08030174 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON TRACTOR INFORMATIO
PERNIFF NU.
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TAN LEANDRO AVE TBD – TO BE DETERMINED 08030174
WS7NAA5ME: b PERMIT ISSUE DATE
STEVEN PENG & JIM YANG 06/10/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECffENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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woo LICENSED CONTRACIDR'S DECLARATION Job Description
i�u 1 bmoby affirm tlw T 3 fthe Bu unser provisions of s Code. 9(commencing P
with section ndefaroi.ision3afde Business and Proressiuns code.and mylicereeu SFDWL-2 STORY 3 , 485, GARAGE 624 ' –ALL ROOF PITCHES
^ N in full torte and effect
iq? License Class La. TO MATCH. NO ACCESSORYSTRUCTURES IN FRONT
e_
r
Dam.Contractor ARCHf1EC1'SDECLARATION SETBACK. THE CONC PILLAR IN THE FRONT SETBACK IS
e I understand my plans shall M used as public meet&
e7�
JyU
tai Licensed Pmresnomadl
3 OWNER-BUILDER DECLARATION
ix I hcrehy.Iron Nn 1 am exempt rent the Comractors License Law for the
s O O following won.(Section 7031.5.Business aM Prefeuions Cade:Any city or county
3
29 which mquires a permit to construct,alter.improve,demolish,ar minor any Immune
iy prim to i%issuance,Hsu requirestk applicant for such permit to file a signed stammer
H
that he is licensed pumaatd to Ih provisions of the Contractor's Ucesese Law(Cytaper 9 Sq.Ft. Floor Area Valuation
(comm cncingwith Scetion700Mof Divleion3af Ne Busin=ss dPmfmiom Coup)m $400000
$ that be s exempt thetefrem and Re treat for Re alleged exemption.Any vloladon of
SeNon 7031.5 by airy applicant for a permit subjects that applicant he a civil pcnstity,of
nm more Nan five hundred dollars($500). 3 5 7 0 5 0 2 6 .)�§14N Number Occupancy Type
0 1,as owner of the property,or my employees with wages a Neto win compensstlon.
will de the work,and the smcturt is not ineMed or offered lot sale(Sec.7(th,Business
and Prufestiom Code The Conuacmh License Law doss amt tipsy m an owner of Required Inspections
property who buildsori npromsthereon,and who does such workhmandfmthrough his
awnemployese,proided thatsbah impmwmanuareretimaneloroQcrt foraxle.IL
however,the building or Imp svenere Is mid within ooe year of mmplation.Re mwner-
builder ,will have th<burden of proving that Im did net build or improve for purpose of
sake.).
d1,sa awrcr of the propeny,w exclusively convening with licensed conurmors m
construct the project(Sec.7Wa,Business and Predications Cade:)The Contomm's U.
eeme few des not apply to an ownor of pmpeny who builds or improves themon,and.
who consistent for such pmjecs with a contracter(s)licenced purwam te the Co muchn's
Liceve law.
❑lam aae nda Sec_ B&PCF Nis on
am
WORKER'S OMPENSATIO ECLARATION
I hereby affirm motor penalty of perjury roe of the following duclaradons: _.
0 1 Inward moil maintain a CeniBnte of Consent elf-insure for Workers Compen- '
sation,as proviupd fm by Section 37W of the labor Code.for the performance of the
work for which this permit is issned.
O 1 haw and will maintain Workers Compensation Insurance,as required by Socabon
3700 of the later Coup,for Re performance of the work for which this permit is issued.
My Warkefs Compenudoo loss.carriv and Polity number ice:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ihescomm recd ret be completed if the permit is fmonc hundred dollars OIOM
or lest)
1 ctrdfy that in the performance of the work for which this permit It issued,I shell not
employanypersonin anY 9;r taco bject he the Workeri Compcpmmkm
Taws o(Wiramia.Dam
Applicant ✓l
NOnCE TO APPLICANT:If,ofmr musing thin CcN(cae o Fscmption,you should
become subject In,the Workers Compewuon previsions of the labor Code,you most
.J O forthwith comply with such Provisions or this permit shall be deemed mwked.
zy CONSTRUCTION LENDING AGENCY
F I hereby drum that there is a connected.lending.genmy for the K...f
Qi> the work for which this permit is ushod(Sec.3097,Civ.C.)
W L<nupri Name
U z Lenders Address
U O 1 certify th.,1 have mad this s ridicatien W state Rat the above infemudun is
Is, cmect.l agree in empty with all city and county ordinances aM sue laws raising to
Wilding consuuction,aM hereby authorise mpmwntstives of this city an enter upon the
W above-mentioned properly for inspection purpoxs
gk, (We)agree to save,indemnify and keep harmless the City or Cupertino against
rat Vl liabilitics,judgmens.coats and expenses which may in any way ametue against said City
U Z in consegoence of the granting of Nis permo.
'—' APPLICANT UKDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
sou" ULA710fjSr f O
-roofs
Re
-roofs
�—
Signature of Applican✓Caatrwmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof -
Wit]the applicant 01 picture Wilding oaupommore or handle ha ommus maerial
JAkflncd by 0e Cupenina Municipal Code.Chapmr 9.12.and the Health and Safety
Section 25532(.)7
OYe. &No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Re applicant or future building occupant ata equipment or devices whirl P
cDiamsnisrdnus nor canuminanu u defined by the Bay Arta Air Quality Management all new materials for inspection.
0 ret
I haw real the hasandeusmatedals requirements under Chapmr5.95 ofthe Califor.
nu Health&Sony Cede,son.25505,25533 and 25534.I undcrsund thatiftk building
duesnot currently have a tenon,that it is At,resporuitulu,as car",the occupant of the
mgai nntwh¢nmun metpriar nancenncemrmaldgft) patty. Signature of Applicant Date
Owner or suthomce agent (� Dbw All roof coverings to be Class' ^or better
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