06050191 CITY OF CUPERTINO �• •'£:x>+ +• ,ria ` v �"x9 ''
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,u
INGADDRESS: M-TRAN CONSTRUCTION, INC PERMIT NO.06050191
_ 641 RUNO CT
R'S NAME: PERMIT ISSUE DATE
CANH PHAN 348 SURBER DR. 07/07/2006
PHONE:
SANITARY N0, CONTROL NO.
(650) 996-6099
ARCHIEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+oa LICENSED CONRACTOWS DECLARATION lob Description
w I hereby affirm that I am limosed under provisions of Chapter 9(rammer Bing
with Section 70M1)of Division 3 ofthe Business and Pro(cssioru Code.and my became is
s=s in fun mm"nd cftce HOUSE DEMO
j,�_ License Chu Lm.N R2D�98
=� Da¢ Conlmctrr Mir
ARCHITECTS DECLARATION
1 1 understand my plans shall k used as public mcnods
>du
m o Licensed Pmfcssionai
q 3 OWNER-BUILDER DECLARATION -
2 f 1 berehy affirm that I am exempt from the Contramor's License Law for the
O O following mason.(section 7(13 1.5,Business and Profasdnns Cc&:Any city at county
which requires a permit to eons oseL alcor,improve,demolish,or repair any Rmeture $9000
_I< prior to its issuarcc,also requites The applicant for such Permit m file a signed statement
Thatkis liccmcd pursuant to the provisions of to Contractor's License Law(Chapter 9 Sq.FL Floor Area Valuation
eF0 (commencing with Section 7000)of Division 3 of the Business and Professions Coda)or
y dist k u exempt thuefrom and the basis for the alleged exemption.Any violation of
Secure 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of Occupancy Type
not more dun five handled dollars(5500).
wi Lara woraf the propeactur myemployces wiThwagmss the(Sec.7ompewtion,
will dolhcwmk,anddm ase Cimister's License
ndede Law
do formic act
70 an Business Required Inspections
pompand erty who
Cade:M vesthecton,Ld who law does not apply f an owner is q p
man enywhobuildsmimprat well Hereon,andordsmea netuch work or offearthr Weugh h.
man employees.the building or
vemimprovemenssaremyearn of
completioculn.
for We. r-
h ifiku,.Nebuildingorimprovementasoldwithinane Year of impletion.purpose
owner-
buildcr will love de buNcn of proving that k did rot Wild or improve for purpose of
salc.l.
❑1.as owner of the pmpert,am aelusively contracting with licensed contractors;b
constmct the project(See.70m.Bud.and Professions Code:)The Contracmrs Li-
cense law does not ah,ply m an owner of property who builds ar improves Compactor's and a��
conbactsfor
mat
u cpmycu wiNaconuanor(s)Iiuved WDuamm Ne Contracmh tfp(hjt{e_-`v' f�
w f—
arn tempt undo see ,B&P C for this cousin l'jy
Dare
r WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury enc of the following declinations: ; 72006
Ihave and will maintain eCion 37 m of ContinuaChade,far
Worker'sceCornpin-
C3
of the BU
7�L�U1�t//ll//
we,i ss provided fa by Section 3700 of the tabor Cade,far dm pecfonnams of the IgB/W¢�31]/[1r'(�'31�/tJ[Jgf
work for whim this Permit is issued. ) /,(r
❑I love and will maintain Workers Compensation Importance,ss required by Section
3700 of The labor Code.far Ne performance of rhe work fm which they permit is issued.
My Wmim ssfCCompe¢nsation Inwcham,caricr and Policy number ale:
Carrier. Jf I1T'c �'(.t/�1) Poliry No.:�� ?2R5 _�
CERT F TE—OF EXENP ION FROM WORKERS
COMPENSATION INSURANCE
((This section amid tet bccompleted if the permit is forone hundred dollars(SIM)
or Ica.)
I ecetl(v Nat in the Performance of the work for which this permit is issued.I shall not
employ any person in any manrcrso ss to become subject to Ne Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject an the Worker's Compensation previsions of Ne labar Code.you must
0 z forthwith comply with such provisions or Nu permit shall k deemed invoked.
Z O CONSTRUCTION LENDING AGENCY
[—� T kmhy,affirm that them is a construction lending agency for the psr(c m ince of
FL > dm walk ter whim this permit u issued(see.3097.Civ.C.)
Landes Namc
CL S
a z Lenders Md.
U 0 1 cer i(y that 1 have read this application and sum WI die above information is
B, torten.1 agree to comply with all city and county ordinances and sum laws relating m
0U building convection,and hereby authuire mpmscnulives of this city to enter upon the
above mentioned nmpc si to,iespcNun which mpuroms.
H a (We).,me m save,indemnify and keep harmless Ike City of Cupertino against
to liabilities,"a "I'd, rt
cxpcosa which may in any way acerae egalmT rid City
V z A eonmquence of Ne g ung r(Nu pe
^ APPLICANT UNDER AN AN 1 COMPLY WITH ALL NON-POINT Issued by: & Date
SO GULATIO
/7&6 Re-roofs
Aidnature ofA 1ican ontracmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dre applicant or future building occuptu tsmin w lundle hammous material
fined by the
Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.
Section 25532(e)7
0y. �10 All roofs shall be inspected prior to any roofing material being installed.
Will the applie,nt or future building occupant use mgripment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit cosine. it coeumimmus as dcOrcd by dim Bay Arca Air Quality Managemcns allnew materials for inspection.
Dis0ict?
DYa titlu
1 have read die hvaNwssmmaterials requirements under Chap eT6.95 of Nc Califon
nialicallh&SafctyCede, tions25505,25573 25534.1undcisand NatifNc building
does tet eurtently have
a and it u m ponsibilitY m notify the occupant of dm
'rcmcns which must met or ante ata of "cu ,Y. Signature of Applicant Date
7 �6
Owner or alifloorml assent Data� � All roof coverings to be Class"B"or better