07100208 (2) CITY OF CUPERTINO rel-I�'Vf�' "P
BUILDING DIVISION PERMIT COI�I�RACT�QR Ill�RMATION ;
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euap�'Offid"buNBAR DR TBD - TO BE DETERMINED P 07100208
NER'S NAME: - PERMIT ISSUE DATE
CATHERINE LIU 02/08/2008
PHONE: SANITARY NO, CONTROL NO,
ARCHIECTIENGINEER: BUILDING PERMITINFO
DEMO BLDG J 0 O PLUMB O O
Sop LICENSED CONfRACMR5 DECLARATION Job Description
UM 1 hereby!Mon Net I am Ilmnscd under provisions of Chapter 9(....act., p
i with Section 71)(MB of Divided 3 of NC Buunw and Pmfeaeiow Codc,end my license is
<� in full fr a and effect.
Z
14 Ucenac Class Lic.Is -
D Dam TS DE .
f Contractor
ARCHITECTS tor TION
S 1 understood my plans shill W used as public word,
1
k toil Licensed Professional
h OWNER-BUILDER DECLARATION
s� 5I botchy mf rm Net 1 am exempt from the Conuacte,License Law for the
y p O following mason.(Scedon 7031.5.Business and Pmfeasiuns Code:My city or county
1$ Which mod.a permit un ennpnaL alum.Wpmw,demO11N,or semi,my a4uemm
YZL^ prior ut it,Women.also requires the applicant for such Permit m file a Signed statement
€< Nal he a licensed pussum,tothe provisions ofthe Contrantuesukeam Law(Chmur9 Sq.Ft. Floor Area Valuation
(commencing with Section 700(t)of Division 3 of the Business and Profession Coads)or
that he is exempt therefrom ad the bub for the alleged assumption.Any violation of
Section 7031.5 by my applicant for a permit Objects the applicant to a civil penalty of APN Number Occupancy Type
act mane than fl.hundred dollars(M).
Q 1,as owner of the property.oe my employees with Wages as Neo role eompmeadon,
will not the work and the smcusc 6 not intended oeoffered for sale(Sec.7M4,Business
and Pmfaadpm Code:The Contracmr's Lkmae Law does not apply m an owner,of Required Inspections
pmpeny who buildsorimPmvesthemon,and who doessuch wprkhimmlfoe through his
own employers,provided thatsuch Improvement,are not intended oroRemd for sale.IL
however,the Wilding oe Improvement k Old within oro year of eompleuon,the owner-
builder will have she burden of pmving that W did mot ddb or Improve for purpose of _
sale.).
C u cone,of the property am exclusively contracting with licensed comeactms m
tinct the project(Sec.7044.Business and Professm s Codec')The Comuacma's U-
ccnss law does not apply m an owner of Property who Wilda or impmws timmon,and,
who contracts for such pmjccm with acommemr(s)licensed purwent as tiro Contractor's
License law.
❑lamas P, do ��—' ,BdPCfm this muse"
Data
n
-WrO*9ER1 COWENSATION DECLARXff0N
1 Wmby ailuro under penalty of perjury m of the following declmulou:
Q I hawed will mainuina CerdOesmofCmmemus self-mw.fm Workers Compere -
saWn,as provided for by Section 3700 of the labor Code,fm the performance of the
wank for which this permit is ivad.
Q 1 have and will maintain Workers Compensation I.,as mquimd by Seedpn _
3700 of the Latour Code,for the perfmmmca of Ne work forwhich this permit is Issued.
My Worker's Compensation Insunna cancer and Policy number am: `
Carder. Porky No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mussecd®matt rot W completed lithe permit is for oro hummed Moan($TOO)
or leu)
1 emdfy that in the perfotmma of the work for which this permit Is issued.I shall not
employ any person in any manrc, o Ip o0p subject to the Workeri Compensation
Laws of Calirs,Da
Appliant / n sO Awn A"
NOTICE TOP :I�f.after makfinj4hrCemlimm,of Exemption,you should
bamme subject m the Worker'.Compensation provisions of the labor CdC you muss
,J 0 forthwith comply with such Provisions m this permit shill W damd rewkd.
tiCONSfRucnON LENDING AGENCY
[-r IWreby affirm that them to a commudon lending agency for time Performance of
f>rthe work for Which tht,permit is issued(Sm.3097,Or.C.)
4ESLenders Name
.7 Z Lenders Address
U 0` 1 certify this I Mw mad Woe Oclicadd suth
an ais is the W.micummm,is
{L V comm,!agree m ComplY with all City and county mdinumces ad sum laws totaling m
Wilding construction,and hereby mlhorim rep emnmivea of this city to color upon the
[g7 move-menduned property for inspection Purposes
(We)agree to save.indemnify and kap hatmlev the City of Cupertino!1-cm,m:Cn liabilities,judgmentacom and expea. co
..which may In my y acerae againat saidCby
V Z in emormi.of the granting of this POTTIL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU {tEGU�]Tp10NS. ,./�%� �
ax-f4f i. 0OO� Re-roofs -�
Signature mApyliamuCommcmr r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appOant or future Wilding oampanmme or handle hrarmt.material
deBncd by the Cupertino Municipal Code,Chapter 9.M and the Health and Safety
de,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applictinl or future Wilding occupant use equipment o devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h47AWOU3 air condominiums u dc0wd by the Bay Area Air Quality Management all new materials for inspection.
D tr ct?
'
r]Yea Q1Ju
1 have toil the Wardens materials roquitomcnu under Chapter 6.95 of the Califor-
riaHcaW h Safety Code,Sauons 33505.25533 ad 25534.1 mdemand that lfdm Wilding
Jars uncrolly have•lonanL that It k my responsibility to ratify the aeppanm of the
redoon u_wh' muss W.1 poor to fcalo of Oce
yy������ � "t' w�T d Signature of Applicant Date
,t-a.�^ _ /�/A All roof coverings to be Class"B"or better
0 i ca mthctbwd agent Dad