07120254PERNUT
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BUILDING DIVISION
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amLT9tNp�7goaE;TANFORD PL
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TBD — TO BE DETERMINED
PERMIT No.
07120254
OWNE/WSS NAME:
PERMITI%UEDATE
JOHN LIN
03/21/2008
NE:
SANITARY NO. CONTROL NO.
ARCHITECrIEENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CON'TRACTOR'S DECLARATION
Job Description
1 hereby afnrm am 1 sm Iischad under provisiau of Chamer 9 (commencing
with Section 7000) ol'Dirlsion 3 ofthe Business oil Prowssiam Code. ad my license is
ADD BAY WNDW AT FRONT ROOM
I. full fora and ellen.
License Class Lk. R
Da¢ Camrseur
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ARCHmSCrS DECLARATION
1 udcrshsnd my Plans shut W used u public mmrAs
Licensed Pmfcssiontl
OWNER-BUILDER DECLARATION
I hereby alflrm that I em exempt from the Contramo', Umme Law for Ne
following moon. (Section 703 1.5, Business ad Profead0ex Cade: Any city or county
which mqultex • permit m cnruuow, mun. improv. demolish. a repair my stmnum
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prior m its issuance. afro mamma Iran Applicant ronuch permit a file asigned mumem
Nu he is Bcenaed the of we Contractors umac Law (Chapter 9
Sq. Ft. Floor Area
Valuation
purmantW provisions
$10000
(eanmcing with S.W.7000) of Division 3 of the Business and Professions Cde)or
en
Nu W is esempt therefrom and we basis far the alleged esemptim Any Molatim of
�,ppt Number
3 93 2 02 6'
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
ml seam dn five hundred hundred dollars (5500).
5 : Y1 U'
❑ 1, u owner of use property. or my employees with .3n.linear role mnpemadon,
..
Required Inspections
will do Newark. and the structures is ml rounded or ofwred for saw (Sm. 7044. Business
and Pro(ndam code: The Ganuseufs License Law does mt apply w an owner of
property who builds m improves rhermn, ad who does such wok rimself ar through his
own cmployen-paNded than such Improvements are not rounded maRered for saw. if,
however, the Wilding or Wpmvmant is to within ore your of.amphadon. Cu owner-
Wilma NE have the WNm of pmHng that h did ma would or Improv for purpose of
uw.).
1, u owner of the property am exclusively contracting with licensed mntrsemn in
.
construct the pmjen (Sea ION. Business and Profnsiam Cade:) The Conmcorrs Li-
came Law don set apply an an owns or property who Wilds or imp.. demon. and.
wWmntacls forsuch jecta with a corma,N(s) limed pursuant to the Comnctofa
Wnrust Law.
❑ 1 ore exempt under e 11 . E A P c far aw awo
0.a^a r Dau
W KERS COM ON DECLARATION
I WsebY under peexlty of 'ury I o(Ne following declantiaex:
M+eAMwillm tsieaCeNOnu fCansentmself-Inaumfurwo1we.Compen-
m, u Provided f by Section 77110 of tits LaWr Cade. for dm perfonnarc of Ne
a ala for which this permit is issued.
❑ 1 have and will maintain Workces Compeuadon Imuranm. a required by Section
3M of dam Labor Code, for the performance of the work for which this permit is imued.
My Words Compensation Leanne curter and Polity numbs are:
Cartier: Pollcy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Olds send. sed set be canpkud Htiw permit c forma, hundred moan ($100)
or ectal
1 eartify then In tic,wromrance Ne ruck (m which thus permit a issucd, l shall set
employmypermninanymum,r m aslobecammmbjecl tiulVorkwo'C open m
'
Laws of CaRfolow. Dow
Applicant
NOnCE TO APP fP. If. a Ter m ng this Cool I w of Facmpuon, yaa should
Immune subject w Ire rkerS ampeexlu0n pm "i m Labor end,, you reset
forthwith comply with sue oris or Nu petmi All mod m okd.
'
CON CIION LENDING AGENCY
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1 Wmby afllrm this Nem is a conmudan lending agency ren IW performance of
IW work for which this permit is Wood (Sm. 3097, Civ. C.)
'
Larder's Name
Unice. Address
I I certify that I lave read this application ad saw that we aWve informdm a
' cortam l artme w comply with all city and county ordinames and raw laws wiNng In
Wilding construction. and hereby authorise representatives of this city N enter upon the
shoe-mentioned property for impecum purposes.
(We) agree to am indemnify and lamp harmleu the City or Cupertino against
j IIabllides.jdgmens.cats and summer which may In my way amu, agairut said City
in eansegthe f the standing of Nis limit
2
i APPLICANT NDERSTANDS AND WI C PLY WITH ALL NON-PO NT
SOURCER LATIONS.
/ —
Issued by: Dale
3 /
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Re-roofs
Type Of Roof
signal fA ❑eanUCanRsewr Dau
HAZARDOUSM A ISCLOSURe
w911 pplicant or future building occupant show m handle haurdmm natural
u deflnd by Cupenim Municipal Code. chap= 9.13, ad Ne Health ad Safety
cde. SCLilen 25533(a)1
All roofs shall be inspected prior to any roofing material being installed.
Oyes 0N
If a roof is installed without first obtaining an inspection,agree to remove
Will the applicant our fumm Wilding occupant ran mpopmeel or devices which
.l
it huallom air conumiexnts u defined by Use Bay Area Air Quality Management
all new materials for inspection.
cff
❑Yen ON.
I have mad tits udaw materiawmquimments under CMpterQ95ofNeCAlifor-
nwHeal"Safetyco e, Sections 35505,33533 and 75 q. Iwtl,nuod was a Ne dtildrng
does set monody het a manL thsh it c mymmvaappp vi I11+p na ley dam occupant of the
requirements which mW met priof wjpmancr! a m'fulw aroampaney
Signature of Applicant Date
�N II 3ylo
All roof coverings to be Class "/¢ or better
ow owe
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