06070066 CITY OF CUPERTINO >x
BUILDING DIVISION PERMIT CQNTRe� � QRINFURMe� T(?.N
nt
BUILDING ADDRESS: ENDE WU PERMIT N0.06070066
20641 SCOFIELD DR
R'S NAME: ISSUE DATE
/ ENDE WU 02 /16/2006
PHONE: SANITARY NO. CONTROL NO.
4D - �e 8
ARCH NGINEER; BUILDING PERMITTNFO
BLDG BIvECf PLUMB' MECH
op LICENSED CONTRACTOR'S DECLARATION Job Description
�+ 1 hereby affirm d a I am licensed under provisions of Chapter 9(commencing
with Sector 70(0)ofDiNdm 3 O th.Basin.and Profestiuv Code.att my lice.is
' in full force anderfecL NEW ACCESSORY BUILDING INLAWS QUARTERS 631 SQ
i License Clus Lk.N
rs- Dur_Contractor
ggg ARCHITECTS DECLARATION
j I understand my plans shall he used as public records
s
'Q Llcomed Professional
I OWN ER-BUILDER DECLARATION
:M 0 I joichy dent 11. exempt from the Contrutors Lieenu Law for dee
.p O following won.(Seton 7031.5.I.S.Business and are.de Professions Cade:Any city st manly
j$ixi which inquires a purer re cnvtrucL short.improve,h per demolish,u a repair any mumunt $135267
.zY privmits issuamPalmro to the the applicant forthe Cohrarmi'mfileasigned
..(Chxmem
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that heialic.nxdfurwanllolh.provision sfdecContractur'eLicenseimw(Chapter9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Profess ions Cade)or
that he Is exempt thaefrom and the basis for the alleged exemption.Any violeton of
Section 7011.5 by airy appliant fora Permit subjects the applicant in a civil pmdty of r Occupancy Type
not mom tun five hundred dollar(5500).
❑I.u owner of the property,or my employees with wages u then ink compensation,
will do the work,and the structure is Out Intended or offend for sale(So.7044,Business Required Inspections
and prordoe v Cade:The Communities License law don ant apply m an ower of q P
property who Wlldseimproves termn.and who docusnb wort himxlfonr tuougb big
own=play=,provided thu such improvements aro set Intended eroffered for sale.If.
however,On.building or Improvement is mid within one year of cempl.m.,the owgor-
builder will have the busman of proving that he did Out build or Improve for purpose of
ante '
1.
as owner of the p.Perry,am exclusively mnmeming with licensed conmame,m
.=I tse posca(See 7044,Businex sed limitations Code:)The Constructors Li-
cove law does not apply man owner of property who builds ar improves Merton,and,
who convects for such projects wide a conumtor(s)licensed pursuant to the Communities
License law.
❑Ism exempt under See .B&Pcfa deism n
Date
WORKER'S COMPENSATION DECLARATIO11FN
r 1 dertby e?m under penalty,of perjury one of dee following decluadans
❑Ihom nttwillmaintsinsCenifimto of Covent to self-InmrtforWarkersCmnpan-
onargf u pro h thi fpe by sedan 7700 of the labor DOde.fm tx peRonnan¢of dee
wort for which Nu permit is issued.
❑I Mw and will mainmon Wahers Compensation Insurance.as required by Satan
3700 of the labor Code.for the perfarmane.alias work far which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number one:
Lamer. Pocky Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITlssectinn good Out h.compimed If the permit Is fm one hundrod dollen 411)
or les.)
I cutify dons In the We..of the work for which this penell is Wood.I shall me
employ any person in any mangorm to become subject m Ute Woreari Compenutm
Laws of California.Dim y
Applicant
NOTICE TO APPLICANT;If,after making this Certificate of Exemption,you should
become anbjca to the Workers Compmado,provisions of the lahnr Cede.you muss
.J O foMwith comply with auger provisions a this permit shall be famed tevokcd.
�
CONSTRUCTION LENDING AGENCY
'Z,r'
EIhemhyufirm"then ion covtrntim lendingamney for the peffurnme,or
rl,> tx work for which this permit is land(Sec.3097,Civ.C.)
14Q Letters Nun.
n7. lendersAddress
U O 1 certify that I haw rend this application and sum that dee show Information u
ly f~ torten.l agree Is comply with all city and county ordinances end sum laws relating to
Ubuilding construction,and hereby Authorin mprvcnwivcs o(this city to enter upnn the
417 above-memiuned property for inspection purposes.
!F^+fy (We)agree to saw•indemnify and keep harmless t¢City of Cupertino ayinst
cn liabilities,judgmanls,costs and expecting which may th my wayumue agdvtsaid City
U Z in conxquance of the gaming of this permit.
^v APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON-PORTf Issued by: Date l7 `yJ
SOURCE REGULATIONS.
& 166 Re-roofs
Signuum of ApplicanUCanwmorax
HAZARDOUS MATERIALS DISCLOSU Type of Roof
Will fm applientu future building oc<upantatme or handle her udous material
de0god by the Cupentire Municipal Cade.Chapter 9.13,and rte Health and Safety
SCNan 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes )(No
Will the applicant a future building occup ut use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit humorous air contaminants an de0ned by dee Bay Arta Air Quality Management all new materials for inspection.
District? J
Ely. Dp Ni
I have read the hevudrus muariala requvemewunderCMPxr Q95 of the Cilifom
nu Health&Safety[tide,Seetieru 25505,15533 att25534.i underswd thuifthe building
des not currently how a tenant,thus it is my reputability to nodl'y occupant of the
requirement which must be m or issuance tiro ccrulic r way Signature of Applicant Date
�4/Q6 All roof coverings to be Class"B"or better
Owner or authorbmd agent Dam