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CITY OF CUPERTINO
BUILDING DIVISION PERMIT.CUIY`.['RrCCTQR
,
TIU„RMATION,
BUILDING ADDRESS:
PERMITN0. 06030110
0
OWNER'S NAME:
PERMIT ISSUE DAM
HARRY AND CAROLINE HUANG
NE:
SANITARY NO. CONTROL NO.
HITECTYENOINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IDa.m.
0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
I Wroby afnm Nn 1 m lican voter provisions of Chapter 9 (commwtlng
SectionlOOMof DiMelon3ofde B,Wnoud Professiom Co .andmyIkenmk
ll farm Ideff.a
SFDWL-2 STORY 4,403! -GARAGE 718'
Ova Lie. d
Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used an public escorts
Licensed Professional
OWNER -BUILDER DECLARATION
1 barely AMM that 1 am ucmpt from the Contractors License Law for the
following mason. (Section 7031.5, Bulinus and Prureuinu Cole: Any city or county
"
which tequiroa a permit in construct. alter, improve, demolish, or repair any structure
prior to ids iuuanee, sten requlma the applicant for such permit b Trio uigneJ wtemem
also Me
rrite Conuxemitorile slaw
Sq. Ft. Floor Area
Valuation
tludm previsions (Chapter9
that he is licensed pursuant
(commencing with Section 7030) of Division 3 of the Business and PrerCRlom Code) m
$1100970
that he ds exempt thmefrom and to heads for the alleged exemption. My violation of
APN Number Occupancy Type
Section 7031.5 by any applicant for a permit mbjecs the applicant m a civil p.uhy ter
not mart NN five hundred dollars (SSW}
0 1, at ower. of tie property, army employees with wages u tle'vwkc.npenntion.
tended.o@forsak(Sec.70 .Burman
wiBdathewrk.wdtheaw. wtkrtd
Required Inspections
9 P
acrs Laeue wm law does t apply an owner of
The Cum
and Preheating CadeThe w
property who Wants or improves themon,aM who doessuchwmthimselfor through his
own employees, provided Nat man mprovements me mt intended araRnN f.asle. U,
however. the Wilding or improvement's sold within am year of oompledon. the owner -
build. will have Me boom of praying that he did wt build or improve for purpose of
ask.).
1, as Owner of Ne property, am eaclusively cwbuting with licensed conaact.s in
constmet the pmjecl (Sec. 7044. Business and Profassions Code:) The, Contractors W-
ceue law does not apply in an owner of pcopenY who WIWs or improvm thereon, and.
who contracts for such pmjeN with a conuectm(s) licensed pursuant to the Contactors
License Law.
❑Ism teem under . B d P C far this maysen
-
Owner Damn w
W RK SATIC L.ARATION
1 hareby atom pewit of pe' oro f de falkwing decWadoee
Ihsroatdwillmaimanacenifcs afC w-Ir.a mr.Wtultse Compml-
on, u pmvidcd far by Section 371 of Lha Code, for the peRarmarce of the
work for which this Pamir is issued
❑ 1 lune and will maintain Workers Compensation Iamumco, as required by Section
'
3700 of the Labor Code. far an Performance of On work for which than perch an issued.
My Workers Compensation Wunnce carrier and Policy number am:
Caution Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
,
(Than modern need notbe completed If the permit Is farm hundreddo0ns ($100)
err lass)
I cer ify that in the perf.m sn¢ of On work for which this Permit is humid, I shall not
employ NYpermnany roam .amt ports h orotic Warks' Compenutian
Lawn of Califs am
Applkwt
NOTICE TO APPLICANT. If, along this Cer incae o mpdon, you AMW
become subject m the Works:f Ca emaum pre,bar myy c b. Code, you am
2i
foMwith comply with such Prov tam m this permit ma met revaked.
AGENCY
MaiCONSTRUCTION mdonleLENDING
1herebyarnrm Mai Mom iss lending for thepMurmenco of
issued .)
' the work for which rola permit h isuW (Sec. 31191, Civ, C.1
'
Lender's Name
�"
Lenders Address
I certify that I haw mad this application and sus thea me above information is
' comet. l agree to comply with all city and county andinanws and Aute laws refining w
building construction. and hereby authorim representatives or rah City to enter upon me
far
shove-mcntioncd property impcctim puryoms
(We) agree to taw, indemnify and app harmlo de City of Cupertino agaimt
I Iiabilities,judgmenu.cros and upeuu which may Lamy way.ache against said City
In Conse lCme of the of thh
training Permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date ` V
SOUR EGU ONS. /
- /8 -ted
Re -roofs
Type of Roof
Signuurt of Applleen or DamDOUS MA A
URE
Sam
Will the applicant or (alum Wilding ante or handlehusutoos material
as refused by the Cupertino Municipal Cade. Chapter 9. 12. and the Health and Safety
Code, Section 25532(1)7
All roofs shall be inspected prior to any roofing material being installed.
0 y ONO
If a roof IS Installed without First obtaining an inspection, I agree to remove
WIII me applicwt L' cvi.a which
fuwre Wilding ocoupani use equlpmenl or 'Mm
h huadam adr eoetamimnu u debwd by the Bay Ama Air Ovallty Mmagcmem
all new materials for inspection.
N n7
❑Yea ONO
I have rand the hassedous maurials mquncmemsuhhlerChapterd.95 of the Calif.-
nhHealth b.Safety Code.Sued. 25505.25533 am125334. 1 understand that ifte Wilding
dam mol cumently haw a m=L tut tit a my mVom bilily w nmify dw er pwl of to
roquim which tLemel '0 issuance or a ccrtncim Of occupancy.
Signature of Applicant Date
All roof coverings to be Class "S" or better
Owl ar.amadzed a t Date