04090046CITY OF CUPERTINO-_ . p AT -
BUILDING DIVISION PERMIT ��,,NTli1L\ =
BUILDING ADDRESS. TERENCE KWAN 1""""04090046 .
NAME:
ARCHITECT/ENGINEER:
1 bcmby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7") of Division 3 of NC Business and professions Code, and my Hear. in
• in full force and effect.
zLicense Clan Lt. #
Dam Contractor
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
U
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
I hereby .(Rete that I em exempt from Ne Contractor's o License Law Co the
following tenon. (Section 7fln 1.5, Business and Professors demolish.
C9de: Any city m county
which requires a Petted mrumstruct, eller, improve, h Permit t m repair any swauro
y ptormits iausnce. also dpursant to Me Theapplicantof for suchmodes LMe aicense ned Law
that me cased pursuant Ne provision of the Contmcmr's nd Prof Law (Chadd) or
$ (cat he
(commencing wish Section 7") nd of basis for
ofdo,
eged toaandon.An Professions
.-
that M r comp, tWmfrom and or aper it Ne alleged exemption. Any viordon of
Section Inn 1.5 five
any applicant fora permit subject the applinnt to a civil penalty of
not more Man Ove huntlmd dolhn (5300).
❑ 1, a owner of the Property, or my employcu with wages as their sale rompenndon,
will do the work, and to sVucome is not intended or.Rased for aale(See. 7044, Business
and Professions Code: The Conoations License Law dues not apply to an owner of
progeny who builds or im prams thereon, an d who does ouch work himsel f or through his
own employes. provided Nat such improwme da are, not Intended oroRered formic. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving Maul he did not build or Improve for purpose of
sale.).
1, as owner of the property. am exclusively Contracting with licensed conmacmrs to
Construct the project (Sec. 7044, Basi om and Professions Cade:) The Contramrh Li.
came Law docs not apply to an owner of property, who Wilds or improves Monsoon, and
who controls for such projects with a contractor(s) licensed permit, to the Commctae.
OU. Law.
arm exempt underage. . B d: P C for Nis meson
w
1 hereby a(fi. under penalty of perjury oro of Me failox�tleclantions:
1 haw end will maintain a Contritely of Consent to elf -insure for WormesCampen-
smion, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued,
❑ 1 have and will maiment Worker's Compensation Insurance, a required by Section
3700 of the Labor Code, for the performance of Ne work for which this permit is sated.
My Worker's Compensation Insurance carrier and Policy number are:
COMPENSATION INSURANCE
(This section need not W cumplemd HIM Permit is Mature hundred dollars ($100)
per las)
1 certify Nat in Ne performance of 1. .,it for which this permit is brand, l shell not
NOTIC "APP{KAN7 If, after making His Certifies of hon, you snoum
WIC
jest to the Worker's Compensation pmvisi - t e Lshnr Cnde. you most
� Z forthae dl comply wish men provisions "this permitsha W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[r Ibon:by dfirm that there la a coawctinn lending agency for the performance of
yes 7 dm work fur which this permit is issued (Sec. 3x97, Civ. C.)
ALender's Name
Z) z Lender's Address
U 0 1 certify that I have reed this application and state Net Ne shove tar .mlation is
V. F correct l agree to comply with all city and county ordinances and state laws miming m
0U building construction, and hereby authorize repraentmiva of this city to enter upon Ne
W ehovc-mentiomod PMPcny(Or ipepeaion PuTosea
gy (We) agree to save, indemnify and keep harmless the City of Cupertino agebal
Tn liabilities, judgment. costs and expermes which may in any way acme against aid City
U Z in consequence of tty�c granting of this N rail.
F.. APPLICAB'y UUERSTANDS AND WILL COMPLY WITH r)tL NON -POINT
Will Ne a'
a defined by the
and the Health and Safety
PERMIT ISSUE DATE
bY.1JaY.1:Y6b1���aG1:YL•p] alprg
Job Descriptiofi 1 ®O'OIw Lea L./
KITCHEN REMODEL NOV Oj 2004
BUILDING
G'T inn
3
Issued by -
Re -roofs
Type of Roof
If]
Required Inspections
Date
Seenen 355320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yad No
� If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or forum building occupant use equipment or devices which
emit hexardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
Cl Y. ANu
a tenant.
6.95oftheCalifor-
Ithat ifNe Wilding
W occupant of the
Signature of Applicant Date
All roof coverings to be Class "B" or better
w
OWNER -BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform
A V All the work authorized by this permit
B.= A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be -performed
3. _ I will utilize unlicensed persons) other than my immediate family to perform all or
portions of the authorized work I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner -Builder Information r7 i
Property Owners Signa n Date:
9 1/0V-
ob Address: [./ �_ �` � I `� g.� Perarit # �L 0
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
Dear Property Owner.
City of Cupertino Building Department
10300 Torre Avenue
Phone:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner -builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personalty performing their own work. If your work is being performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required try law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
if you plan to do your own work, with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law, contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you are aware of these mutters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed an Recoled Paper