02040131 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10708 S TANTAU AVE 02040131
OWNER'S NAME: APPLICATION SUB DATE
ALFRED & MONICA WONG 04/23/2002
PHONE: SANITARYNO. CONTROL NO.
°O O ARCHITEC"PENGINEER: BUILDING PERMIT INFO
°y❑ BLDG ELECT PLUMB MFCH
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LICENSCD CONTRACTOR'S DECLARATION
n- 1 hereby affirm shut 1 am licensed under provisions i f Chapter 9(commencing Job Descriptio
'4V° TEMP POWER
F-; withfill omen,1of Division Jof the Bu' ass end Profes.'ons CrNe,and t lirrase
j m PIce full omen, tiff
:H,
Q Lice a ns_ }/fi.p
" Date Comma r
3 3 w
or ( used DECLARATION
Vg I undo and my ens shall be uuJ as public records
l7
i p O .acmA Professional
' y OWNER BU ER DECLARATION
at 1 hereby omnn Nal Iain exempt from the Conuanor's License Law for the
1-z f- fallowing reason.(Section 7031.5,Business and Professions Code,Any city or county C 5 O O
Y o which requires a permituct
dt to construct,alter,improve demolish,or repair any structure Y
nor
n3� Po' .also req ' Ih PPlicam for such permnt fl -grcd stammem _ .._
but he-Is,licemedputpuani to the provisions of the Contractor's License Law IChaprcr9 Valuation
(commencing w on Section]O(p)ofDvision 3 of the Business and Professions Code) i �l s ts3:7r"!j ./r��Jl3•i(U,V i:_I4 J.:SY. it r''�
or that he is exempt fl ciefrom and the buss for Ne allege)uemptmb.Any violation
of Section 703 1S by any applicant for a permit subjects the applicant to a civil penalty Uu
of not mom than five handred dollars($500). 10: xPN 1 N .., Occupancy Type
❑1,as owner of the progeny,or my employees with wages as their sole compensation,
will do the work.:,oil ldid xfracture is not intended or offered for sale(Sec.7044. R1 RCTR CAT
Required Inspections
Business and Professions Cade:The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon and who does such work himself
or through his own employees.provided that such improvements are not intended or _
offered for:ale.If,however,the building or improvement is sold within one year of
iompletion,the owner-builder will have the burden of proving that he did not build or
mprove for parpom.frafe.),
ro .. .. . _
❑L tr owner pr the progeny,am exclusively comnaing with licensed Contractor's contractors to
License
the does
(Sec.7044.Business and Professions Code)The Co thereon, - r -
Lid who
co docs not apply man owns of progeny who builds or improves thereon, '
_and who..micens for such pmjsts.wish a contractors)li<ensed.Pursuam.m the. _. _... _. .. .. _ ._ _-.._ ..__-..___ _ t__ .--...____..__::.. .__ ..-.___
El Iam ewe pt Inde Law.
❑lam exempt under Sec.' ' ,B 8:YC for his mason
_ Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the following declarations:
•O I have and will maintain a Cenifcam of Consent to self-insum for worker's
Compensmion, as provided for by Section 37W of the Labor Cede, for the
ps,f nor ds,of the work fm which this permit is award.
❑I have and will maintain Worker's Compenxaion Insurance,as required by Section
3700 of he Lima,Code f ❑ peibarnaince of the work f which this Nami, s
ivvu�cd My Worker's once ca�d P-
•Jr.AI C•Rf[fit ON F i'TION tROMW 1 SI t IL, td'r Yi u tf l'fl " v
. .,t COMPENSATION INSURANCE," „ ' . .._. .-_..
(This ic�tio ncW not he completed if the permit is for one hundred dollar s f' '�` J. IN
(51 W)or less.)
1 carrify that in the Performance 0 f the k for which this permits issued,l - v
shall not employ any Person to any manner so as to become subject to the workers '
Comjansation Laws of California.Dae
Applicant
NOTICE TO APPLICA oTo rs Compeer nsation
sats this Provision,ate of
Exemption.you,your i,r
becomeh comps the Worker's Comns or
is provisionsofthe Lame Code,you man
ld
0 forthwith comply with such provisions or This permit shell be deemed revoked.
F ' . ' I CONSTRUCTION LENDING AGENCY
C ' '` I hereby alfmm that them is a conslrucdon lending agency for the performance
�. of the weak for which this permit is issued(Sec.3097.Civ.C.)
P. Q Units,',Name. ... _. a . . :..... ..,. _, -- .. . ..
7.z Lender's Address orf
C)fI certify that 1 have read this application and smut that the above information is /IA
armee,:I agree to comply with all city and county ordinances and state laws relating /VYvi1`
�.V to budding conswetioo,and hereby authorize repowandarvea of this city,to enter upon
W theubovcmeminned aropeny for impaction purposes.
t„t 0. (We.a to s ve,indemnify an cep hamilesi the City of Cupcnino against
.y liabilities.' cots,costs and as which may in any may uccrue against said
C.Y.sZ City i li ance of the cousin f ,permit. r.
ANI UNDE ' AN N ILL COMPLY WITH ALL VON PO ed b Date
s0 C. Jr N Y'
- atm p <an✓ tr re "Re-roofs
CoecfnWlb�Ihe Cv nAlur Wllcgoamrpmrt9.l oranaat tmha hanroom ma anal Type of Roof...
_ H R O ATfiRiALs DISCLOSURE
pP 8 WIN _ .. .. ._.
Health and Safety
Sty25532(e) p p . ,` T'� ," `.( , sal •• •
0Ye' "° r ' All roofs shall be inspected prior to any roofing_material being.instal led-- -
wnm- pphra I r r huldiagoc'cupe tequipmentorde iceawhich If a roof is insWled without first obtaining an inspection, I agree to remove
emit hasoNo- out m a t dcfned by theBal Arca A Quality M nagement
Donnm,? all new materials for inspection. Applicant understands and will comply with
❑v. - No% - - - - all non-point source regulations.,, - -
1 have read Ih m out materials requiremems Louder Chapin 695.f.tFe
California Health - ty Code.Sections 25505,25533 and 25534.1.understand that
if the building d I Can
have a ten tha it is my rcsponaibiliry t n fy the
occupant oft ircmems which m - ren poor m issuance of e sTp1
oecupan.y„ / ignature of Applicant Date
owns n. ,gen, ae All roof coverings to be Class "B" or better
,_.., .,_ ._ .. .. . . . . . ... . - — OFFICE