08090182 Permit Card CITY OF CUPERTINO. , '.::..vim <s 7/:�.✓
BUILDING DIVISION PERMIT CONTRAGTOVNFO,RMATION ,;g
BUILg1IMD,[tESFPERMIT NO.
LORA VISTA AVE TBD — TO BE DETERMINED 08090182
VNER'S NAME: PERMIT ISSUE DATE
MR XIE 09/29/2008
PHONE: SANITARY NO. CONTROL NO:
ARCHrfECT/ENGINEER: BUILDING PERMIT INFO
REV ADD 7 . 5 ,X7 . 5 ' PORCH, BLDG ELECT PLUMB MECH
O O O O
9923
+oo LICENSED CONTRACTOR'S DECLARATION
m 1 horeby Watch that 1 am licensed umlcr pmvim.of Chapter 9(¢mmcad., ' lob Description
i<
on with Section 70flOrn Dhisian 30fth Basis.and Pmressiom Code.snd my license is
in full free.and effuL
j n= Liman aess Tic.0
g F o Dam Contra.,
EQQ uuuy ARCHITECTS DECLARATION
< 1 understand my plans shall he used as public records ,
s t, Licensed Pmfessi...I
5 OWNER-BUILDER DECLARATION
8 1 hreby arrrna Nat I am MaIMPL from On Convanars license Law ran th
i e O following mason.(Section 7031.5,Business and Pmfeuiom Code:Any city an county
5= which"uhan a Permit to construct,elme improv,demolish,or repair eery stmclum
prior to its issuance,also tequiru the applicant for such permit to rile a signed summers
EE <
than he is licensed pmrmant N the Provisions Of Lk Common's li¢ess,low(claims 9 Sq.Ft.Floor Area Valuation
Y1-$ (commencing with Section 70X))of Division 3 of the Business and Pro mass
Codcj or
3- that he u eaempl thucfrom and Ne bases for On alleged caemption.Any violation of
Section 70315 by any applicant for a Permit subjects the applicant 10 a civil penalty of APN Number Occupancy Type
tam mN
are an Bwun
hundred dollars(SMP Y YP
0 Las owner of the praperty,army employees with wages as Noir fele compormuon,
will do the wort and the structure Is not Nmnded or offered farsale(S¢.7014,Busrneas
and Pmresuom Cede The contract U.Law dote oat apply m an owner of Required Inspections
property who Wi lcis m improves thereon,and who does such wmk hi lest through hes
own employees,pmWded that such impmwments are not intended oroffered formic.If.
howewr.the building or impmvemem Its said within ane year of completion,the owner.
builder will have the Wttlev of proving out he did not build car improve far purpose of
sale.).
❑1,as owner of On property,am uclmiwly contracting with licensed¢manors to
caravan On project(See.7044,Boum and Profasumu Cade:)The Contractors U.
sense Law doss ant apply as an owner of property who Wilds or improve thereon,and
who contacts for such projects with a cones ar(s)licensed Pursuant to On Contractors
Lie'.Law.
❑I am.ceras under Sem ,B&P C far Nes reamv
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby eman under penalty of perjury arc of the following dechurchons,
❑1 hire and will maintain a Ccnificm of Consent to self-insure for Warkces Comport-
work u It f u provided(an by S¢uan 3]00 of Ne labor Code.for the pcnlorman¢of Nc
wfor which this pmnil is issued.
❑1 have and will maintain Workers Competuauon Insurance,as requited by Section
37W of the Mbar Code,far On pedo...of On..,it far which this Permit is issued. '
My Workers Compemauo s Irmnr ere¢nim and Pali,number arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need act as,completed if to permit Is fmonc hundred dollars($IDB
or less)
I cavort,that in the performance of But.,it for which Nis Permit is issued.I shall not
employ any person in any manrerse as m bccomc subject to Ne Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,arm,making Nu Ccnificam or Escmption,yam must;
become subject m the Workers Compensation previsions of the Labor COuc,you must
.J O forthwith Comply with such provisions or this Permit shall he deemed rawked.
z y CONSTRUCTIONLPNDINGAGENCY
F-m I hcrehy affirm dust there its constrwlinn lendingagenry for On sufoanacrettf
FG
the work for which this Permit is issued(See.3097,Civ,C.)
W�Q Undcrs Namc
Z) z Undoes Address
V Q 1 comfy Nat I have read this application and sum Nat On anew infatun mauis
it, correct I agree m comply with all city and county ordinances;and sum laws slating as
C) building comsvvction,and hereby suthoiim reprommatiws of Nu city to sous nano the
ymew-menuondproperty for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
fn I.Maiuclumetmcnthe'ausnd expenses which may in anyway attruc agumtsaid City
C)z in eonsequen¢of the&Hoang of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
Stgnazmc of APPIiaHAZAR Data Re-roofs
HAZARDOUS
S MATEaIALS DISCLOSURE Type of Roof
Will the applicant or(Muni Wilding s.chapter
store 1 m handle Heald,
an material
az defined by t25 Cupertino Municipal Cade.Chapter 9.1;teed de Hu1N and Safety
one.semfon zss3z(.)? All roofs shall be inspected prior to any roofing material being installed.
❑lm ON.
If a roof is installed without first obtaining an inspection,I
Will On applicant or future Wilding occupant use equipment or deviem which g agree to remove P
trait havvdnus air can.!...4 as defined by the Bay Area Air Quality M....cmcm all new materials for inspection.
District?
❑Yu ONO
I haw mol Ne haysidou materials requimmenu under Chap e,6.95af the Calif.,-
me H¢IO&Safny Codc,Scdom M05,25533 and 25534.1 Mastermind thalifie Wilding
deas not currency hew a tmu n,that it IS my mapouihility m naury the occupant of the
requirements which most W met prior Is,issuance or a centuries.of Oecvpary.
n .
Signature of Applicant Date
Own..or asNori.<dapem Dae All roof coverings to be Class'%?"or better