04120062 (2) C[TY OF CUPERTINO - -' - ' ?' tar -a' ri::x3•i-a'" c m '"" �-a''`':?Id- ' : - - _ _ .._ _
auILDLNc DIVIs1oN . PERMIT CONTRACTOR INFORMATION -
_. _.
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BUILDING ADDRESS: BAY AREA REPIPES -' PERMIT'N"4'120062
• 1194 CRESTLINE DR
W NER'S NAME: PERMIT ISSUE DATE
BEN SONG CHEN 1861 ORANGE GROV
SANITARY NO. - CONTROL NO.
' ONE: � � •
• (408) 371-5763
ARCHITECr/E NE
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LO0 XICENSED CONTRA R' ECLARATION - Job Description _
wF I reby-efface Nn 1 am lua u D'sura.of Chapter 9(commencing "" - Ipr'�� rrLLLRRtaasssp��p Ittt ///��
U
with 700th)of Division Sof ,,,. _ Pr.fesmmsC dmy license is I' �p �1/r-A\LED _—
j Z Lru1seC1 'nderre L Lie.. 5hjl93 an REPIPE/WATER HEATER/.WATER SERV ���iiiE---!!!r. .0 _ •- _
�— Dalen conlDocCwr�BAj1 �
1 r nd my plans hal W used as p➢hM1�iecords - IAN
1005
oats
`u Licensed professional '
03 OWNER-BUILDER DECLARATION 'e1 B _
1 hereby alarm that 1 am exempt from Ne Commelm's License Law for the III--®
0r, following mason.(Section 7031.5,Businrs and Podcssions Calc:Any city m county LLLr¢rr aaa
3:0
m� which informs a pa mil m construct.alter;improve,demolish,or repair any structure - —
FZ< PH.,m its ia4U8M4.1.requiR lWifipheanlfar Such permit la Glea signed sachronl
manta is licensed parmam to the pmvisiov or tW C.... ,Liecom t,w(chapter 9 Sq.Ft. Floor Area Valuation
'�Q (commencing with Section 7d00)of Division 3 of the Business and Professions Csde)or
i $ that W u com pt therefrom and the bus for the alleged exemption.Any violation of
Section 7031.3 by a"applicant for a permit subjects me applicant a civil,penally of Occupancy Type -- --. -- .
not mom than 0m hundred dollars($500).
❑L.owner of me pmpcor,ofmyemployes with wags.lhehsohcompen.tion, '
will do ftwork.and deswcum is not infemdcd cr oRamd Tarsale(See.7W.Busine.
and Professions cox:The Controversies License taw dos teat.pply to an owner or
Required Inspections
property,who builds arimpows demean,andwho doessuch work himsel(or through his _
ownemployces,provided thrusuch impronnurouarenotimmorid oranered formle.If. _
however,Ne building or impmvement is sold within one year of completion.de owner-
builder will have the burden or playing that ha did not Wild or implam for purpose of -
sale.). _-
❑1,u Owner of the property,am exclusively contracting with licensed contractors to ..
construct de project(See.7004.Business and professions Code:)The Contractor's Li.
came law does not apply to in owner of property who Wilds or improves IW mon.and
who contracts for such projects with a emimea fr(q licensed posuanuo the Contractors . .
License law,
l am ucmpt under Sec. .B h P C far this recon
TECT
Owner Data ..
WORKER'S COMPENSATION DECLARATION —
I hereby affirm under penalty of perjury one of an following declarations:
1 ham and will maintain a Certifcme of Consent to sell-insure for WorkeriCampen-
satian,as provided for by Section 3700 of the Labor Code,for the pnoremsanee of U,e
work for which this permit is issued. -
I have and will maintain WmIum's Compensation Insurance,u of the worequited by Section
3700.1 the labor Code,for de pert rmenee Weak for which this permit is issued.
yW. Co neatRIOlnsun eanimmul Pol, number
Carver Polity No.:
CERTI CATEOFEXEMPTIONFRQM WORKERS'
COMPENSATIONI ISURRAANCE
(Mis section need not W completed if the permit is for one hundred dollars(51110)
or less.)
I certify that in de performance of do work for which this permit is chiral,l shall not
employ any person in any manner an res be become subject to One Workers'Compensation
Laws of California.Data .- - - -
Applicant
NOTICE TO APPLICANT:IL offer making Nis Certificate of Exemption,you should
become subject 0 the worker'a Compensation previsions or de Labor Code,you must
.JO forthwith comply with such provisions or this permit shall W deemed revoked.
Z � CONSTRUCTION LENDING AGENCY
-
j-+�-• I hereby affirm that there is a construction lending agency fat the Performance of _
G' the work for which this permit Is issued(See.31107,Civ.C.)
U] � Lender's Name —__-----
11 Lender's Address
az
UI certify that l base mad this application and sole that IW shove inform.liun is
D.F correct-I.gate to comply with all city andl county ordinances and sure laws rdming to
0U building construction.and hereby authama rems
penutises of this city t0 enter upon the
r•' about-mentionr4 propcny for inspccuon purposes
(We)egree to save,indemnify and keep harmless the City of Cupertino against /t
F h
liabilities,judgments,costs and capcnscs which may in any way accmc against said City / //
U z in consequence or the granting ofJl permit. J
APPLIC"Ayy�NDE9S' N 6 D WILL COMPLY WITH ALL NON-POINT Issued by:,_ Date
soyRG�Rssu off/ Re-roofs
Signe ADpicanl/ collector Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant s fudm building..,..,stere or handle h.allous material
.defined by the Cupertino Municipal C .Chapter 9.12.and the Heald and Safety
We.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ys
Will the applicant or future budding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mi,ha amass air eonmmin.nu as Jtfncd by the Bay Area Air Quality Management all new materials for inspe n.
District? �•(J/
❑Yes
1 base mad the hautmms materialsmquiremairs under Chapter695 orthe Califor- //
nia Health A Ssfey Cox,Sections 255115,25533 and25534.1 understood that ifmc Wilding /Y
does no,earyo hot a term,that it is my responsibility to notify thea p t nr
mm, uwhc rock
metpdormissuanccoraCcniGcamafo up•a Sig ureofApplicant "-- - Date
owmefar mm;utdagemt Dato All roof coverings to be Class "B"or better