeacS which may in my way seem against said City
U Z in communnee of the Swung of this permit.
^' APPLICANT UNDER ANDS AND'WILL
�COMPLY WITH AIS.NON
�-10IIINT Issued by: 6Date
SOURCE REG�W�� IA bll5 (W
�-�- Re-roofs
Signature of AppliantlConuacmr a I Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the application or future wilding orsupatsore oNndlc hauWous mamriAl
As defin d by the Cupertino Municipal Code.Chapter 9.12,ad the Has th ad Safety
sem_255324)' All roofs shall be inspected prior to any roofing material being installed.
❑Ya ISta
Will the aPPwat or Tatum vending occupam use equipment or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
emit hueaho air cmuminanu As defined by the Bay Area Air Quality MAna3emenl all new materials for inspection.
District?
❑Yes py o
I have mail the hna,drwr mseriW mquimmem underCnapmr 495 of site Califor-
niaHcalth&SafmyCe ,Scctiaa25505.25533uW25534.1undcnundthsifdte harking
docs not curmn0y haw a tunas Wt It is my responsibility in notify that aacup rl of IN
rcquimmena,'niC muuxmnPna,t iaaaaaf.amicm, fDan .jcA. �• Signature of Applicant Date
Owner orc �authom<d gent DL,mr O All roof coverings to be Class"B”or better