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03020046 CITY OF CUPERTINO m - BUILDING DIVISION PERMIT, ' I,CONTRAC"�fOR INFORMATI,ON ',-�,. BUILDINGADDRESS: PE•RMITNO. CHARLES CHU OWNER'SNAME: W�PTPBRLIQII BR. APPLICATIO H 64A�kQ ONE: - SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BL00 ELECT PLUMB MECH ] O O O O Z, LICENSEDCONTRACTOR'SDECLARATION I hereby affirm that 1 em limned under prevision of Chapter ook.a9(commencing Job DeSCrIp000 n� with SectionndI1Baf Division 7.f the Business and Pro(cuinnx Cndc.end my license is in full foes and effect. —qz UmnuCleo C.mr SEWER LATERAL FIIV.ALED Dau Convenor �YeARCHIILCfS DECLARATION Y I understand my plans chair be used as public records MAR .0 3 2003 Oy ZO Licensed Professional OWNER-BUILDER inexemptfrom DECLARATION BUILDING I hereby affirm that I em exempt from the Contractor',License Low for thefollBUILDING ES which requires Permi(Sectt 70.11.5,Business Aber, mp va,dcions Code:Any city structure$ which roqusea a permit re enres the plug improve,demolish ore A sig any statement F¢S^ that hepoor in itscensed e.also puncemroquiru theappduefor sucCohpermiuoienseLaw(Caumenl p that(commencing pu.usnuothe pro vision of du Contractor's License law(CNpur9 Sq. Ft.Floor Area CIV8Ig�IOn ❑z$ 'at he Is with Section7000)and i Division?ti the Buxaged exem ProjectAny Code)ion of Y 3 Net Section hexempt1.3 bany and or burs for the alleged kattexemption.Any violation of Out ra 7071.5 by any applicant for a permit Subjects the applicant to a civil penalty of ..AA pg9]aaar7,7pT {, not mo.Nen Ove hundmddollen(5500). 3`P�'d COTYef OO Occupancy Type ❑Lunwner of the progeny.or my AmPloyw with waguutheir tits mmpenAStion, Tq�T will do the work.and Neauuctum i...t intended or offered for sale 7041,Busineu -lO6 — SEWER 1 U1F eCt10DS and Profusions Code:The Commerce,License Law docs not apply to an owner of q properly who builds or improves thereon,and who does such work himself or through his 202 - UNDERFLOOR PL BING own emplayeu,provided that uch improvements are not intended or offered formic.If. 301 — ROUGH PLUMBING however.Ne builJing or improwmcnt is uld within one wv of wmpletion,Ne owncn - builder will haw She burden of proving that he did riot Wild or barrow for pepose of 507 — FINAL PLUMBING ASIA.). ❑1,as owner of the property,am eacludvely contracting with licensed contract..I. consumer the project(See.7041,Business;and Professions Code:)The Contracwra Li. came Taw does not apply to an owner of property who Wilds or improve Nem.n,and who contracts for such pmjects with a,moracter(e)licensed pursuant to One Contractors License law, ©lameempiundcr Se ,B&PC(.rthis.u.n gwncr au WORKER'S COMPENSA7TON DECLARA , 1 hereby aRrce under Penalty of perjury one of the following declarations: _ I have and will maintain ACertiMau of Cement to selPinem for Worker's Compere Won,As provided for by Section 3700 of the labor Code,for Ne performance of the work for which this permit I.heated. ' ❑1 here and will maintain Weaken Compensation Insurance,AS required by Section 7700 of the lahor Cade,for he performance,of the work for which Nia permit is iuued, My Worker's Compensation Insurance carrier and Policy numberam: Cartier. Parry No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This acction need not W completed if the Permit s for one hundred dollars($Iraq nr less.) f eeni(y Net in the pc Oaxaca of the work for which this permit is iuued.I shall not employ enymr n' ymapncgs�uJhr�mc ubjen to the Workers Cmmpcnaation wa Czouomta.Date�rJJ��ll// Batt!! A ant —y CE TQAPPWe Worker's ork ,e tNu CemnceOf the Eempuodyou should become Subject to it Worker, ,Compensation,ti, emulsions of the IaMn Code,you mwt J,� forthwith comply with wch provisions nr thin permit shall rddeemed revoked. OCONSTRUCTION LENDING AGENCY [—i I hereby affirm that Vert is a construction lending agency for the performance or Qi ti the work for which this permit is issued(Sec.3097,Co.C.) 0 Lenders Name Under's Address O 1 cenify that I haw read this application and sue that the above Information ie - !i.F comca.I agree to comply with all city and county ordinances and state laws relating t. O U building construction,and hereby somorva represenmiws of this city to enter uMn the 4kl ahovcmentinned popeny for impaction purposes. agree to sew,indemnify and keep harmless the City of CYPertma against vy Iiaconsequncejodgmems.Shecoauandofpenusmit. may In Anyway accrue egein¢tuid City U 7 in consequence of UNDERSTANDS ing Sthis permit. «7 APPL CANT UNDERSTANDS AND WILL COMPLY WITH ALL NPOINT Issued by: Date SO EREGUL IONS. /���Z Re-roofs `y Signalurc of App�l¢�enVC.n a HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will Ne apprompt or future building occupant n.se or handle hs.Now material AS defined by the Cupertino Municipal C aper 9.13,and the Health sed Safny Code,Section 25532(e)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building esu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it humorous air comaminantsu or Aor Bay Area Air Quality Management all new materials for inspection. tiro? ❑Ycs 1 have mad the hvaNtms mauritlsrrquiuments undcr Chapter�OfCalifonniaHulth&Safety Code,Sccdou25515,25533ud2553A.Iundcr uilding dors not currently haw a taunt Nat it is my usporuibility to notify ttofbacuquimmcnu whic m.¢t Wmet prior m,is¢uanmaf.CAmmm�a IDeSignature of Applicant Date water or auth.med agent to All roof coverings to be Class "B" or better