07070142 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
11629 BIRCH SPRING CT CASTILLO' S ROOFING 07070142
PERMIT ISSUE DATE
OWNER'S NAME:
LI SHEN Y AND SUSAN S 1703 CAr,'HAY DR. 07/17/2007
SANITARY NO. CONTROL NO.
NE:
(408) 25:--3565
BUILDING PERMIT INFO
A RCHITECI•/ENGLNEER:
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
;'U with Section7000)ofDivision3ofdtcBusincssandProfcssionsCodc,andmylicenscis TEAR OFF (E) SHINGLES, INSTALL 30# FELT,NEW GAF
=y in full force and cffect l Lrc 4public
O
�z License Class f COMP SH:=NGLE, 25 SQ CLASS A.
u p Datc Con
ARCHITECTS
i a< 1 understand my plans shall be useds
iyU
U.F- Licensed Professional
' a OWNER-BUILDER DECLARATION
aI hereby affirm that 1 am exempt from the Contractor's License Law for the
:a o following reason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z r prior to its issuance,also requires the applicant for such permit to flit a signed statement n<' .Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $8500
that he is exempt therefrom and the basis for the alleged exemption.Any violation of N
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 6 5 4 0 7'3p Number Occupancy Type
not more than five hundred dollars(5500)
❑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 docs 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
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cease 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
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
L]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 performance of 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:_S�H7<P �L�n Policy No.: 238 6!� 99
CERTIFICATE OF EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need 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,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z"" CONSTRUCTION LENDING AGENCY
H I hereby affirm that there is a construction lending agency for the performance of
ter> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q
Lender's Name
z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
[> correct.I agree to comply with all city and county ordinances and state laws relating to
L)U building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(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 to consequence of the granting of this permit. Date �//
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE EGULAT NS.
7 7 i Re-roofs C/
S' alurcof he UConuactor °are Type of Roof `
HAZARDOUS MATERIALS DISCLOSURE
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 ;hall be inspected prior to any roofing material being installed.
❑ [7
Yes Nu
If a roof i;installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as dcfi by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes u
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- / 7 7
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building / `1
does not currently have a tenant,that it is my responsibility to notify the occupant of the l
requiremehic Atuts et prior to issuance of a Ceraftcate of Occup cy. Signature pf Applicant Date
767
All roof coverings to be Class"B"or better
O ncr ora hori-red agent Date