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CITY OF CUPERTINOv+.s
ON
BUILDING DIVISION PERMI
BUILDING ADDRESS:
FONG JAMES J AND LINDA Y
PERMIT NO D6030094
j4'9
.R'S NAME:
PERMIT ISSUE DATE
FONG JAMES J AND LINDA Y
07/07/9009
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm Nat 1 am licensed under provisions a( Chapter 9 (commencing
with Section 7000) of Division 3 of 0m Business and Profvsiuns Cade. and my license is
to full fame and affect
REVISION TO ROOF CONFIGURATION ON PERMIT DRAWIN
LDam icense Chis Omfl
ORIGINAL PERMIT #05060179
ARCHITECTS DECLARATION
NO NEW PERMIT ISSUED
1 understand my plans shall punned ss public acnNs
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am ucmp, from the Convector's License Law for the
i fallowing mason. (Section 7031.5. Business and Professions Cade: Any city or county
which mquitm a permit to convect, alter, improve, demolish, or repair any strunum
prior m its issuance. also requires the applicant for such permit to file a signed statement
e is licensed of the Contractor's Uncus, Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he pursuant to the provisions
(commencing with Section TIDO) of Division 3 of use Business and Professiev Code) or
$ 0
cption. Any violation of
that he a commit, therem froand the basis for the allogcdarm
Y
APN Number Occupancy Type
Semon 7031.5 by any applicant or a permit subjects the applicant to a civil penalty of
no, more than firs hundred dollars (3500).
❑ I.sswner of the pmprny,mmy wployeea with wagmuthir sole compcwum,
wilt de the work, and the structure is not intended or offered foaath (SO .7061, Business
Required Inspections
and Professions Code: The Contractor's License Law does Out apply an an owner of
propeny who Wilds Or improves dterron,and whodom,t chweh himlelfpr through his
Own employees, provided thatauch improvements arc Out intended oroffuW forsale If.
however, Ne Wilding or improvement is sold within one year of cumplction, the owner -
builder will have the Wrden of proving that he did not Wild or improve for putpme of
sale.).
❑ 1, as weer of the allusively confessions with limned ronactors m
�\
Sec. 70y, . Business Code:) The Contractors Li-
comet La it Project pply 706x, wneofropand ry who
cove law dao not apply je caner of property who Wilds or improves thereon, and
v
is
for such projects with a canuumrts) licensed pursues, u the Contrxura
whence
Lasts
License taw.
I am eze�mp�tpinder SeB & P C ImAdis
erCZma
WORKERS COM PENSATI DECLARATION
I hembY aRrA under penalty of ped arm of the following dceluazidv:
❑ I ham and will maintain a Cerufavm of Canuen, to all-insumfmWorkeraCompen-
satidn, an Provided for by Section 37M of the labor Cade, for Ne Performance of the
work for which this Permit is issued.
❑ 1 have and will maintain Wor e a Compensation Insurance, as tcpimd by Section
3700 of the labor Cods. for the performance of the woh for which this Permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This send. d.Ml cdmplemd ifthe Permit u(mane hundmduall.(3100)
rr leu)
I cenify Nat in the performance df the work for which this pemi, u issued. l shall tut
employany Panaminany maa�r brCome svblmel to than Workers'Campcwuon
Laws of Cmifomia�.Datc OL>
Applicant �-i� tNT
NOTICE TO APPLICANT: If�Mr n ak,ng th' csions of df Exemption you should
mLLA
Woth ro CnmPGW4o rmitshal of Norind
becorfortowitecompy
vde,.
it
' forthwith comply with such provisions mNia Permit shall D<deemed mwkm.
j CONSTRUCTION LENDINGAGENCY
+ Ihorwhih thi Nat deem isond(Sec.30 lending agency for the petfurmasme of
' wort for which this permit u issued (Sec. 3097, Civ. CJ
Le Name
Under,
Under', Address
'
I mer ify that l have read this application and state that the above infomatiun is
' correct. I agme to comply with all city and county oNinances and sum laws relating to
building eonmmc,inn. and hemhy amhnrim mOcsenutivea of J,i, city to curt, upon the
•huvcmcnuoneddgm pmpcny for inspection
(We) agree to save, indemnity and keep harmless the City of Cupertino against
whichpur,mcs
j may in anyway accrue against aid City
equnce
in
m consequence of the
or thee9stsandof this permit.
of Nis permit.
RSTAN
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR EGULATION . _
O
7
Re -roofs
Sigalu c of ApplipnUConvacsor Date
HAZARDOUSM ALS DISCLOSURE
Type of Roof
call the applicant 0r forum Wil ngoccupantsmmorharMle haallon, material
dcfood by the Cupenuo Municipal Code. Chapter 9.11. end Ne HeaIN and Safety
.Section 15531(6)? ❑ Yes l
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvicm which
If a roof is installed without first obtaining an inspection, I agree to remove
emit havardom air contaminants as dcOvd by the Bay Ama Air Quality Management
all new materials for inspection.
DiWIQ?
0y. u
I have mad theh modus materials requirements under Clepter 6.95 of the Califon
not Hcalth k Safety Code, ScO ms73505.25533 and ]5531.1 unectsuM that ifNc Wilding
does not currently have a mvv that It u my responsibility In notify the occupant Of the
mgai wh me,prinrmiananeenncertire.morama ry.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or aothommd:gentDate -