07010048 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C1T .Ct'1�tRMTION'
...:. .:
BUILDING ADDRESS: PERMIT NO.
10292 TERRY WY TBD — To BE DETERMINED 07010048
PERMIT ISSUE DATE
OWNER'S NAME:
KONG, HAN, YUNG, CHENG
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0
p Z0 LICENSED CONTRACTOR'S DECLARATION Job Description
U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;Zw withSection7000)ofDivision3oftheBusinessandProfessionsCode,andmylicenseis EXTERIOR REMODEL FACCADE, EXTERIOR STAIR
<e in full force and effect.
Ln License Class Lie.# REPLACEMENT, WALKWAY REPAIR & NEW WINDOW AT REAR
p Date Contractor
:� ARCHrfECTSDECLARATION OF BUILDING (UNIT 4)
i tz< 1 understand my plans shall be used as public records
.LU rJ
0.
'
U.F' Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
ino following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m(ii which requires a permit to construct.alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area
at- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $35000
y 5. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 64 Number Occupancy Type
not more than five hundred dollars($500). 35917013
5illI,as owner of the property,or my employees with wages as their sole compensation,
do the work and the structure isnot intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code: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 sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
rlas
owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
Law.
am&Cppt under Sec B&P C for this reason
Doty
Owner
ER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations _
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performanceof the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certi(that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Califo
Applicant
NOTICE TO APP f,after making this Certificate of Exemption,you should
become subject t orkcr's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
F-u 1 hereby affirm that there is a construction lending agency for the performance of -
tYi> the work for which this permit is issued(Sec.3097,Civ.C.)
WR,A Lender's Name
z Lender's Address
U C) I certify that I have read this application and state that the above information is
LL r r correct.I agree to comply with all city and county ordinances and state laws relating to
rJ Ubuilding construction,and hereby authorize representatives of chis city to enter upon the
U ahovc-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P9`NT Issued by
SOURCE ATIONS.
/7 Re-roofs z —'
Signature oTA_ppIica5vdo-njr&eLor ba T of R oof
HASkRDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munid�Lpal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
E]yes [J No
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District? '
C]Yes 19Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certifies f c pane. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner o autho'.cd a e Date