05090213 (2)L
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
SUNBRO BUILDERS INC
PERMIT No. 05090213
22363 STEVENS CREEK BLVD
NEWS NAME:
PERMIT ISSUE DATE
KAM LI
1285 TOURNAMENT
NE:
SANITARY NO, CONTROL NO.
PF
(408)483-2637
ARCHITECVENGINEER:
BUILDING PERMIT INFO
BLDGEIECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION
lob Description
P
I l meby affirm Nal 1 am Monad under under provisions of Chapter 9 (commencing
with Section 70f11)ofDi,"' n3addi Busncoasdpmfc "cam Codc.mdmyliccnbi5
in full falmanderfecn.. 'Vl/ ,
DETACHED GUEST HOUSE (666' /PORCH 36')
mL7%i CoIlmmor
Da¢
CONTRACTOR: SUNBRO BUILDERS, INC (10/28/05)
ARCHITECTS DECLARATION
W used
1 understand my plans shall o used u public nxorde
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Licensed Pmhssional
OWNEDECLARATION
exempt
I tensityatiand u I am exempt from IM Convectors IOccnu Law for the
following moan. (Section Trp 1.5, Business and Pmfoasiom Code: Any city or county
which unions, a permit to emmruen mer. improve, demolish. or minor any svuetum
! prior b its issuance, also m9udies the applicant for such permit to fk a signed Mmourd
Ne Cont fxmts law (Chapter 9
Sq. Ft. Floor Are VaWdi6A 8 0 0
Nat he u licensed pursuant b Ne provisions of actor's
(commencing wish Section 7000) of Division 3 of the Business and Proressiosu Code)or
1 that he is axemp shmcfrom and One basis for the alleged eumptiom My violation of
Section 7031.5 by any applicant fora permit subjecu the applicant to a civil penalty of
ens ane Type
ml mom Nan row hundred dollm,
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3ANT0
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Required Inspections `
will do cis wont. and the structure is Mt intended or oQemd for miss (Sm. Mal, Budder,
and Pmfevsiau Cade: The Convectors License Law doss cot appy b an owner of
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pmpnty who Wilesofimpmws commit, and who doessuchworkhiona forthrough his
own employees, provided shalmeld improvements art net intended m offered for sale If.
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bowever, the building or improvement is sold within one year of compkcod. Ne owner.
Wilder will haw the burden of proving that he did set MW or improve for purpose of
ank )
❑ 1, u owner of she prpeny, am exclusively convecting with littved comme5ors b
conswct the project (Sec. 7044. Business and Prafeesau Coder) The Coouaebr's Li-
cense Law dean not apply in an Owner apropeny'who Wilds or improves Merton, and.
who contracts for such projects with a condiments) licensed puruant b mtr Character's
License taw.
❑ lamuemptunder See .B&PCforshumabn
Date
WORKERS COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury use of the following declaruionc
71 1 hiwn and wB1 malnlllo aeClllfClm Of L'Onamal b Ylf-IW WC fC( WOrkCYa GOmpetr
union, as provided for by Section 3700 of the Ichor Cade, for Ne performance of the
work for which this permit is issued.
❑ 1 have and will msntaN Workers Compenudon Instal., as ret Bred by Schon
1700 aft totem Code.fm Ne perfornmeeaf Newark forwhich data permit is issued.
'
My Wode .CCompenuuon Insurance tarda and Policy number am:
Cartier. !9/ ';2%r �,O Policy N�aZ��S
CERTIFICATE OF WORKERS
EKEMPf10N MOM
COMPENSATION INSURANCE
(Thu sermon need rot W completed if the permit is fmonc hundrtddollan ($1007
.
ns' less)
,
1 certify that in the performance of the work for which this permit is stood. I shall not
employ any person in my intimated as to become subject to Ne Workers'Gompmourtion
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Cenifcam Of Exemption, you ahead
became subject an IW Woheh Contamination provisions of Ne Ladd, Code, you must
' foMwilh comply with such provisions or this permit shall o deemed rooked.
i
i CONSTRUCTION.is.LENDINGAGENCY
1 hereby aRrtm Ne Nem u s
30 herding agency fur the performanee Of
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the work fur which Nu permit u issued (Sec. 3097, Civ. CJ
Landers Name
Lcndeh Address
j I certify than 1 haw read ids application and sok Nat the addve information is
' crosect. I agree to comply with all city and county on inorces a di mute laws relating to
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building convection. and hemby auNorim «pmsenotives of Nu city in enter upon led
( Move -mentioned property for inspection purposes
(Wee) acme he new. indemnify and keep harmless ted City of Cupertino agsnst
j liabilities judgmentalimsesud expenses which may In any waymena, Mgsnslmd City
in mismo nee of the grading of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WI ALL ON -POINT
Issued by: Date
SOURCE REG�1
Re -roofs
Type of Roof
��� es�
Sighadurcol'ApplindarsoCcuounachor Date
HAZARDOUS MATERIALS DISCLOSURE
Will Nee applicant or future Wilding Occupant stere orhaadle buudou material
as def ted by the Cupertino Municipal Code. Chapter 9.13. and Ne Health and Safety
.ScNaa 25532(a)7
❑res
All roofs shall be inspected prior to any roofing material being installed.
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If a roof is installed without first obtainingan inspection, I to
Will Nee applicant or ruts. building toe equipment or
agree remove
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emit byftOccupant
air conuminunu u defncd by Nee Bay Ara Air Quality Management
Manna ement
all new materials for inspection.
District,
D SVICIy
❑Yca PAJru
1 have read the WaNsansmaerieu onpimmenu under Chapterfx95 olthe Califor
ria Health& Slety Colo Sections 25505,25533 and 25534.1 undenund thrifcc Wilding
dna nal curmn ty haw a tomem. that it is my mspenchidy in notify, Nee Occupant or Nee
rcyvi¢mens which ustWmet prio,biduance of aCotiRem,acecu
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Signature of Applicant Date
All roof coverings to be Class "B" or better
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Owner uN m Date