02110065 CIG.l° B;
TY ON CUPERI'INOi�
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
,iso@ a F r o
BUILDING ADDRESS: PERMIT NOO 2 110 0 6 5
7
NER'S NAME: PERMIT ISSUE DATE
BEN LEE & DELIA 2003
NE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� = 0 0
30o LICENSED CONTRd under provisions
DECLARATION
I ehcmbyaffirm mat 1amfthe Buundernd ProonaofC aids. Y(rommcnse is Job Description
m
with Section 70M)or Division Sof the Businea and Profesaiena Cade.tad my license is (y
e mlmreeondercen. NEW SINGLE FAMILY DWELLING
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in
eClua Lie.a �y
Dau Contractor LIVING SPACE 4028 SQ.FT. 6
tg ARCHITECTS DECLARATION
I Y I understand my'Ims.hall he used As public records GARAGE 898 S Q. FT. C/
s Licensed Professional
!/
OWNER-BUILDER DECLARATION
C0 q hereby maso .(firm thin 11. exempt from the Contractor's License Law for the
00 followwhichimgmason. crinin 7o construct,
shot. and improve.
Code:Any cityarcounty
3 z which rtyuires s Permit re a iras be Blur,improve,h pc oaah,or repair sig any twaum
Z a'^• prior miuissuaegdmantin rostbe inion of for such permit to Ncsc signedstatement
that heiacingwid Puection7the Pmvivianan.fthc Bsamh Licenulsw(Cboe)or Sq. Ft. Floor Area Valuation
$ Boot he is exempt Section and the
Division r t hh l aged exemption.
Profeon.A y vi Cone)or $600000 6.0 0 0 0 0
Nos he B exempt therefrom and the bus for de alleged cumptlon.Any violicslon of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom Nan two hundred dollars(1500). 35601006 . 00
I,u owner of she property,m.,employees with wag.As their rale ampernat
will do she wink,and On svuctum is not intended or offered for sale 7044,Business Required Inspections
and Professeions Code:The Contractor's License Law dural not apply to an owner of q P
property who Wilda or improves thereon,and who does such work himself or through his
own employees,provided Nal such improvements Are not intended oroRemd torula.If,
however,Ne building or improvement I.sold within one year of completion.Ne owrer,
builder will have the burden of preving that he did nos Wild or improve for p.npm of
sale.).
1,a no,of the properly.am exclusively contracting with licensed convectors to
ouwct the project(Sec.7044,Business and Professions Code:)no Convacters Li.
cense law does not apply in in owner of property who Wilds or improves thmon,and.
who contracts for such pmjmts with a eomrmoor(s)licensed pursuant to the Contractor.
License Law.
❑Iain esemp�d Sec. ,B&PCfor Nl moan
nee Cc
W KER'S C MP ATION D[G ION
I banality ATO under penalty of perjury ane of the following dedmtion r
I have and will maintain a Cero fivate of Consent to sel6iuure for Worker's Compcn-
ution,As provided for by Section 3700 of the Labor Code,for the perform rm or the
work for which this Pamdt is issued.
❑I have And will maintain Workers Compensation Insurance,as required by Section
3700 of On Labor Com,for the performutt of the work for which this perm it is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS•
COMPENSATION INSURANCE
(This section reed not be completed if the Permit is fourse,hundred dollars(SIM)
of lass.)
I certify that in the performance of the work for which this permit Is Issoed.I shall nut
employ any person in any manner an As W become subject m the Werlans Compersatlon
Laws of Califomia.Dick
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Woman Subject to the Workers Comparx.LWn provisions of IW Latter Code,you must
.,O forthwith comply with such provisions or this Permit shall W deemed invoked.
z.~N. CONSTRUCTION LENDING AGENCY v
I hereby afsm that than its convection lending agency for tae perfom orneof
1'Y the work fur which this permit Is wood(Sec.3897,Civ.C.) '
fg1 QLenders Name
a Lender's Address
�z .
J Q 1 Certify that 1 have read this application and state that the show I.R.Kikn I.
It, cusmct,l grace to comply with All city And county ordinances and sou laws mhling An
O Wilding construction.and hereby auhoorin repmxmauves of this city to enter upon the
W above-mentioned propcny,for inspection propose.
gy (We)ague m save,indemnify ad keep hermlea the City of Capitoline against
h liabilities,judgments,costs and expenses which may In any way acerae against old City
TJ 7 in conSAIMACe of the granting of this Permit.
�i APPLICANT UNDERSTANDS AND ILL COMPLY WITH41.NON-POINT Issued by: Date
S URC NS. a/ 49/S-25
7
49 b3 Re-roofs
upstate Appl' m/Contr or ate
BAZAR OUSMA ERIALSDISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hnallous material
As defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code, C3 Yea
25532(.)] All roofs shall be inspected prior to an roofing material beim Installed.
❑InaNa P P Y g 8
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants u defined by the Bay Arc.Air Quality Management all new materials for inspection.
isvin7
❑Yes Nu
Ihavcreadthahma c smaurialsmquiremenuundcr Chapkr6.95nf Ne Califor.
ria Health&Safety Code,Sections 25505,25533 and 25534.1 understand Naz it lM building
does not currently have a tenant,that it is my rostr nsihility w noul'y the occupant of the
reyuimmcn bemclpdo or mtifie0k fQupaay. Signature of Applicant Date
er or Ihorl, agent^ G DAM All roof coverings to be Class"B"or better