06010115 CITY OF CUPERTINO d ' ryr.�rn„ax+vr 8"'+I + ' " �""/;
BUILDING DIVISION PERMIT �N'J, �^ ��
BUILDING ADDRESS: • PERMrr1100601011'J
147 TWIG LN
R'S NAME: PERMIT MSUEDATS
CHAU TRAM 07/10/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHIIEC IPNGINEER: BUILDING PERMIT INFO
BO EO PLUMB
MECH
O
lop LICENSED CONTRACTOR'S DECLARATIO Job Description
I Wmby affirm t I em limned a m umns.fCM err commencing P
wish Secuon70(IB)o1, n7o(she Bus an rofwirmG ,and IIkcmc la
'oro Wrml derfec4 SFDWL-4 , 013 ' /GARAGE 421 '
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Ti An ua Common ITARY IS SUNNYVALE ' S JURISDICTION
ARCHITE DEC ORATION
f0 I undmm.d my plans shall k ase a Iic mcmds
)fid
A W Liconsed Pmressional
SO3OWNER-BUILDER DECLARATION
a 1 hereby MB.
that I am axcmpr from the Conan tOel UCAMe Law for the
Loo following mason.(Section 7031.5.Business and Pro(euium Code:Any city or county
3$ which requires a permit N construct,alter.improve,dcmalLvb.or mink any structure
_i< priarmitsiasuen<c.aburequi,catheappliwtforsuchpermitmfileasijned,utemcn' Va%&BA001
EiC
that he u licensed pursuant to lie provisirm trne
of the ConarS License❑w(Chapter 9 Sq.Ft.Floor Area Ys
9i-g (commencing wish Section 700M of Division 3 of she Business and Pro(wimu Cadc)Or
L' that he is exempt shctefrom and the bub for that alleged mempdon.Any violation of
secure 7031.5 by airy,applicant In,a permit subjects Ne applicant to a civil penalty of �+p jf�}7�uyi1 er Occupancy Type
eat mom dum five hundred dollars(5500). 3'/'JO V 17 . 0 0
❑L u owner o(tls prrpAoty as my employes with wajca u the4 vele campeondon,
WRdn she work.And the fmuctami,notinrended mmfemd break(Sec.7044.Baottma Required Inspections
W Aofcsdom Cade:Tie Contravenes Liana(ave does m1 apply a an owom Of
9 P
preperty who Wildsor improves themon,and who des such work hknvdf m thmvgh his
own employees,provided dist such improvements are trot attended ma@sed for sale B.
however.she buildinjor impressment is sold Whin one year of completion.Mc.wner-
Wilder w01 haw the huNrn of pouring that he did"m Mid As improve for purpose of
wk.).
4_1.As awns a de property am mekadvel,contruung WN licensed consranms Of
comeun the pmjca(See 7014.Business and Professions Code)The Coamemrs Li-
come law does eat appy to an owns,of PnspertY who builds or improves Nemsen,and.
who canaaM fm such projects Wth a contractrrts)lianme pmwunt m the commem e.
License taw. ("
lArt exempt ugv .BkPC�
�J( Dee
WbRKERj COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury rota Crum,following deelarWCos:
❑I haw and WII maintsin aCenifscateo(Cmsem m self-Insure fm WarteraCompon-
smon,As provided for by Section 3700 of the labor Code,for Ne perfarmanee of the
work for which this permit is issued.
❑1 haw and WII maintain Workers Compensation Imuran¢,As MQtdMd by Senior .
3700rf Ne labor Code.f000rW��rrrpppeeertrrmareeo h fmwhkh Nb pe,mBb issued.
My We Compensation�sw c+mir+etls P.� num1
Grim. ` EM PoII\if No , \ l
CER EXEMFROM FAS'
fPENSA710N INSURANCE '
(This session need not W completed if Ne permit is fmone hundred dollars(SIW)
or less)
I mdry Nat in theperformance of the work far which Nis permit b issued,L"I cot
mnployany person in any m `'A'111 M she Workea'Compewuon
Law,of California.Date 4
Applicant /^• y
NOTICE TO APPLJCANT.1f.after Call this Ceniflonc of Eamp ion.you should
become subject to des Workers Compensation provisions of the labor Cede,you mean
.,O Imutwith comply with such provisions or Nb Permit Nall Wmm
dcd mvrkcd.
Z y CONSTRUCTION LENDING AGENCY
[ti Ihereby arum that dem its construction lending agency for um,performance of
CL ti
be work for which this Permit Is issued(Sec.3197.Civ.C)
W� Q Lender,Name '
z Landers Add.
V Q 1 comfy that I haw and this application end sum that the above informNun is
Correct.l agree N comply with all city and county ordinances and amu laws mlMing to
QU building crnsuunion,and xneby amhome rtpmscnstivca of Nis city to onto,upon the
r W abrvc-mentioned property for inspection purposes.
a (We)age to save,indemnify and keep homlw the City of Cupertino against
h Iiabilides,judgments.costs anal expenses which may in any way amore against said City
V Z inconsequence pifthe growing or Nis permit.
^� APPLICANT NDERST AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC08 ULATIO � f61 di
( "k;�(--, l 5 Re-roofs
Simatumo(ApplicanUCa' ,Do
H US MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building OccuPmt atom m handle hnallou mamdal
Rmd by the Cupertino Municipal Cade.Chapmr 9.11.and the Health end Safety
a,Section 155320)7 p}�,` All roofs shall be inspected prior to any roofing material being installed.
�r. T If a roof is installed without first obtaining an inspection,I agree to remove
Will be applicant or future building Occupant use equipment at devices which
emit haemdrus air conunn m is u&find by the Bey Ams Air Quality Management allnew materials for inspection.
Disuiet?
❑Yes b/nu
IM dtheharard=mamrialsmquimmcnmundcr Chapwrd.95orshc Califrr.
nice Hc.hh S yCode, 25505.25533am125534.1.W. ndsh ifde Wilding
dam not have nan4 shat It b my rmpoosibllity m..uly than a upant f the
require n ichmua me d rmbsuanccaraCenificamo((. cUP w�y. 1 Signature of Applicant Date
Owneror suthrrirmde em / D,te b All roof coverings to be Class"B"or better