05070206CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
,gAjNTkXCTOI2INF&MATION.`'::
BUILDING ADDRESS:
271 TORRE AVE
PERMIT ND.O 5 0 7 0 2 0 6
ERS NAME:
PERMIT ISSUE DATE
I PETER CHENG
PHONE:
SANITARY NO. CONTROL NO.
ARCHI7ECTMNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm On 1 am licensed under provision of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Proficamma Cgda.jnd my lie.. is
in full fares and eGaL A
REVISION -FRAMING MEMBER -
Lice Lk. N
Dem ContractorHOUSE
ONLY -NO NEW PERMIT ORIG 04120088
ARCHTTECI-s DECLA A
onderriand my plans tall he used an public mends
Licensed Profnsiowl
OWNER -BUILDER DECLARATION
I hemby affirm Nm 1 am exempt from the Commator's License Law for the
following mason. (States 7011.5. Buranna and RnfeWom Code: Any city or county
which requires a permit to construct, alter. W pow, demWiab. ar repair my su sclum
prior An its issuance, Alan requires the applicant forsuch permit to file a signed statement
that heisliccnmpursuant dpursuanoNeprovisionoftoContractor'sLicenselaw(Capur9
Sq. Ft. Floor Area,
-
Valuation $0
(commencing with Section 7000) of Division 3 of the Business and Prpmssiom Code) or
that he u exempt Nemfrom and the basis for teassumption. My violmioe Waged an of
APN Number
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the spplkmt to a civil penalty of
not mom than Ra hundred dollar (5500).
36940017.00
❑ I, asowmsofthe property. ormyemplo)en with wgaudse'u anlecampertatian.
Required Inspections
willdm tawork, ondueauucwahatinmukdorortered forum(Sm.7044, Business
and Professions Cole: The Conlmctor's License Law dao tai apply to an owner or
9 P
property who but Ids or im pante thereon, and who dues such wok himself o through his
mm employees, pmvi thmsesh improvements am not intended mo0ered forsale.U,
however. the building or Improvement is mid within on year of completion, the owner -
builder. will hew the burden of proving this W tlld not build or Improve for purpose of
ilde
.in.).
\
❑ 1, As owner of the property. am exclusively contracting with licensed ttnumtom an
construct the project (Sec. 7094, Business AM Profession Cm 1c:) The Cantraemfa Li-
V
cease law don not apply to an owner W property who builds or inapmw.t Norton, and
who anueem for such projttV WN a ronuator(s) licensed punwm an the Conuactots
License Law.
\
❑ 1 oto exempt under Sec. . B k P C for this moon
Dam
WORKERS COMPENSATION DECLARATION
I hemby affirm under penalty of perjury one of the following dedatadons:
-
❑IaveaMwBlforby •CWOwm mf ConventmselFWmeue Wadrm..of
the
codon, provided for by Section 3700 of the IdWr CMe, for the performance of the
r
work for which this permit is issued. ,
I ave and will maintain Worker's Compensation Insurance. As required! by Saction
of the labpr Code, for the Perfm ofthe wok for which this permit is issued.
Myier: ati
BI con palnntte 'er and Policy number art:
s p
Cartier. Policy i
6SS'
CERTIFl NFROM
COMPENSATION INSURANCE
(Thisscedmn need at W comple ed if the permit is furone hundred dollars (5100)
or less)
1 certify thin in the performance of the work for which this permit Is issued. I call no
employ any person in my manner an u to became subject to the Workeri Compcnsamm
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, Mact making this Can ricate of Exemption. you should
become subject to the Worker, Compcwuon provisions of the Labor Code. you mum
forthwith comply with such Provisions or this permit shall W dorso d ranked.
CONSTRUCTION LENDING AGENCY
I hemby affirm that there Is a comuneWn lentling agency for the performance of
to work for which this permit m issued (Sec. 3097. Civ. C.)
L<Mer's Name
,
Lender's Addrns
1 certify vel I have rW this application aM sum that the own information is
mann. I agree to comply with all city and county ordinance and sum law retailing to
Wilding convection, and hereby mthoim mpresenutins of this city to color upon the
ahove-mentioned Property fm Inspection purports
(We) agree w an, indemnify and p less the City of Cupertino against
'
lubilitree,judgmenta,cou andcapcaa I Amey In any coy secrw against cold City
In consrgmnce of the gaming p(thi3
APPLICANT UNDERSTA AN IL LY WI ALL NON -POINT
Issued by: Date
SOURCE REGULATIO
Re -roofs
Signawre ofd wanVCmnlnop Dau
NAr AS 5 MATERIALS DISCLOSURE
Type of Roof
Willftapplicant a(alum Wildingrto handle materisi
Iter
Health
defined by the Cupertino Municipal Code. ChaNer 9.12. ami IM Nnith and Sanity
e. Chap
e, Section u53za)7
Yes ro
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without fust obtaining an inspection, I agree to remove
Will the applicant or (,m\um Wilding occupant use equipment or devices which
emit haurtlnw air cenmmimnu a dc(Ined by tiro Bay Ams Air Quality Management
all new materials for inspection.
DiWictT
❑Yes �Nu
Ihave read thehmsNom alt on un4r ChaPtor6.95 oItite Glifor-
nhHwlth6SafctyCodc,Secti SOS. 53 35534. mund thin ifthe Wilding
Jas rel cumenlly hon t R b ymspoaibl we mify the ace to
mqulmmcnuwhich W priorto1 ammonia ficateof cap
Signature of Applicant I Date
All roof coverings to be Class "B" or better
owner
or nmrirna.gen