05030156 CITY OF CUPERTINO *^v'�?
BUILDING DIVISION PERMIT £C0N" 12ACTgIi=TNFORMA"1I0�V"
BUILDINGADDRESS: ATLANTA CONSTRUCTION INC PERMITN1b5030156
OWNER'S NAME: PERMIT ISSUE DATE
ft LIN SHINN-H
E: SANITARY NO. CONTROL NO.
(408) 205-5520
ARCHITECTIENGINEER: BUILDING PERMIT INTO)
BLDG ELECT PLUMB MECH
+�o f LICENSED CONTRACTOR'S DECLARATION O O O
Job Defind
1 hereby 0)of that 1 em fthe Bu under pmvlsiom of Chapter 9(commenting �,II�`\\II
wireSatianmyafofDivision3 ofNeBminess der pr Proos,of hadte9(co licensela
Lifull am. aand e0e SOLAR PANEL
3 z Lkenc Clan ED
Contractor O��
Dem Cmn DECL
ARCHITECT'S DECLARATION
lieu
I understood my plans shall W used a public records � 2005
Jr U J
a.
Licensed Pmfesaional
S OWNER-BUILDER DECLARATION BUIL
{�vr�
f 1 hemby affirm that I em exempt form the Commato's License Law for the ■e®BaCn:9B
00 following resaon.(Section 703 I.S.Business and improve.
demolish.
em li Code:My city or county
$iE which mqulm+•e.also ro aim th 6 tlam improv,dPermit,lire a sig any statement
tuctureement
�b< pdorbiuiuuma,rsuant to the the applicant for such ant's Elca Law ned mold4 ming
pursuantto the of Divisum of the eBuecmr'Wceoselto(C Code)
Sq.Ft.Floor Area Valuation
z❑$ thammcndng with Sutirom and the basis
l of the
egad exemptandion.
Preon.My vi Cade)ter $10000
0 0 0 0
a..
that he'l,exempt therefrom and the hula for rico ellegctl eaempBan.My vlolatlon of
Section 7031.5 by any applicant for a permit objects the applicant to a civil pamhy of APN Number Occupancy Type
not me.than firm hundred dollars WWI.
0 I,as owner of Na propelty,or my employees with wages as their sale campewtion,
will do the work end the swctum 4 not Inmnded oroffemd faesie(Scc.7044,Busims, 3 b 9.2 2 u 4 2 ,
and Professions Cade:TW Conusames Liana law don cot apply b an nwner of Required Inspections
property who Wildsor improv+thereen,endwhe doeaah work himael(ar Waugh his
own employees,provided that such Improvements as not intended oroffered for ale.If.
however,to building or Improvement is sold within am you of compkdan.the owner.
builder will haw:the burden of proving that he did am build or improv fa purpose of
sale.).
0 1,as owner of the property.am exclusively contracting with licensed contractors to
eommeat the project(Sec.7044,Business and Profession Code:)The Contractor's U.
come law doe at apply m an owner of property.who Wilds or improws memon.and,
who contracts for such projects with a contracKs)licensed pursuant to the Contractor's
License Law.
❑hem aemptunder Bh"dedl .::
P Cim b n
own
e Data
WOR R' COMPENSATION DECLARATIOIhereby afrm under penalty of perjury oro of the fnllowin
0 I ham and will maintain a Certiftcamof Comento self-insum fer WarkerSCompen.
melon,as provided for by Section 5700 of the Labor Code,for the performance of the
were for which this permit is Issued.
0 1 hoc and will maintain Worker's Compensation Insurance.as required by Section
3700 o(the labor Cade,for the performance of the work for which this permit is issued.
My Workees Compensation Insurance carrier and Polity number use:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This wifim need nothecomplead Visa permit isforone hundred dollen(f 100)
wr lass.)
I aNfy than In the performance of the work for which this permit 4 issued,i still am
employ,any person to any moneran sa b Wcomc object m the Workeri ns
Compeation
41
Laws of CaI far Deb
APPliIt —'
NOTICE TO ANT:IL after making this Certificate of Exemption,you+hnuld
Wcome+u t to the Worker's Compensation provitiom of the L War Code,you most
.J O
Eforthwith amply with wch prm4lmm or Nis permh shall W damc l mvaked.
Z 5 CONSTRUCTION LENDING AGENCY
(~ I hereby offren that them I.a caustnatan kndingageay fm the perfurmanc of
0.i the work for which this permit 4 issued(Sec.3097,Ci,C.)
94 Q lander'+Name _
z Lender's Address
U p T certify than 1 have read this application and sum that the eWw Information is
ly Fcorrin I agree to comply with all city and county ordinances and ma laws misting m
U Wilding convection,and hereby authorize mpramumadws of Nis city to crar upon due
til Ahovomentioned property for Wpection purposes.
y (We)Agree to saw.indemnify ad kap harmless the City of Cupertino agslot
y Ilabilitie,Judgments,caw and upenca which coq In way amaegsimtsaid City
U in APPLICANTuseof the UNDERSTAN of tAnnit
rND WT C P Y WITH ALL NO POINT Issued by: Date
U ONS. ` �L
U Re-roofs
�taftwW Appl can onu+cmr V D
10( HAZARDOUS MATERIALS DISCLOSURhaordou material
Type of Roof
Will meapplicant ter future Wilding occupant same or hand
M defined by the Cupertino Municipal Code.Chapter 9.17,and the Health and Safely
Coda,Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
41 Oyu Olue
WIII the applicant or rutum Wilding oaupantucequipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit haurdous air cont+minnO as defined by me Bay Area Air Quality Management all new materials for inspection.
District?
0Yea CNu
T haw mad W bsrardrmsmaterlahrequmcments under Chspter6.95 of&CAlifor.
lila Health&Safctyam.Sadaohat iti my
mWdry muifine tof the
dao not currently haw•anan4 that it 4 my m+pomihility m notify tW oecupant of da
req mmentwhich uBWmetpdarmWmccmfaceruneeaar cap y Signature of Applicant Date
neru authorized agent as
All roof coverings to be Class"B"or better