05080263 CI TY OFCUPERTINO �...,„ ,
BUILDING DIVISION PERMIT ON-RAC�TOR INF RyMATIO g
BmLDINGADDRESS: MASTER BUILDER & CONSTRAC MMI,NO-05080263
10510 S TANTAU AVE
OWNER'S NAME: PERMIT ISSUE DATE
WAYNE LIN 2003 ABBEY LANE 09/15/2005
E; SANITARY NO. CONTROL NO.
(408) 866-0999
ARCHf1EC PENGINEER: BUILDING PERMIT INFO
BLOO ELECT PLUMB MECH
3"0o LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 or N^Business and Professions Code,and my license is
^ infullf.rcemWeffem REVISION--STRUCTURE .CHG TO TOWER PORTION
Z Lken.Clans�_Lk.g t 2a�-aR-
Dam Contrxw NO NEW PERMIT ISSUED/ORIG. #04100126
ARCHITECTS DECLARATION
I understand my plans dull W used u public records
gyU
y Licensed Pmfeani...I
OWN R-BUIIDER OEthe Communes
E ON
I hereby Maso affirm that I's..Rm.ptBare from Ute Conine Coast:
Licence Law for sic
O O following Mason.a Permit
t 7031.5.Bualter.and ere,de Indications Conk:Any city or county
$� which requires a panic w c.nstrec4 alms.Improve,demolish,or repair any structure
_ZH^ prior to its issuance.&)an requires the applicant for such permit to file a signed statement
$Fq< tisat W is licensed punuamto the provisions of den Contractor's Let=Law(Chapter 9 Sq.Ft. Floor Area Valuation
3$ (commencing with Section 7000)of Division 3 of the Business and Relations Code)or
bxe
3 that W empt Nerefoem and te hbub for the alleged exemption.My vloh0on of
Section 7031.5 by my applicant fora permit subjects the applium Ina civil penalty of pPN Number Occupancye
not more than On hundred d.11ars(SSW). 37537021 . 00 �'P
❑1,asownmoftiie property,ormycmpluyses with wagesas thelrmlec.mpemation,
will do the work and theswuure b not intended modicum fouale(So,.706/,Business Required Inspections
and Professions Code:The Contractors License law does set apply to an owner of q P
property who WIlds.improns therecn,andwhodoeasuchwwkhimaelrmthmugh Ms
oem.mployean.provided Nat such improvement.are not intendW..Rael fee sac.if.
however,the building or improvement is sold within one year of compledw.the ower-
builder will ban lie burden of proving that he did not Wild or Improve for purpose of (�
Nle.). V
❑1,as owner of the property,am exclusively contracting with licensed ronuuurs to
construct for project(Sec.7064,Business and Profeulom Code:)The Contractor's U. v
cense Law does not apply 0 an owner of property who Wilds or improv demon,and, \�
who contracts for such pmjem with a contractors)licensed pursuant be the Commeto's V
License Law. j�
❑lamaamptundu Sea ,Bk PC(.thisman.n
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affime under penalty of perjury oar of the following declentions:
I ben and will maintain a Ce thiata ofCnment in self-ince for Workers Comp^n- .
cation.u provided be by Section 3700 of the labor Code,for the performance of the
work for which this permit is Issued.
❑1 ban and will maintain Worker's Compensation Ins oract,a enquired by Section ,
37M of the lab.Colo,for the performance of the work far which this permit Is Instant.
My Wmkte�hfCom�per.edonInmra.neauicr and Policy muster Ron: n,
carrier.f� l tl fE Policy N..:y... Pen 1g
CERTIFICATE OF EKEMPrION FROM WORKERS
COMPENSATION INSURANCE
(This semiean mod not W compced Hdo permit bforen hundred dollars(SIM)
nr los.)
1 certify that In the performance of the work for which this permit is issued.I shell not
employ any person in my manner an an k beamembjact to the Worked Compemetion
Law a.f Calit.mia.Dam
Applicmt
NOTICE TO APPLICANT:If,after making this ccedrum of Exemption,you should
become subject to the Workers Compensation provisions of the LAW Code,you muse
.J 0 forthwith comply with such provisions or Nb permit shall W deemed mocked.
'Z
,-s tiCONSTRUCTION LENDING AGENCY
F" I hereby Libre Net then Is a mrtsvuc0on coding agency for the Performance of -
ai r7 0th work for which this permit b Issued(Sec.3M.Civ.C.)
W�Q lenders Name ,
�Z Lenders Addrs
V 0 1 certify that 1 Mee rod this application Rod sum this the awn Information Is
Dr correct.I ages to comply with all city and county.min•M•and main laws relating no
0 Wilding construction,and hereby authorize rtPnxntatins of this city to enter upon the
[i7 above-mentioned property for Inspection purposes.
A. (We)gree to an,indemnify and keep barrels tie City of Cupertino against
TA limilidu,judgments.e.0 and expense which may in any way accrue again&,said City
V',Z in Comeque race of the granting of this pemsit.
APPLICANT UNDERSTANCOMPLY WITH ALLp4I��P0� Issued by: Date ��'�� �'r
SOUR REGULATIONS ,ALL)
1{ween Appli. �. GatRe-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliemt or run=building oaupam store.handle heumous mm oid
an defined by the Cupertino Municipal Code,Chapter 9.13.and fie Health W Safety
,glk.de.secuon 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑YuNu
Will the applicant o"ulu Wilding oaupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
R haumnan ter C.Itamimn4 u defined by 0u Bay Arta Air Quality Management all new materials for inspection.
lricl7
Yu �a
Than rtW Nehuanlas mamrab rcquiromcnu.tier Clupmr6.95 afore Glifor- `
nia H^alNkSafcty C.do,Sccdwu25505,25533ud25534.lundcoand Wtifde Wilding
dao not cunemly bon a tenant.Net It is my responsibility to notify acts ant of 0th
require not which mustWmet ruti.Moance Ora Cud11CMICQcupmc. Signature of Applicant Date
37
.r amh.rbsd ages 1 ,m All roof coverings to be Class"B"or better