03010072 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMITIL'CONTRACTOR INFORMATION: '
BUILDINGADDRESS: WONG WILSON T AND SUSAN S PERMITNO.
10397 SOMERSET CT
ER'S NAME: APPLICATION SUB DATE
ONG WILSON T AND SUSAN S 01/13/2003
PHONE: SANITARY NO, CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
G7 0
LICENSED CONTRACTOR'S DECLARATION Job Description
a O G I hereby affirm that 1 am tunder provisions oo
vision
f Chapter 9(commencing p
with Section Tax))of Division Soff the he Business and Professions Code,and my license is
in full force and elfin. CHANG PATO ROOF TO HIP
� Licemc Class Lit.it
p?�p Gato Contractor
ARCHITECT'S DECLARATION
I understand my plans shall br used as public records
u�a
0% Licensed Professional
�s= 3 OWNER-BUILDIiR DECLARATION
u
as
F I hereby affirm that I am exempt from the Cnneacon's License Law for the �+
ti pO whiih"aftera (Smdmn]1131.5.Business and
oa.dmalkh.or:Any can ler county .V\
$ which rets iss a a permit it)re construct.alley,improve.demolish or repair any structure
that heor its e,also pursuant
buvisio ant soff rsuch eConperrninoicensle e sw amrcmcm
StSS=<
that he isliccnwit pSectio 7f the or Division
of the Contractor'snd Prof Law(Chode)or Sq. FL Floor Area $ dY tion
y+F-p (hat he
ing exempt
Section WMMB the basis for
the
the Business and Professions Any vi Code)of
y�$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section)031.5 by any applicant for a permit subjects the applicant to a civil penalty of be Occupancy Type
not more than rive hundred dollars(5500).
❑1,as owner of the properly,or my employers with wages ss their sole compensation,
will do the work,and the structure,is not intended or offered formic(See.70,14,Business 3 05 -
FRAME
and Pmfessmns Code.The Canimctors Lmense law does not apply to an owner of 3 07 - INSULA y-FWd Inspections
propeny who builds or improves barren,and who does such work dissever through his
own employers,provided that such improvements are not intended or offered ler sale.If, 601 - 'ROOF TEAR OFF
however,be building or imprmement is sold within one year of completion,be owner-
builder will have the burden of proving that he did not build or improve for purpose of 6 02 - ROOF PLYWOOD NAIL
sale')' 603 - ROOF BATTENS
01,as owner of the propentiam exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
contained the project(Sec.701 Business and Professions Code:)The Curbstone's Li-
cense Use does not apply m an owner of property who builds or improves themmn,and
who emir acts far such projects with a conenclor(s)licensed pursuant to the Contractor's
I.icrnsc Law.
ryr,[`t am'T"I"
xc pt u c Scc. B&P r�9101is reason
r Date f>
WORKEIRSCOMP DECLA
I hereby M.under peneltyofp .1 ane of be following declarations:
❑I have and will maintain a Crrtfrtcam of Consent to self-insum for Wmkres Comper,
sation,as provided for by Section 37M of be Labor Code,for the performance of the
work for which his permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
371X0 of the Labor Code,for the performance of the work for which this permit is ismad.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed it the permit is forma,hundred dollars(SI00)
or less')
1 certify that io the para t ancc of the work fe which this permit is issued.I shall not
employany perssm anner�n i c rte t a Wnrkers'Cmmpensation
Laws"California at I
Appli ant
* 1050PAPP king t ,ion,You should
become subject to the Workrr•s Comfxfiax X n pmvi.- s of the Leber C,dc,you must
O O forthwith comply with such provisions orbis permi sh 11 ire deemed mvnked.
z 0 CONSTRUCTION LENDIN 2OENCY
[-s fn I hereby allirm bat there is a construction lending agency Tor the performance of
ai 7 the work for which this permit is issued fire.3097,Co.C.)
aQ Lender's Name
r7 z lender's Address
U O 1 certify that I have read this application and suite that the above information Is
L4 P correct.1 agree to comply with all city and county ordinances and stale laws relating to
O U building construction,and herehy auborire representatives of this city to ewer upon the
>' 81 above-mentioned property for inspection purposes.
(~ (We7 agree Io save,indemnify and keep harmless the City of Cupertino id City
h liebilitiese)agr en10 costs and expenses and keep harmlany ess
the Cecerveagertinoa achy
U z A ANT UNDEof the granting of TANDSthis AND Permit. COMPLY WITH ALL NON-POINT Issued by: Date
5 U ERF.GUI. 0 S. 13/
J A)1 Re-roofs
Signature of ppicar"Contractnr Date
IIAZARDOUS MATERIAL ISCLOSURE Type of Roof
Will the applicant or future building mcepant store or handle hazardous material
def tied by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
c.0YCs 25532(a)9 K All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occipam use cyuipmem ordeviccs which If a roof is installed without first obtaining an inspection,I agree to remove
cm it hazardous air conmmirents as defined by the Bay Area Air Quality Managcmcm all new materials for inspection.
District!
❑Vcs 4
Ihave&Safet thode, mus materials re33an,1msunder Corman thatifbeb.2 g ^ n
nia Health dr Safety Crile,SecGons2 ,25533 and 25534.1 understand thazifthe building
Joes Icbk vealcnanl tit my resrynsihility to nodlyt acupam nl'thc
reyu' menta ni, mmatMmel tutu eaaant ,raCenmemeofa,ap. - ignature o Applicant ate
wmrmr Imth zed agent DaI D All roof covering to be Class "B" or better