06080184CITY OF CUPERTIRO
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C.i1,I.'li>TR,�C.t1R IN(?RNIATI
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
J T CONSTRUCTION
PERMIT NO. 06080184
030 STEVENS CREEK B
R'S NAME:
PERMRtSEUEDATE
MICHAEL CHEN
1720 OCALA AVE. —
08/22/2006
PHONE:
SANITARY NO. CONTROL NO.
(408)272-4570
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
LICENSED CON RACIOWS DECLARATION
lob Description
I hereby affirm Nal 1 am thredud under provisions of Chapter 9 (commencing
with Section 7001)) of Division 3 of the Business and Professions Code, and my Inenso is
in Tall fame And=4
DEMO INTERIOR ONLY - REMOVE PARTIAL OF THE
Lia.nAS Clasaue.g
Dumr
em Conu
INTERIOR PARTITION WALLS
•' ARCHITECTS OECLAR ON
I understand my plans shall he used AS public mcnrr4
Licensed PmfG3lonal
OWNER -BUILDER DECLARATION
1 hereby When that I em asempl from the Corcractaes License Law for the
fallowing mason. (Section 7031.5. Business and Professiu s Cade: Any city ar many
which requires a Permit to cansuu t, apes. Improve, demrlkh, m minor any suunum
prior to its issuance. also requires the applicant for such permit to file a signed statement
law(Cleaper9
Sq. Ft. Floor Area
Valuation
mat W k licensed pursuant to Me provisions of the Contrazmriluense
Secdan 7000) of Division 3 of the Business Send Professions Cade) ar
$ 5 5 O O
(commeming wide
that he is eaempl therefrom and the basis for the alleged esemPdM Any NolNan of
Scotian 7031.5 by airy applicant for a permit subjects dee applo sat m A civil penslry of
APN Number Occupancy Type
nor moss man five hundred dallars (SSW).
0 I,uo oflhapmpeny,mmympl0ymwideomegautite4miccompmaadon,
will do She work. And me stmCtan A 11ommo1dedwaffered f0lYm(SO. 7044. Business
Required Inspections
q P
and Profasions Cede The Commences License Law does Out apply m an owner of
progeny who builds or improver die mn, and wheduessuchwork himselfor dmugh his
ownamploloom, provided that such improvements ase notintanded maffered forsak. If.
however. the building m Improvement is mid within am year of wmpleiOn. the Manor -
builder wiB hew the burden of proving that he did Out build m improve for pWpou Of
ASIA.).
0 1, u Owner of the property, am exclusively contracting with licensed contractors in
construct me pmject (Sec. 7014, Business and Professions CAIM) M Communes Lt.
on. Law done not apply n an Mo Ur Of proPeny who booms Os barroom me nun, ted,
who con wm i far such projects with a eonuacmrts) licenud pursuant m the Conuacmes
cats Law.
excenumder Sec .Bk PCfmmismuom
Data
WORKERS COMPENSATION DECLARATION
I hereby R. under penalty of perjury aro of dee following deuvuionz
0 I have and will mminWn a Cesd(amofComent m ulf-ksuu fm WaheeaCompm-
saoon, u provided fa by second 3700 of Me, Labor Code. for dee Per(armanm of dee
wah for which this permit is ivmd.
0 1 have and will maintain Wohees Compmssuan Luurana, u required by Section
3700.f dee Labor Cada, far No onformsnee of the soh for wbkh this permit is issued.
My Workers ampenuuan Insurance artier and Policy number ass:
Grtier. rr Policy No.:
CERTI• EO X PI70N FROM WORKFItS
COMPENSATION INSURANCE
(This Section need sol he completed if the portion fortune hundred dollars ($100)
less.)
I cenify that in the performance of the work for which thn permit is leaned 1 shell not
employ any pomen in my manner AS AS m become abject to the Workers' Compensation
Laws of C311MM A, Date
Applicant
NOTICE TO APPLICANT: If. after making this Ceniriale of EaemPlian, you mould
become subject in the Waheea Compemadan provision of thA Labor Code, you most
r foMwim comply with such provisions or this Permit still he dxmed n eked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that mea is lending Agency for dee performance of
s ed (S .3
the wuh for which this remelt ls Tuned (Sm. 3(197. Civ. CI
Landces Name
'
Landeh Addrw
1 cenify that I have read Ws application and sun Nu the above IAfomudm k
• conch. I aVee to comply with all city and county on inmms and mu laws Slating to
Imilding construction. and hereby authoda reprcunutims Or IMS City AS Cnter upon me
for insrcction
above-menooned property purposes.
IWC) Agree to Yw. Indemnify and kap barmiess the City Of C'upeNno against
I Ilabilitia.judgmmn.cmu and expenses which may in my way accrue agalma Yid City
r M conso umca of the gaming of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
2,-U S/
Issued by: Date
souac, BljgcuLATI
)�
�y�� y !
Re -roofs
Type of Roof
Sigmtu ofAppli HAZARDOUS MATERIALS DISCLOSURE Dan
Will the applicant Or future Wilding accvp uanae ar handle hundous material
Bned by ote Cupmino Municipal Code. Chapter 9.13, and the Health and Safety
Je. Semon 25532G)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Ya EA
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will dee applicant or future building occupant an equipment Or devices which
emit hauJNous Air conuminanss As dented by the Bay Area Air Quality Managemem
all new materials for inspection.
Disuict7 ,.,(
❑Yes lino
I have road site humdma materials mquirerrcnts under Chapter6.95 ofthe Cadifor.
maHaW st SafetyCoOA. Secuats255a9, 35533 and! 25534.1 undcnund thnifthe building
am ont amordoy haw a rmanl Nat it is my rapamihiltly to noufy den occupant of the
roquiscmena which most be met psiormiscumccofa Ccrori waf0cm cy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
OWmrIXaY n)lda end Dam