06090051 (2) CITY OF CUPERTINO -> * +
BUILDING DIVISION PERMIT CONTRACTQR INIt,O$MATION
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BUILDING ADDRESS: PERMIT N0.06090051
21720 RAINBOW
OWNER'S NAME: PERMIT ISSUE DATE
Ah CHANG, HENRY
E: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
ipa LICENSED CONTRACTOR'S DECLARATION Job De$Ci1pL100
C 1 bereby arfim,chat 1 am liccma d under provisions of Chapter 9(commencing
b Mind Section 70M)of Divuion3 ofthe Businev and Professions Code,and my licence
I'2% infull force and affect. ADD POST AND FOOTING
a Date Class cone REVISION TO #06060258
F 51 Dam Contractor
pp As&hall use DECLARATION
i C� 1 undcrmanJ my plans shall W used as public rccrrJs
lyU
LLH Liccnsod Pnsfcuional
OWNER-BUILDER DECLARATION
in 1 Wrthy affirm dal I am exempt from the ConuamaYs License law for the
OO following mason.(Section 103 L5,Business and Professions Coda:Any city or county
s$� which requires a permit to construct.a@r,improve.demolish,or repair any structure
.xi Prior coir iaswnce,also requires line applicant for such Foram,to rile a signed sudmcm
: C thatW is licensed Foment to an,provisions of Contractor's LiLaw w(Chapter 9 Sq.Ft. Floor Area Valuation $0
i (commencing with Scccon7000)o(Division 3 or the Busineuand Profcssioes Codo)or
199 Nat W is account therefmre and the basis for the alleged esempdon.My violation of
Section 7031.5 by any applicam for a permit subjects de applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(150es), 36637008 . 00
❑I,as owner of the property,or my employees with wages as their sok compensation,
will do the work and the..mum is not intended or offered for sok(Sec.7016,Business
and professions Cody:The Contractors License,Law does not apply In an owner or Required Inspections
property who Wildsrrimproves crucon,and who dressuch work himaelfor Brough his
awn employees.pmvideddaweh improvements ancrunmmnded oroffered for sale.If. (\,
however,the building or improvement is sold within one year of complctirn,the ve Jur owner\
builder will haburden of proving chat he did not Wild or improve for purpose of
7�l,) S
4,as owner of the property,am exclusively contracting with licensed contractors to
consuucr the pmjea(Sec.7014,Business and Professions Code:)The Contractors U.
cense Law does not apply to an owner o'properly who Wilds or improves Berton,and
who contracts for such pmjecu with a comncrogs)licensed pursuant to the Contractor's
Leeve law.
lam—mph unde B&PCfar thisreason
Owner 'v Data zcq�-
WORM'S COMPENSATION DECLARATION
I he by alrum under pwley of perjury one of den following declarations:
(] 1oi rad will maintains Cinifcna.f Common iself-ircurefrrWrrker.Compem-
satirn. provided fm by Section 3700 of the Labor Coda,for the performance of the
wort for which this permit is issued.
Q 1 have and will maintain Wei Ounpereatinn IN11MCe.as rcgaiRd by section
37M ufdc labor Cock,fords performance ofde wort for which this permit is issued. '
My Worke's Compensation Insurance carrier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not decomplocd time Permit is Ln.hundred dollars(SIM)
or less.)
1 certify that in dm perfomance of de work for which this Permit is issued.I shell not
employany per son ins verso mWcp ewbjecyt the Warkeri Compensadrn
laws of Catifirmia _L',+-LSLG
Applicant
NOTICE TO CANT:If.after making du Cenirsam of Eumpdoo,you should '
b% rub' t to the Worace Comiseasation provisions of the Labor Cada you must
.,O 1.Mwith reply with such pmvisimes or this permit shall W deemed rcvokcd.
z CONSTRUCTION LENDING AGENCY
[—� 1hemhyi'l, u Per Bert isscoes.ct30 len ding agency forthe Ix:rformance of
C� the k fur which this permit u issued(Sec.J09],Civ.C)
CL
CL Landch Name
.7 z Lender's Add.
U O 1 tti ify that I have read Nis application and sum dust the aWw information is
I, P conn.l agree to comply with all city and county ordinances and state laws mlating to
0 building convection.and hemhy aucheriae repreaenmtives rrdis city to enter upnn the
show mentioned property for mipeetion purposes.
H4 (We)igmc to save,indemnify and keep hamJcss the City of Cupcdino against
N
liabilities.judgmcros,cosu and espe"•^n which may in any way ace..gaiest said City
Q z in consequence of the g,anting of this remit, /'�
APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / ✓_
SOURCE REGULATION
3' Re-roofs tet—_
Signoure of Appli enuumr Dad
NAZARDOus MATERIALS DISCLOSURE Type of Roof
Will applicant or future building occupams.c or handle havardous material
-1
b the Cupenino Municipal Code,l]upmr 9.13,and IW Hnith and Safety
Code.Scor 2553I(a)7 All roofs shall be inspected prior to any roofing material being installed.
e Nu
Will the applicant or future Wilding occupant use equipment or devicoa which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha ardous air contaminants as defined by the Bay Asa Air Quality Management all new materials for inspection.
District? a��///
❑Yes yq Nu
I have read the hvaMrws\mamrials requirements underChepmr6.95 of the Cables.
nia Heald&Safety Co e.k dons25505,25533and25534.1ondemmnd Omifthe Wilding
dons not curmnlly bac a mount,WI it u my responihili,y m notify Jur cecupao rr de
rcgairemcnts whichamt IPdormiazuamecrf.ccrdreamrr Occupancy. Signature of Applicant Date
74 �' All roof coverings to be Class"B"or better
Owncrorauthc' dagcnt Dam'