06120099 CITY OF CUPERTINO
BUILDING DIVISION PERiVIIT CONT.RAGT�,C)R INI<'ORMATION
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: B ATE
-TEPHEN WONG 2362 WALSH A 2/21 /2006
E:
SANITARY NO. CONTROL NO.
ARCHITECUENOINEER: BUILDING PERMIT INFO
INSTALLATION OF BLDG ELECT PLUMB MECH
0 0 0 0
p0 LICENSED CONTRACTOR'S ACR'S DECLARATION IO escrl tion
w EE 1 hereby affirm Nal 1 am licensed under PMV WOns of Chapter 9(commencing p
:zw with Section 7")of Division 3 of the Bu}Ineseled Nofeaiuns Code.and my license is
! H in full farce and elfect� 7 /3
License CI s Lic.N - l
o Dam COnv
am, ni C / n
l 'y ARCHITECT'S DECLARATION
i s a 1 dors nd my plans shall be used m public records
iyU
LL y Licensed Professional
Met I am exempt fr DECLARATION
f O C 1 hereby resso .(Tion on I am.Bump(from the f sn ons Co License Law for the
:OC o fallowing reason. emit i ](n L5.Business and Pm(cctium Code:Any city of county
'm which requires n Permit m cores the alcor.improve,demnlW.Ore a sig ed swnont
a a prior w is,issuance.also the applicant Me Con Permit acto's file a signed summate
that he aracinwithSrsilim 7to ne provisionsof3.(ft Business
ianscl,w(Chap¢r9 Sq.Ft.Floor Area Valuation
(cat he ix xempttSeNon]W01 of Division oftheeged.ando.A.vi Code)or
m«y$ that he u exempt th«efrom aha the baso for Um alleged esempuoa Any violaumn of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally of APN Number Occupancy Type -
not mom Nan five hundred dollara(SSW).
1,a owner Of the Pmpury,in my employees with"gas a their colo compensation,
will do the work,and thesvunure is no(intended or offered for sate 7044,Business Required Inspections
and Professions Coddao WE The Contract License law daM(apply m « e ns an ownof q p
property who Wild or impro es th«mn,andwbodmessuchwortb essee lmthrough his
own employees,provided that such imprommenu art n rtimmnded ormRened forsole IL
h Tamm.the Wilding Or improvement unsold within one year of completion,Ne owner-
builder will ban the Wrden of proving Nat he did rot Wild or improve for purpose of
ale.).
❑1,as Owner of be property,am exclusively convening with licensed ronvanars in
construct the project(Sec.7W.Business and Professions Code:)The Convacm`3 U.
cove Law docs not apply to an own«of property,who Wilds or'unpmwea Uemon,and.
who comas,for such invoices,with acon reamr(s)licensed pursuant in Use Convenor's
License Law. '
❑limeacmptund«Sec ,B&pCforthu...
w r Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Pemvy Of perjury one of lie following decimations:
rl I ham and will maintain a Ce+dfi®m of Comcnuo ulFinam fm Workefs Com ker-
ation.as Provided for by Section 37W Of the Tabor Code,for the peRarmana of de
work for which this permit is issued.
1 neve and will maintain Worker's Compensation Insurance,a required by Section
of Ne labor Code,for the performance of the work for which this Permit is issue( '
My Wafture C(ompensation Insurance artier and Policy numy«a :
Cartier. 7.J 4/ODS–'(i Policy Nm.:.,mt �
CERTIFlU OTk F�EXEMPTION FROM WOR ERS'
COMPENSATION INSURANCE
Tbus seenuo need Mt be complced if lbe Permit is formic hundred dollars(SI W)
«less)
1 certify thin in the performance Of Ne work for which this Permit is issued.I shall not
employ any person in any manner so as of become subject Of the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificam of Exemption,you should
become subject m the Worker's Compenseumn prwmarks of Me Labour Cede you muss
.J O foMwith comply with such provisions or Nu permit shall be m
deeed rooked.
Z h CONSTRUCTION LENDING AGENCY
t-i Ihemhy ar0rm Met there use coosvucdnn mnding.gcmy for the perfurmanmof
C' the work for which this Permit u issued(Sec.3o97,Ci,C.)
GQ Lmdcr's Name
z Lender's Address
U Q 1 certify but 1 have read this application and sate that the move information is -
D. correct.1 agree to comply with all city and county ordinances and sure laws minting to
tF.7 building consimetimn,and hereby authorise mpreunutives of this city to cnmr upno the
a W we-mentioned pmpeny for inspection ra"ua.
Er„ 0. (We)agree to save,indemnify and keep hamless the CITY of Cupertino agmina
liabilities.Judgments.casts and expenses which may in any way seems against aid City
V z in consequence,of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WIL Y WITH.ALL NON-P01
;- souR c noivs. Issued by: Date �'2.�, p L
Re-roofs
Si reof ApplianUCantracor
HAZARDOUSMATERIAL�VI SURE- Type of Roof
Will the applicator forum Wilding Oce$ stomorhandle hayardoa mammid
a defined by the Cupertino Municipal Code. aper 9.12.and the Health and Safety
COM,C1 Y.on zss3z(a)7 ,a All roofs shall be inspected prior to any roofing material being installedwill the m,liamto if .
r
If a roof is installed without first obtainin an inspection,l a uwre Wilding arupam esu cyuipmem ser dcvims which g Pe gree to remove
omit boyamous air conaminants as defined by the Bay Area Air Quality Management all new materials for Inspection.
District?
❑Yes q
1 have real the hasardn is materials requirementsundo Chapter 6.95 of the Cali for.
"is Hold,h Safely Cede.Sections 25505,25533 and 25534.1 undcrsund Naz ifde Wilding
does rot cunendy hoc a enanL that it'a mihil' ufy the occupant Of up
requiremcnu ich bemetpdO .am m'enihO:mmraapa Signature of Applicant Date
ow ran bori.m agent D All roof coverings to be Class"B or better