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BUILLD c DPERTONNO PERMIT
CON'TRACT'UR INFO MA,TION
BUILDING ADDRESS:
MASTER BUILDER & CONSTRACT
MITN`b4100126
OWNER'S NAME:
PERMIT ISSUE DAM
WAYNE LIN
2003 ABBEY LANR
02/lS/2005
NE:
SANITARY NO, CONTROL NO.
408)866-0999
ARCHTECTiENGINEER:
BUILDING PERMIT INFO
BLDG EIPCr PLUMBMECH
LICENSED CONTRACTORS DECLARATION
Job Description
under provivons of Chapter 9 (commencing,lie.is
1 Mmby affirm Nal 1 am lfdW
Bu
with Section 7IXI0) of Division 3 of Jo Busimavand Rofestiom Code. and my licence is
in
infnllro eandeff �_
ne.Class
SFDWL-2 STORY (2395'. LIVING)
D
_Uc.A
Dam Covenantor
GARAGE 418 SQ . FT . -
ARCHTE(=S DECLARATION
undcrmnJ my plans shall M user as Public rtmrds
Liecosed Pnsfeuimml
3
OWNER -BUILDER DECLARATION
f
1 hereby affirm Nal I am exempt from the Conuanols License Law for the
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following mason. (Section 7031.5, Business and Pmfeatiom Code: Any city or county
which requires a permit to cnnsuuct, slier, improve, demolish, ver repair any suveture
prior to its issiumee'riburequires Ncapplicamr.'such permitm BleasigrvAsummcnl
thdhc is licensed pur.antro Nc pmvisiov oflbc ConuacwrslJavc law chapmr9
Sq. Ft. Floor Area Valuation
=
(commencing with Section 71100) of Division 3 or the Business and Professions Code) or
that he is exempt thcrefmm and the haze for the alleged eumpdon. Any violation of
$421950
Section 7031.5 by any applicant for a permit subjects Ne applicanUo a civil penalty of
APN Number
Occupancy Type
any mom Om five hundred dollens500
().
❑ Lo owner of wish wgaaafei(See
and0. strsy.mmYemntende 70",B sines
will Prthework soda: swmurt Isnotintendedorove defor Ne(SaAOan,Bnerof
.d oro Cade: The Litems uw doet not apply m an owner or
00
Required Inspections
property musermis
property who builds orire and who doe ssuchwork himalf edthrough his
unit such
Nat such impmsemenuart not intendedmoffned for sale
otramemployoct.WiProvided
however,mantis sold withinamWildormmpkdon,the r-
builder,Ne building .den
of puowner-
builder will have Um Widen of proving Nd he did net build or improve for purpose of
sale.).
❑ 1, as owner of the Property, ant eaclusivelY commeting with licensed ennammrs in
comwn the project (Sec. and Cade:) The Co 's
o an OwneHudr
of whnistWi
come taw dies not appy m an owner of property who builds or improves Corton, and
property theree nd
whofor ms such pmjewish aconvm
contractor(s) licensed purwm m the Contractor's
��
Lace
License .law.
slam eacmpt under See. ,B&PCrm w
0 Nis on
Owner Dam
WORKER'S COMPENSATION DECLARATION
O�
1 kraby affirm under penalty of perjury one of the following decimations:
haw and will maintain aCeNOnu of Consent to self -insure for WorkeriCompce-
u provided for by Section 37W of the labor Code, for the penrormma of the
work for which this permit is issued.
L have and will maintain Worker's Compensation Insurmtt, az required by Section
l of NC Labor Code, fm Nc performance of the work for which Nu permit is issued.
My Werice.Coom..p�e�tti
Compensation Insurance, artier and Poli, num6cr me -
Carrier. V-�''�-..eK-Ct:YY-451 Poli, No.:
_
CERTIFICATE OF MON FROM WORKERS'
COMPENSATION INSURANCE
(This sectian need not W completed tribe permit Is fmonc hundred dollars (SIM)
or ksa)
1 certify Nat in Nc performance New rk for which Nis permit is issued, l shall not
ereployanypermnirsmymannef nazi ccome sOutto the Workers'Compensation
Laws of California. D k
Applicant
NOTC ANT. I. sR n t ts CenTcam or Exemption, you should
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become subject m the Worker's Co eme, on provisions of tae Labor Code, you most
ronhwith comply with such provisi soy Nis Permit shall M deemed revoked,
vy
CONSTRUCTION LENDING AGENCY
>
1 hereby M. Net On. is a eomvuction lending agency for the perrormanm of
the work for which this permit is issued (Sec. 3M. Ci, C.)
0
Lenders Name
Lender's Address
z
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1 cudfy thai 1 have road this application and stem that the above information is
F'
mum. I agree m comply with all city and county ordinances and sum laws mlding m
VWilding
conscdrn, and hereby authodm mp sacntatiru or Nu w city enter upon the
unabove mentioned pmPerly for inspection
W
gy
purposes.
(We) agree to save, indemnify and keep harmless the City of Cu againd
h
autism
gnu, gritting c.pactuOf cennit. may inanyway attmc against aid City
incoitiutanct, Of Negrantin this
this per mil.
APPLI
'-'
ANT DS
APPLICANT UND R ANDS AND WILL COMPLY WITH A NO POINT
Issued by: Date
SOURC REGULA S.
C IS m
Re -roofs
-
ignatuic of A,lian p k
H DOL S MATERIALS DISCLOSURE
Type of Roof '
Will the applicant or future Wilding occup intstore or handle haranlous material
az defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
user
0Ya No
Will Ne applicant or future Wilding occupant use equipment or devices which
vaMous air contaminants ss defined by the, Bay Area Air Quality Management
W"'b Yes An
I have mal the hxramousmamrials requiremenu undcrChepkr 6.95of thc Califon
nia Hcal"SafetyCodc.Sccumu 255(15.35513.115534. Itndcrsl.d thaifNe Wilding
rocs not cumcntly how • 4 Nm it i my romibility ic notify the occupant of Nc
myvi4cmcnu which must t prig . iaudwc mc fir a CcmOcak of Occup.cy.
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
Applicant Date
All roof coverings to be Class "B" or better