07120231 BUILDING DIVISION PERNIIT '�CONTRACTQR I1�tE„qU.�R., MATiQN' �=
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WAY - TBD — TO BE DETERMINED P071MIT20231
R'SS NAUME:W PERMIT ISSUE DATE
ICHAEL LEE 01/17/2008
PHONE: SANITARY NO. CONTROL NO.
ARCH TECUENIGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
p
Yjp LICENSED CONTRACTOR'S DECLARATION l IObDesCiDescription
1 hceby aRrm that 1 me licensed under Provisions of Chapter 9(commoncing p
with Session 7")of Division 3 of W Business and Profcaiom Cade,sell any license is REVISION—MINOR INTERIOR WALL PARTITION CHANGE,
I.full forte and mtat.
Licm.Clau Lke# ROOFING STRUCTURAL SUPPORT. NO EXTERIOR
a
Dan.Contractor
ll ARCHITEC SDECCLARATION CHANGES—ORIG #07090003—NO NEW PERMIT.
e 1 undersand my plane shall W used as public record(
y tOn� licenced Professional
y OWNER-BUILDER mDECLARATION
<S 1 (esu o(Sum a n I am exempt rate Ne Contrumfs License Law for W
%o O fallowing moon.(Satiate 7031.5.Business and improve.
de oli Cade:Any city an county
S 9N which rtgmrea•pewit m comwct tete(,impmse,demoMh,or repair any structure
�ZY<
priorissuance,ate lLforsuch to BlSigned statement
thmWIislicensed puuentto the provisions of six contractors licemLaw
(chapter 9
Sq.Ft. Floor Area0 Valuation
(eammeWng with Section 7000)of Division 3 of the Busi em and Pmfcssiam Cade)or
than he is unapt tharerrom and W herb for the alleged exemption.My Halation of
Section 7031.5 by lay applicant fm a permit ubja s the applicant to a civil penalty of A, ,�Number Occupancy
not mom than live hundred dollars(00(f), Aff). 36204044Type
❑1,u owns of uie pmpwy.m my mployem wpb nges o dubmle mmpewdon,
and do thewms and acuuCore ra tet s Usemd w arm de(mule(Sly to an Business
and property
bis Gude The Contravenes U4nx Law uct, tet apply ll m awgh is Required Inspections
Own employees,
Wlltlsmimpmves such
dwho ammo,Mwart MmxlredWaugh his
awn employees,provided that tuck lit Is Improvements am not Intended moeeretl forsade.Own If,
however,Ne Wilding hem improvement within one year or completion,the Owner.
Witter will have the burden of peeing out lm tlM tet build or Improve:for purpose of
ale..
1.u owner of W proper,,am esdumtI,cmum min{with Ec mod mnmamems to
mecum,W project(Sec.7014.flusinem arta Proreamam Cade:)The Costumier.Li-
Mom law deal mot apply m a.owner of property who Wild.or improv Waren.and,
who convects for such project,with acmuanar(s)licensed puouant to W Contractor',
Lk:emse Law.
❑law map,made Sec .B&Pct this r/5sso�n
Data
WORKERS COMPENSCLARATION
1 harmy afBma under pemity of perjury au or W following declua6ose:
❑1 haw atb will msintsin a CusiOesm ofConaen,m self-imam fm WoduMa Compen-
amem,as provided fm by Section 3700 of W Labor Code,for Na performance of tin
wok for which this permit Is issued.
❑1 have and will maintain worker'.Computation Imuran,as acquired by Section
3700 or the labor Code,for W performance ofthe wok For which this permit is bound.
My Wakafs Compemation Wurance carie and Policy number are:
Curics, Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(rhes sec0on need not be completed!film pewit is forme hundred dollars($100)
or lose.)
I certify that In the perarmanen of W wok rte which this pewit is Island,I Nall not
employ anyperarlm any munerx asapeub'et a Wohun'Cmnpewdon
Laws of Califom
APPliesn, a
become
ct e p ANT:IL compensation
Ccmnesof of Labor on,you room
become subject m W Wokefa Com or tKs Permit
steal m d a hoar Code,you mut,
�0 roMwtith comply with stela proveslot m Ni.pewit shall o dttmrA rooked.
ti� CONSIRUCTION LENDING AGENCY
(–a I omby affirm than Wrt is a construction lending agency for f performance of
FL> W work for which this permit Is island(Sec.3197,Civ.C.) '
W�Q Lender's Name ,
D z Lowden.Andreas
U O 1 mainly that 1 haw lead this application and rum that six move inror madon es
IL r corral I agacn to cam ply with all city W county ordinances and state ban relating to
.O Ubuilding construction,aM hemby uthods mpmsenudvrs of Nu city x enter upmnf
Dd
above-mentioned property for impaction purpues.
p5. (Wc)agree to taw,indemnify and keep hanmleo W City of Cupertino almost
rat IhhilidesJudgments.corn and cap..which may in any sty ammo agsImn laid City
U in consequence of the granting of this awit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
7z
� P Re-roofs
SI{ / fA IIcenVCommetar '� m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the mppllcent or future Wilding occupant mom or handle heutdoes team ial
defined by W Cupertino Municipal Code.Chapter 9.11 and W Health and Safety
Section v53x(a)+ —// All roofs shall be inspected prior to any roofing material being installed.
❑Yes [P<.
Will the applicant or fmurt Wilding oceupsm use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove
emit huoux!.u.sircmumi...M a defined by Ne Bay Area Air Quality Mum;..at all new materials for inspection.
DhVict7 ''/
Oyu Myf10
I haw mal W ha7mdms material requirements under Chapter 6.95 of the Cmifoo-
me Health k Safety Coca,Scmmm25505,15533 and 25534.1 undersand that If f Wilding
does not cuwmly haw a moat that It is my maponmbility m ratify W ucupont of W
mquirt uwhIt be tprlartahaaammar.cm,iee.mar/Cji7�j� Signature of Applicant Date
ow ;uln�gent I Dam All roof coverings to be Class"B"or better