06060194 (4) CITY OF CUPERTINO &. i :K+c t "' u
BUILDING DIVISION PERMIT
INFURMATIUN
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BUILDING ADDRESS: 1 DAPHNE LIU ,,. `m"u,06060194
10428 S FOOTHILL BLVD
_ NER'S NAME: PERMIT ISSUE DATE
DAPHNE LIU 06/22/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
eO EO �l� O
a0z LICENSED CONTRACTOR'S DECLARATION Job Description
1 thereby affirm Nu 1 am licensed under pon,140na chapter apter 9(Commencing
with Section 7000)of Division 3 of the Business and Profemom Code,arta my license Is
In full to=And Affect. KITCHEN, 2 BATHROOMS, REMODEL MINOR STRUCTURE,
Dave Clua Lle.g
Dam contraua ADD 4 PIERS TO SUPPORT JACUZZI TUB
ARCHITECTS DECLARATION
p U I undersand my plans shall be used as public record+
a
�G Licensed imfeui...I
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Comraxwe,License Law for the
Zoo O following mason.(Section 71171.5,Business and Profession Code:Any city or County
i 9 t which wouires a permit in eonmucs.eller.improve,dims.h h,or repair my summere
°z S^ prior to is issuance.also requires nm applicant("such permit to file a signed ssumen, VBIUBC/y�0�0
F5 C dot be is lfcvctl Forearm to this Provisions of Nrc
e Canumr'I Liamm Law(Charter 9 Sq.Ft.Floor Area ay
ad l-s (commencing with Section 7000)N Division 7 of the Business and Promasi.m Cade)a
- Nat he is exempt therefrom and the basis for the alleged emmption.Any violNon of
Section 7031.5 by any applicant for a permit subjects the app iam an a civil penalty of p;N Number Occupancy Type
not mom Nan fiw hundred dollars(5500). 3 5 7 0 3 071. 00
❑I,uownar of tBe property,"my employees with wagnuNeir Cole Compermtion,
will do the Mark.and the suucmm is nolinaMed or.nered foraalo(Sm.71N4.Budw+ Required Inspections
and Profeuiou Code:The Co. mmes Licensew ladw ml apply man macer of q -
property who builds or im prom most and who does such work himself or through his
a wnemployces,provided Nal=himprow Uamoa(ine waResedfascia If.
howem,the building a Impmwmmt la Cold wiNin.m yea of mmplcdan,Ne owmr-
Wildm will have the burden of proving that he and Cot bwld"improv for purpose of
Ask.).
5L u owner of the property.Am exclusively comaming with Banded Conuatmm m
natrucy the project(Sec.70".Business and PrnfeWona Code:)The Contrumr's Lt.
come Law does not apply in an owner of property who builds a Improwa Omsmn,and,
who contacts No such projects with ammncmr(s)Banded pursuant in don Convumfs
License Law.
❑lamexemptunder See ,B&PCfm Nlareawn
er • Dam -226
PENSATI ECLARATION
I hereby alum under penalty or perjury one of the following declarations:
❑I Inward!will malnwn aCeNnmm of Covera m self•inaun f"WorkA`-Canpcn-
ution,u provided for by Section 7700 of dm Labor Code.for the perfomanee of the
work for which this permit is blued
❑t haw and will maintain Warl ces Compensation Ivunme.u required by Section
3700of do Labor Code.for the peRomanceaf Ne work fa which Nu permit ts luued '
My watch Compeuam.lsrmsance earner and pmlry numb"am:
Cartier. Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS
COMPENSATION INSURANCE
(This section need Cot be Compleum If cite permit a foram hundred finnan DIOB
or lest)
1 Certify Chat in as perfom ice of the work for which this permit Is issued I Mall not
employ any Person in my roamer ubhmme mbjeclmth Worlras'Canpevadon
Laws of C+lifnsSlDam �-�•' -^�
NOTICE, f]"an"
� tl�- b'
NOTICE TO APs she If,after Commaking n this Ccriprovisions
o the
Labor Exemption.you slmust
became subject y the Worket+Camp or this erov4lom of Nc labor Code,you muss
.J O foMwith comply with such provisions or this permit shall be domed revoked.
z CONSTRUCTION LENDING AGENCY
rA
Q•v I hereby anion thn Nem is...Amucd..lending agency for we performance of
D: the work for which this permit Is Darned(Sec.7097,Or.C-I
W�Q lender's Name
7 Undoes Address
U0 1 certify that I haw read this application and+am that the above information is
U.6" comet.I agree m comply with all city and county aNlnamea and sum laws relating In
Obuilding construed..,milhacby autharix represemsdws of his city a enter upon da.
Uabove-mentioned properly for ivpeco.n purposes
91. (We)agree to caw,indemnify and kap hiamleu the City of Cupertino against
rvF'w,n liabilities,judprana,costs and expcnsea which may in Any way amue Against aid City
U'4 In consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 62i Date O
SOUR ONS. 2Z��6
�— Re-roofs
pplicamucoHAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the Applicant or fume building occupant sten"handle huudous material
As defined by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Section x553:(.)± All roofs shall be inspected prior to any roofing material being installed.
Oyes ArNa
Will the applicant or future building occupant ase If a roof is installed without first obtaining an inspection,l agree to remove
g W ea Air Qat a devices which
emit Mum.us air conuminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea AW.
I haw mad IN,bacardw,materials requirements under CTapmr 6.95 of the Califor-
nia HealthkSLCsyCAde,S"6oas 25505.25577 will 25534.1 understand Itself Cher building
does ml currently haw a moans.ft it is my responsibility m miry Ne occupant of the
requirements which most bemet prior In issuance oraceNne.m.r111,c! y. Signature of Applicant Date
� � 6 = �6
o n adxmd agent Date. All roof coverings to be Class"B"or better