03020081 RTINO
BUILDING DIVISION PE IT
67 o�& �;i F'7 *W, ki�,!,%V�
BUILDINO ADDRESS: PERMIT NO.
Agges,22489 N -WALNUT CIR pqn?nnAj
WS NAME: PERMIT ESUIEPATE
IMING WANG 02 /20/200-�
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTMNGINFER: BLDG BUILDING PERMIT INFO
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80 LICENSED CONTRACTOR'S DECLARATION
Uncut under provision,of Chapter 9(commencing Job Description
9H .11A Sol t�io M7'oyp-or-Ult I.3-olfi the Bounties and profCaUdmat Conn.end my license is FINALE0.1
n� so
.5 infrillroV ffm LAR ELECTRIC SYSTEM
on CONTRACTOR: REGRID POWER MAR 1 3 2003
A I
oil mandury'lime absed burrace,as Public mounds
Licensed Profoummid OWNER-BUILDER DECLARATION BUIL61NG
I hereby affirm that I am exempt form the CounClorl License Law to,the
following..(ScrUmt 703 U.Enormous it PrOfeead.os Code:Any city or county
which umul..Noull to co.,&Ion.ftp..dtonjub.rv�repair any tarrernme
prior 0 its ussuance.sun mcluinue the applicant for curb permit to rile a signed strorment Sq.Ft. Floor Area Valuation
that he I.licensed purment 1.the provic..Of due CruftneCtOrl Lkx—Law(Chalmo 9
(courcumbig with Section 70DM.f Division 3.f the audeausax.od Prediction.Code).,
that he Is exempt therefireen and the basis fee the alleged counimption.Any violation of S13700
Section 7031.5 by any ppliox,fine Permit subjects the spplLcami to a civil penalty of APN Number Occupancy T�pe
our...them five hundred dollars($M 35703061 . 00
0 1.as Owner of the property,Or my employees with were as their=to
will do due work.and thre,"chum is not fintranded or offered(or salo(Sec.70,44,Busleacces BE
and Protcordom Code-The Commenon's Liorms,Law does not apply to In Owmarc Or 304 — ROUGHPA TaUE
property who Wilds or improm thencon,and whouningstath weak himulfor through his
ownemploycent.provideridust such imprOwnrecols ars,Out Intended oroffencid forsexte.If. 501 — FINAL ELECTRICAL ENERGY
however,the building or improverneot is sold within one year of completion.ft camer- 505 — FINAL ELECTRICAL
builder will knew the burden of leaving chat he did not build or improve for purpose of
I.as Owner of the propeny,am exclusively courrecting with licensed contractors an
constroct the preject(Sec.7044.Business and Professions Code:)The Commerce's Ll.
widen Law does not apply to in owner of property who builds or improves thereon.and.
who contracts for such pinjecras with I contractoo(i)licensed p.mus.t 1.ft Contractors
L m Law.
roa
�Ptr See B&PCf lial
WORKERS COMPENSATION'DELCi-A&ATIO
I hereby&ffhrn unit.,Penalty Of perjury onu.f`dX;owUg decianations:
0 IT hhve and will maintains Contrast,of Consent toself-insum,forWorkersCompen-
an
saft.,as provided for by Sued..3700.f the Labor Code,for the, or Me
I
th
work for which this permit Is Issued.
I haw and will maintain Worluct's COMP131SAL1011 Insurance.as required by Section
00 U
37M f the Labor Code.far to performancerif the vank for which this permt Is Issued.
My Workers Compensation Insurance catdu;F
cy 7numbcr sm:
t CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cmhilan�dnol�cmplewdiflt�l..ItisfOr...Inandruddollium(SIM)
which this peurnal,is ismed.I ithall net
I Ocutify that 1.th Imnumce of he�wofor
me ro sur eard
empt, ran ad subjeVotlieWorkirrCrunpoisrillon
w
NO
,AE of Exemption.You h,,.W
he suhjmt to the Worker'&Compensation provillorri Of ft Labor Codk.YOU must
forthwith conniply with such irmutsin..this parrunit hall In deemed revoked.
Z CONSTRUCTION LENDINO AOBNCY
1 hereby arrum that dirre,is a construction lending agency fix the putformarouna of
> the week fou which this permit is issued(Scre.3097,Civ.C.)
Under,
Undc,',Accrued,
z
U0 I cenify that I ban read this application and law that the oWw Inicertulour 11
cancer.I as=an comply with all city and county onfinsurnas and else,[am misting 10
C) building CrUMMUCIfir",and hereby authodue mirmsentatim of this city to enter upon the
8 &W.-ruenthuned property for Insipection purprOJOL
(We)agree in saw.indemnify and keep hadmince the City of Cupertino Ilpif&I
cl� me against sand C�uy
V) :Iabilide.,J.dSmc.u.cwua.do.M�.hi.hm.yi.mymym
UZ n consequence of ft granting or this recruit. Date
APPLICANT A WITH ALL NON-POINT Issued by:
rRCE N
Re-roofs
SignsluWCAppliciuke/Co mme,tor
HAZARDOUS MATERIALS DISCLOSURE 7ype of Roof
Will the applicant or future Wilding excureact some or handle huntrilentat material
fined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Will exe ap"Ons"Rut"m Wilder'"copsn"
ourd It Pat Code'Charon
� building—.Pa.
Y do Co no Minnie,
Sudion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
sent Z
Oyu
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding Occupant usc,equipment or duvions,which
IthatuUndnosai,curnuortur Us �r,�hyftB.,A.Ai,QatlityM.�.glm��t all new materials for inspection.
con
[j Yes
ev
Invented!�huArd�mawriall�ui=cnuun&rChpwr6,9SortheCalifor-
"s
.I. �WS 25533
HeaturSkSafm S=U=23305.25533��5M.lunk�ftirft building
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not correctly have.me I isinym.po mlUYWZ.OdfjyuxD.P8UU.rft
no
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cut"::��:3 Signature of Applicant Date
�1OwFxrm&unfiownz&d&VnL All roof coverings to be Class"B"or better