06010111 (2) CITY OF CUPERTINO mi '� -w m + /,,,;- - " " '-r'r-^ .
BUILDING DIVISION PERMIT CONTRAC-�TORTNFORMATIO�N,
BUILDING ADDRESS: CREATIVE HOMES PERMIT NO.06010111
20810 PRP FR TRRR IN
ER'S NAME: PERMITLSSUEDATE
MICHELE LUM 625 VICTOR WAY 01/20/2006
NE: SANITARY NO. CONTROL NO.
(650) 996-2444
ARCHI EC MNGINEER: ¢ r 0' ABUILDING PERMIT INFO
Ei BLDG ELECT O'Oe-"VOPLUMB 0
�Ins,o siS
LICENSED pm
ECLARATION prion t 'ice
I Wmby affirm Nat I amONT cd under provisions DECLARATION
Y(commencing lob Description x, lryt'Jk i§ISi^99�/
U with Section 7M))ofDi .km3afNC Business and Pr°rWopc,Codc.mdmylicense is ��7]
+may in fullforc andcffect. 1� /� - `� REPLACE RAILING @ (E) DECK JAN ^aT ZOOS
l nr Liccnu Clan Lit.N
n t-� Das Co I to
CHITECTS DECLAR
5� I uMcrsanJ my plans shall W mud u puhlic �'7
^ FA
nods�
,y n a--/ /= . !/(Z// Imp{IIVFtry77 I/rLrylt7 `/
p Licensed Professionalo I g OWNER-BUILDER DECLARATION
C20 I hereby affirm that 1 L exempt from Nes Contractor's Littnu law(or the
iC20 o following mown.(menton 703 L5.Business and Pro.doom Calc:Any city structure
m which rets ism r permit re cnrtsw0.ally improve,demolish,or repair any swetum 500
yi> Oat he itsissuemc.alsarcquirne tWapplianf for such Corrosion'W mets,Law
stammer
Fi p RmWuliceoscdporstion7eofDiviomofofOnBuazessancemylaw(Chapmr9 Sq. F[. Floor Area Valuation
>;� (commencing with Section]OW)of Division3 of Ore Business and Professions Cale)or
y Nat W I.exempt Nemfram and Be basis far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of
not mart One five hundred dollen(5500). Occupancy Type
❑I,as Owner of the property,or my employees with wages as their sole compensmon,
will do Ne work,and Ne structure is not mounted or offered for talc(Sec.]061,Business
and Profession Cale:The Commences Licence,Law dans ant apply W an Owner of Required Inspections
property who builds or imprases thereon,and who doesmah work himself orthrough his
own employees.provided Nm such improvements art not intended redirected for nit.It,
however.the building dr improvement is sold within one year of completion,the owner-
builder will have the Widen of proving that W did Out Wild or improve fon purpose of
ale.).
❑1,as owner of the propeny,am exclusively contracting with licensed contractors to
construct the,pmjca(Sec.7014.Business and indications Cade:)The Contrxmr's U.
cerise Law docs not apply W an owner of property who Wilds or improv themon,and.
who contracts for such projects with a contractor(s)licensed pursuant to Re Contractors -
License Law.
❑1 am exempt under Sec. .B&P C for this maxon
I Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decimations:
I haw and will maintain a Certificate of Cnnum to self-insure for Workers Compere
nation,as provided for by Section 37W of the labor Code,for Ne performanm of the
weak for which this permit is issued.
❑1 bade and will maintain Worker's Compensation Insurance,as required by Section
37W of the LaWr Code,for the performance Of the work for which this permit is issued.
My Wohcrs Cam d° .,rtpvye c/ynQPolicy number me:
Cartier: / / Polity No.: _
CERTIFlCATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
CThu section nerd notion completed if the permit is forma,hundred dollen(SIM)
or less.)
1 rertify Nat in the performance of the work rot which this Permit is issued.I shall not
employ any person in anymanncrw�Wieoyc wbj feta tW-W—Compcnnti°n
Laws of California.Dam d`/
Applicant Tr^
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
Wcome subject W the Workers ComPenation provisions of the Labor Code.you most
.,O foMwiin Comply with such provisions or this permit W deemed mvokcd.
Z M CONSTRUCTION LENDING AGENCY
H� l hereby affirm Nat dem is a construction lending agency for the Performance or
7. dW work for which this permit of issued(Sec.3097,Civ.C.)
rA tender's Name
M z tenders Add.
U Q I cenify that 1 have read this application and same Rat the above information It
Ly F correct 1 agree a comply with all city and county ordinances and same laws miming W
p U building construction,and hereby autharne representatives of this city in enter upon the,
r W ahovomcmiuned propcny fat inspce ion purposes.
F„ a (We)agree to save,indemnify sad keep humless IW City o(Cupynina again,
y liabilities.judgments,costs and expenses which may in any way accrue agaims said City
U z in consolation of the granting of this permit. •O /
'+ APPLICANT U TAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date U
SOURCE NS. .�f�
r+rL� Re-roofs
slerr pphcmv ntmcmr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tW applicant ar future Wilding aaupam nom or handle loomak us material
as defined by the Cupertino Municipal Code,Chaprer 9.13.and the Health and Safety
dc.Section 15532(x)?
❑Yes � All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
crit ha>ardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
C3 Yes
I have read the hnnrdous materials requimmcns under Chapter 6.95 of the Califor-
niaHwlR&SafetyCode,Sections 15505.25533 aa125534.I undersand this ifthe Wilding
it.not curtcntI hate kysit it u ms
my pmtsihilit W rwdfy IW axupant of Re
mgmiremc°` c(primWi -alporoccuparcy fSignature of Applicant Date
Ownyr rranmrria agent O D,m All roof coverings to be Class "B"or better