01090004 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11631 UPLAND WAY FERMA CORPORATION 01090004
OWNER'S NAME: APPLICATION SUB DATE.
ROGER WANG 1265 MONTECITO AVE 09/04/2001
/ PHONE: SANITARY NO. CONTROL NO.
(650) 961-2742
M 25Z ARCHITECTIEN'GINEER: BUILDING PERMIT INFO
w_F 'VLDV ELECT PLUMB MECH
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lo
LICENSED CONTRACTOR
under rDELLA RATION Job De sc tion
_ erchy orf rd,That I am licensee under provisionx of Chapter 9lcommencing
v,t-u.,
with mion]W(B of Uivi.ion3ofthe Business and Pmfensiom Codc d license DEMO.
ullnhean_ ' 2 "-3 (, 3 3'
z z a s Class Lic.x
t0 o.O Cnnvamr
ILL O G. ARCHITECT'S DECLARATION
S 1 undemmnd my plans shall he used as public records
in Y_
i u O O Licensed Professional
a.o OWNER-BUILDER DECLARATION
1 hereby affirm that I in exempt from the Conbuctor's License Law fnr the
L-z r following ma„m.(Secnnn]031.5.Baxines,and Prafessh,ns gala:Any city nr emn°y $10000
Y F O which require, I i mit to convect cher p- demolish. P Y mmmre
se
i3 prior t0lbissurearce,alsome,fairea1he i,plivarof ch revant torile a aignod! ItenlCllt•
than he islet dp Woad,to she pmveons of the Contractor's License La (Chapter9 11ppr a; - Valuation
(commen<ng is ah Section 7000)of Division 3 of B slncss and Pmf I
sCai v, .Ya t3�aa tl-� ( 11:-.t7V
or that he is eumpt ibcsdtdm and the basis for the alleged eaemptioa.Any violation
of Section 1031:5 by any applicant for a Nornit subjects the applicant to a civil penalty
or nmmnrctban rise hundred do11.(S500). NO u'S'li"'N D INSPECT ONS' o Occupancy Type
°1,as Owner or the prnpeny,or mY co phtyeas with wages as theirsole compensation,
.111 do the wmU and the"xWetum is nnl Intended or offered for sale(Sec.01144: 1,
1.
ns
than ,
Required Professions cM c t I i doe. I veldan o
oxo f p dny Whobu Js o p Ih d hod such k himself
oyyh n, n y p.. d e h p improvements ort tintended or
comer le rI.If.howe Ih
tit Id' t improvement . sold i year of -
' na"me theminer-builderwill have the at b (p gthathad0 tb Id or
i
mp f pry c f I )
°1 fhpprty l :' lyt rthle . ttsm
-• _ consw t thep 1 cl(S ]ULt B d Professions e t C MeJ The Contractor's
,)
' Lim nu Inw trot not apply to an Oxncr of a i sono who build oImproves thereon.i ,-end.wccommas fur.such.emjars with a convanurfsl.licenud pursuain to the. _ . . ............ _. _..__...
I
Contractor License Law. - �/ •
°lamcxcmpsundceScc!" .0&PC fonhis mason t"'1 l}-,,^p.; l❑
Owirtr x
Date° -
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of arjury one of the following Jcdaratinns-"
1`° 1 have arn! Hl Tommi m a•CcniOcam of Con,sm iO self-i...m for Wool
4t Compensation, os provided fur by Section 3700 of she Labor Code, for she
performance of the work fm.which this permit is issued
°1 Fade and will mairlint Wod.er 1C, ;,caiiinmi In,uiunec,of iequimJ by Section
3]W of a LnWe Code,fur Lha licifannancc of the work lilrcY=1
hich this pemtit is
ziia
auetl y Warkcts Co pv inn Insurance carrier and Pol „mberart
er S_Z& )�yxwro i Y N ..
_ .
.2.. a 4CERTIFICATION OF E%EMPf10,, M. RKERS'•, -
(TM1isscmm�neM nOMENSATIQN,INSURpNCE� .: "r
.,v
cmnplcmJ if the permit is fnr anehundmd dollars ' "• ' ' •" (JC�Glf,11':v -�',�:U
(b 1110) I..d •, ,,.., r t.., _ _
r17
- .....__._. _._...._. _. . .... .,... _. .. .. .. .. ...- ..... .....
s 1 m fy that in the performance of the ork f which this pc t ucd 1 i•I 1(k._'.�l"1" I
'shall not employ end Peron in any manner so as to become subject to the Workers
Comp,mank o laws Of C.h omia.Date
.A licenl
NOTICE TO APPLICANT:If.after making this CedEleme of Exemption,you should'
become subject u theta olersC Compensation po ' ns of the Labor Cade,you must
Q forthw th nunply w th. 'h p n n or this r t hull he deemed revoked
Z -.. ..
O .. .-._ -_... - - „
-'. .._
F N l I l CONSTRUCTION LENDING AGENCY' - �'� t
�,; 1 h by affirm Na Ihere s a const et o Ind n8 age y f the perfomsmco 'f'
t
.. ofthework forwhich the petmtl is issued(Se17091,Ci,C) ,,, •,. _ _. . _ ._. .-_ _ .._ .-. _ _ _. ._ _ _ _ __ _ .- _.
L Q Lender's Name's - —
V0 ,. 1 certify that I have mad this application and store that the above information-is
tort I agree to comply with all city and coo t,,mi manses and state laws relating
U 1.btfildir, coortil,inin,and h by a.lhod.otortsenuiti,e,ofthssty to enter.,on
thebo a me I L,property f .pe nti porpoise,
(we) g.ids indemnify and Veep humorless he City of Cupen no ogmnst
(A) fiabdities.) ignoms. ¢ d e pedes which may is any way acme against said
V-z. cory nc 9uence or the graining of thispermn. - �•_ �%_��
APpLIAfTUNDERSTANDSANDWITCOMPLYWTTHALCNON-PO. Issued by: Date
SG* ftF TONS.-' y'
._ M reorA plica rnntaclm: .• Ic" Re-roofs
. HAZARDOUS MATER LS DISCLOSURE
Will
the
tli'licu I is future bu(ding occ u,.n, tate m hand,haatdais mama. Type of Roddl
-- ' defn a by the Caren n Mu pal Code Ch pt 9 12,a d sh H<aIIM1 erM SOfery _ t t -• .,� I , „ ,,
'Code.Section 25532(0) -, ... ., .. - -:} g•. - .s: •�
_ ' N.
;-. ...._ _All All roofs.shall_be inspected prior-to any-roofing material being.installed._
WE the applicant or future building occupant use equipment or devices which If a roof is installed Without first obtaining an ilis'pectiofl,I agreeto remove
emit hazardooaulr comammantna,defined by the Bay Arco Air Quality Management ,
Dia al all new materials for inspection. Applicant understands and will coin with _-
°Y a °,"° all non-point source reguplatlons
`v '1 the rcad'Jm hamrdous mmenils rcgmrcmenu under Chapter 695 of.the
Calif a Health&Safety CMB Sections 25505,25533 and 25334.1 understand that
)iok ilding does not currendv ha%c a tenant.that it is mymsponsibility mnodythe nt f th rcyuir ,. vbi,h muss be t prior to iss ane of a Ceni&me f y -' - , , Signature of ApplicantDate.
Plz
ran riaee anent. ate All roof coverings to be Class"B" or better