08040062 CITY OF CUPERTINO aSx,7' �"�'`"
BuaomG DrvIs1oN PERNIIT +W'U1R1CTRIlvk'f} � Ip1 ,s'
BUILD O PSS: PERMIT NO.
�. �� WESTACRES DR FRANKLIN P. LEE 08040062
OWNER'S NAME: FERtar tSSUEDATE
FRANKLIN P LEE PO BOX 1715 04/09/2008
ONE: SANITARY NO, CONTROL NO.
(408) 996-7188
ARCHITECTMNGINEER: BURRING PERMIT INFO
B�LDQ EO PLO O
o O MECH
LICENSED CONTRACTOR'S DECLARATION IOU Description
V I Mreby affirm that 1 am Iimnxd under pmvisions of Chapter 9(commencing
e full
lto n7apu)ect.Meian3oflhe Buvnw and ProtcasiunaCodo,end mylicenec is REROOF,RPLC WNDWS,RPLCBTH SHWR/TUB,TLT,RPLC
Lic.ra y in full class d effete.
a- Date cow Conga WTRHTR,CBNTS, KTCHN STV/OVEN,RPLC LITEFXTRS. RPLC -
t- Dam selar
ARCHITECTS DECLARATION LTRL SWR LINE TO KTCH LNDRY
a I understand my plana shall he used as public records
yu
k" Licensed Professional
3 OWNER-BUILDER DECLARATION
a� f I hemby alErre that 1 em exempt from the Commmor's License Law for Ne
following mama.(Section 701.5.Business and Professions Code:Any city or County
9 n
y which requires a Permit to confrere,eller,improv,douralah.a,.0,any sonamme
+l_ prior to its issuanc.also requires the applicant formch permit Ott file a signed summcal
< Net he is licensed pursuant to On provisions Of Me Cottonton's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
>�$ (commecing with Section 7000)M Division 3 of the Business and Professions Cow)or $35000
uy Nat he u exempt themftom and the buil for the Alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to arnil penalty ofr'1 Number Occupancy Type
Am mom Nan five hundred dollen($500). 3 5914012: U'
1,As am=af doe property,or my employees with wages al their rale compemimim.
And Paola walk.and them Contr ou'sLia o LAwdelan,apply 70 a4.owner of Required Inspections
end property
whons Cada:The ca Cher an, n Liam dove docs ret apply lf an owner is q P
ampeny who builds provided
improvements
sedwM dosssuch work himself or through his
awnemployers,ping or improvement veal impm oto wi are not intendedaroRemd Meown IL
WildertowennNe bvl the bu enPerrin a that
withint Wild of mproedf r Ne owner-
Wilder will Nw the burden of gvvinG Nat he did Iles Wild or improve for Purpose of _
Zi.as awn=of Ne property,am exclusively conlrectinS wN licensed mnlracton to
cambial the project(Sec.7014.Business and Professions Code:)The Cantrsumr's U.
cause law dors not apply to an owner of property who builds or improv Nerean.and,
who contracts for such projects with a conammor(s)licensed pursuant to the Contractor's
License law.
❑lam exmpt und=Sa .B&PCfor his wn
Owner Data 4—n-OR
W R6OMPENSATION
DECLARATION
1 hemby affirm under peeslty,of perjury one of the following declarations:
haveand 1mainWnaCmificemof Cmuemm self-inaum for Wohefa Campem
n,u provitled for by Section 3700 of Ills tab=Cade,f=Ne Adm...of Ne
art for which Nis permit is issued.
❑I haw and will malmaln Workers Compensation Insuraure,As required by Section
3700 of Ne labor Cade.for doe ptrianumcc of the work for which this Permit is Issued.
My Worker's Compensation lnwcance carrier and Policy number are:
Carrier'. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thisorlon need not be completed if Ibe permit Is f=one hundred dollar(SIM)
wicsa)
I certify that in the Performance at the work for which this p=m1t Is issued,I shall not
employ any perm.in any mmncrmppmbbr5�goma ject to tie Wmken'Caummlimon
Laws of California.Dyy Y�4`�
APPllcanl 54
NOTICE TO APPLICANT:ff,after making this Cenificam of Faernnian.you should
become subject to Ne Wohch Camper adon provisions of On,Tabor Cods,you mull
.J O forthwith comply with such provisions Or MIS permit shall he deemed mv.ked.
r(VICONSTRUCTION LENDING AGENCY
(~ Imch,alarm that Nero is a consuenthm lendingagency far Ne performanceof
ai the work for which this permit u issued(Sec.3097,Civ,C.)
W Lender's Name
i7. z lender's Address
V O 1 certify the 1 have mad Wa•ppli.mus.And stem Nat the•bow Information is -
(y;^ correct 1 agree to comply with all city and county ordinances and saw lawn lecrelating to
building convection,and hereby anthorim mm
pmnuwa tiof this city to enupon Ne
W above-marooned property for impaction purposes
Ly, gL (We)agree to save,indemnify and keep harmless the City of Cupertino against
I:y N
liabilities,judgments.costs and expenses which may in my way same against Sud City
U Z in consequence of the grandag of this permit. c
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EGUL ONS.
-'- 0g Re-roofs
Sijr mtum of ApplacmuComrmmr Data -
HA DOUS MATERIALS DISCLOSURE Type of Roof
Will the applictal or future building occupantatore arhandle hazardous material -
as defined by the Cupertino Municipal Cade.Chapmr 9.11,and the Health and safety
Calls.sneoon 25532(•)T
❑Yes Id No All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or future building occupant use equlpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t haaadons air contaminants as defined by the Bay Am.Air QsWity Managcmemt all new materials for inspection.
ct7 y
❑Yrs {,7.j1u
Ihewread Iheha ..,mmcdaumquimmenuunder Chapmrd.95oftheCalifor-
liaHcaTN&SafetyCode,Secd=ts2M5,25533and25534.1.W.,sNndl ifthebwlding
doss not cumendy haw a Conant.tint it u my I=pomihilily W wdfy Ne mcupent.f Ne
myuimm ntswhuhatta Ec numpriortoimutaceofaccrofsasea(Dec�,gency. Signature of Applicant Date
W� 4-ry ^ Q All roof coverings to be Class'N'or better
Owner o�amcd agent Dow