06080222 CITY OF CUPERTINO
BUILDING DIVISION PERMITC�NTRAGTORyINFORMAT19N
BUILDING ADDRESS:
PERMIT NO.06080222
20163 SOMERSET DR
OWNER'S NAME: PERMIT ISSUE DATE
i
CALVIN CHEUNG 2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTPENGINEER: BUILDING PERMMNFO
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9 PMB MnECH
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±oo LICENSED CONTRACTOR'S DECLARATION lob Description
%F Iced affirm this I am licensed Bu under provisions oshaper 9(Commencing
with Section7tlg17 of Diviaion]of the Businessand Profcstium Codc,and myliccvc is
+�„ mrwumeadCffICL � ADDITION 233 ' FAMILY ROOM
y�'? Liecnac Clues Lic.M
i; w Dam Q'Idf Jam-Contractor YN M
ARCHITECTS DECLARATION
F U I uhdersund my plans shall he used u public reCome
ad
C H Licensed Professional
to
OWNER-BUILDER DECLARATION
f I hereby affirm that I am exempt from IW Contractors License Law for tW
po fallowing lesson.(Section lap L5,Business and Professions Cole:Any city or county
CCC
fi which regal.x permit to Construct alter.improve.demwiah.or repah any awcwre - $49948
Prior to its hatamcc,)w requires do applicant for such permit m Ble a signed aammcm
ss< thatW islicmed pursuant to the pmvisions of the Contractor's Uhahsc Law(Chapter 9 Sq.Ft.Floor Area Valuation
ul-� (commencing with Section 700)of Division 3 of she Business and Professions Cade)or
NR�_ Chat he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant10 a civil Finally of r Occupancy Type
not mom Nan five handled dollars(5500).
L u owner of Che property,m mY cmpioyees with wages u their salt compewtion,
will do the woda.aad meawcwmiare,iomtwmoronersd foraale(Sec.7044.Business Required Inspections
and Prof ediions Code:The ConuKmh License law loco set apply m an Owner of q P
Property who builds orimprovrs tWreon,and whodoessuchworkhimself or through his
awn employers,provided dos such improvements are nut intended oraRered forsale.If.
hewevv,me building or improvement is sold within cove year of compledon.the owner-
builder will have the burden of proving Cast he did not Wild or improve for purpose of �W-
sale.).
Q I,as..,of the property am CaClutivCly COnOazting wIN licensed eoa.m.as
conswct she project(Sec.7044.Business and Professions Code:)The Contractors Li-
censeLaw does not apply toanownerofprop,sty who Wilds or improma thereon,and,
who contracts for such Projects with a condacmr(s)licensed pursuant an the Contractors
Liana taw.
❑lam exempt under Sea ,B k P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 WabY Nrsn under perW ty of pmjury ane of she folbwing declararians:
D I ham and will maintain a Certificate of Consenuo self-insumforWorkcrsCompen-
satimn.as provided for by Section 37M of Che Labor Codc,for Ne performanm of she
work for which this permit is issued.
D 1 have and will maintain Workers Compensation Insurance,as acquired by Section
37M of she Labor Coe.for the performance of the work for which this permit is issued.
My WafkCe,Compensation Isuv .aarier and Policy numberan-t— I
Carrier: IWL13L)T Policy No.: —%dk1iQ s M'wp
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu smion head net he Complc¢d if the permit is for one hundred dollars(Slot)
or less)
I certify Nal in the performance of the work for which this permit is issued.I shall not
employ any person in any maxamrso as m become mbjeci to Cac Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ceniricatc of Exemption.you should
WCome subject m the Workers Compensation pmvisions of tW Labor Code,you most
.J vZ feMwuh comply with such provisions or this Permit shall W decm<d raveled.
Z O CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm that them is a cohvuuction lending agent,,for Ne performance of
the work for which this permit la issued(Sec 3097,Civ,C.)
a Q L eadcr's Name
a z Lenders Address
U C) 1 certify Out I have read this application and state that the above ofomtatiun is
UL r Corea I agree to Comply with all city and county ordinances and stat,laws slating to
0U building construction.and hcmhy authorim represcnttives of this city to enter upnnhhc .
W above-m,nhaned pTperty for Inspection purposes,
E6. (We)agme to save,indemnify and keep harmless Ne City of Cupertino against
" N liabilities,judgmenu,emats and C.N.which may many way se.againn said City
U z in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
aAA�fM–� S/416(o Re-roofs —`�
Signature Of ApFlicvwCDOUS MATERIALS DISCLOSURE ontrateder Dan, Type of Roof
Will the applicant or future building Occupant start or handle hanardous material
as defined by tW Cepanin0 Municipal Code.Chapter 9.12 and Che Health and Safety
Cade,Session 255320)?
Dyes ANo All roofs shall be inspected prior to any roofing material being installed.
Will me applicant of future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ,
emit hvamme,air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dixtrict?
❑Yea
1 have mad the hanod ous Materials aquiremcnu under Chapter 6.95 of Ne Califor.
nit Health&Safcty Cade.Seedmu]5505.25533 and 25534.1 understood We ifthe Wilding
docs not Carmody have a tenant,WI it u my aspumsihiliry m may tW Occupant of me
requirtmants vy0lmh moat he at pa ler la issaahce a fa Certificate or Occupancy. Signature of Applicant Date
V `i�/KIOb
Owns,or authanred agent — All roof coverings to be Class "B"or better