07060218 f
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CITY OF CUPER 110
BUILDING DIVISION PERMIT
BUILIT733E5ALCAZAR AVE TBD TO BE DETERMINED 070602
18
OWNER'S NAME: PERMIT ISSUE DATE
DAVID & RIE WONG 07/10/2007
�Et SANITXRY O. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O`O LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
z�d with Section 70(10)of Division 3 of the Business and Professions Code,and my license is HOUSE DETIO-OAK TREES ARE PROTECTED IF THEY HAVE
j 41- in full force and effect.
d Z License Class Lic.8 10" D I A.
F w Date Contractor
ARCHITECTS DECLARATION
aa I understand my plans shall be used as public records
aU
Oe y Licensed Professional
H a OWNER-BUILDER DECLARATION
j a N I hereby affirm that 1 am exempt from the Contractor's License Law for the
:p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
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 rile a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S 1.Ft. Floor Area Valuation
t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9500
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 Number Occupancy Type
not more than five hundred dollars(S5W). 3 5 719 019 'Vl
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not 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 9 P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion.the owner-
builder win have the burden of proving that he did not build or improve for purpose of
sale.).
I,as owner of the property,am exclusively contracting with licensed contractors to
truct the project(Sec.7044,Business and Processions Code:)The Contractor's Li-
ccnse Law does not apply to an owner or property who builds or improves thereon,and•
who contracts for such projects with a contractor(s)licensed pursuant to the Comractors
License Law.
0 1 am exempt under Sec B&P C for this reason
Owner DQV/4d Date '7 10-07
WORKER'S COMPENSA ON DECLARATION
I hereby affirm under penalty of perjury am of the following declarations:
i I I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Workers 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 am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section treed not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manno/o Ly&rgr&smect to the Workers Compensation
Laws of California. arm ! ahi
Applicant '-1 L✓•w AL
NOTICE TO APP OANT.If after making this tertilicate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
.�Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
E-d'�. I hereby affirm that there is a construction lending agency for the performance of
Ix> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lendcr's Namr
5 Z
Len Address
V 0 1 certify that I have read this application and state that the above information is
tL'" correct.1 agree to comply with all city and county ordinances and stale laws relating to
U Ubuilding construction,and hereby authorize representatives of this city to enter upon the
ahove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
M liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b,-: Date
SOURCER Tf0 . 7 Iv -0 _
(/ 7 Re-roof:,
Signatu Applicanr/Con or Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal 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.
Yes XNo
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 materials for inspection.
District?
0 Yes Xu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify tin:occupant of the
requirements rchmustbe t or rssuanaefaCertircateerotcapanry. Signature of Applicant Date
�+ —0 q 7-10-07 All roof coverings to be Class"B"or better
Owner or authorized agent Date