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CY OF CUPERTINO
BUILDING DIVISION PERMIT
COFIELD DR
OWNER'S NAME:
(ESLTE LUONG & THANG DO
ARCHI EC (ENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License Class — — Lic.
Date _ — Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Llconsed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish• or repair any structure
prior to its issuance, also mquims the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars (5500}
❑ 1. as owner of true property. or my employees with wages as their sok compensation,
will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contmctmrs License Law dues not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employees, provided that such improvements am not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for propose of
�)
I, as owner of the properly, am exclusively contracting with licensed convectors W
construct the pmject (Sec 7044, Business and Professions Code:) The Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contmctar(s) licensed pursuant to the Contractors
License law.
❑ 1 am exempt arida Sec B & P C for this reason
Owner Date
WORKER'S COMPENSATION DE RATION
I hereby affirm under penalty of perjury one of following declarations:
❑ 1 have and will maintain a certificate of Consent to ulf-insure for workers compem
sation, as provided for by Section 3700 of die Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the wort for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EX$MPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be compiciedif the permit is for one hundred dollars (EI00)
or leas.)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any mann b m subject to the Workers' Compensation
Laws of CaliforniaDate
Applicaml
NOTICE TO APPLICANT: If, after making this Certificate of Qtemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed mvokcd.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders address
1 certify that I have read this application and state that the above information is
correct. I agree to comply with ail city and county Ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-menLioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE RXGULATIONS, -7
_ r�
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DIS Q 0SURR
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni ipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7
C3 Yes No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
[3 Yes u
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & SafccyCOde, Sections 25505, 25533 and 25534.1 understand thatif the building
dors not currently have a tenant, that it is my responsibility to nodfy the occupant of the
mquiremen)¢ which must be mSprior to issWcc of a Certificate of Occupancy. )
MARK CUNHA'S PAVING
P 0 BOX 1113
(408) 868-0423
PERMIT NO.
08070097
PERMIT ISSUE DATE
07/29/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
Job Description
HOUSE DEMO -PROTECT (E) TREES DURING CONST PER
DRAWINGS.
Ft. Floor
35909004'
Issued by:
Re -roofs
Type of Roof
$150.00
Required Inspections
Date �� L'?
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
P-yj -A - °AA J&&I —I All roof coverings to be Class','." or better