06010113CY OF CUT E! T! O PERMIT
BUILDING DIVISION
3UILUhr+V n�-._
10655 CLUBHOUSE
"uNER'S JE�IFER CHENG
ARCHITECTIENCAINEER:
SED CONTRA�R S DECLARATION
LICEN provision of Chapter 9 (c y license licerhscd under P license is
100 affirm that I am gustocss and Professions Code. and my
m I hereby of Division 3 of the
e U G With section 7000)
t < w in full force and effecL Lie. ft
v� Z License
Class Contractor
DECLARATION
p Date ARCHI TE�ed ras Public records
�-Wh nd my Plans shall used be
2 � < l understand
i U t[cssional ER DECLARATION w for the
u H Licensed Pro OWNER -BUILD city or county
'• Oi,<ty structure
affirm that 1 am exempt front �c Convectors LicAny ense
o following reason. (Section 7031.5. Bttsincss; improve-
PT°fGe o li COQ 1 �d statement
rove, dcmul'Lah, or rep
alter. permit to file a ug
m which requires a Petals r consw a ,cant for such pe License Iaw (Chapter 9
u rn prior w its issuance, also requires the PP
ursuant to the Provisions o[ the Contractor's mess and Professions Code) or
e that he is licensed P on 7000) of Divislon 3 of the ed exemption. Any violation of
z = p with Sccti basis for the alleg licant to a civil penalty of
Y h (commencing t therefrom and the Permit subjects
the app
u � that he is exemP licant for a perm
PERMrr No. 0 6 010113
ESANNrTARY
M ISSUE DATE
fNo-
03 2006
CONTROL NO.
BUILDING PERMrr INFO
AII
Job Description
ENCLOSE (E) COVERED_ PORCH (122'
t Section 7031.5 by any avy nsation.
five hundred dollars (sem) loyces with wages as thew sole earn
not more than or my GnP for sale (See. 7044, Business
I, as owner of the Property' is sot intended or atfeted not apply w ao owner o[
work and the structure ars Licarse t.aw does l[ or dtrough his
will do the ons Codes •rte Contras for
sale If.
and Professions thereon, and who does o>kntended oro erect
Property who builds Of imp a ch improvements yea of completion. the owner-
Provided
wner-
own empinYccs• Pio row meet is sold within oro Ye for purpose of
however. the building ori ii of proving that he did not build or improve
builder win have the with licensed contr�
sale.). Property' am exclusively contracting The Contraeters w'
and Professions Code) icon, and .
I. as owner of the property who builds or unp Contrutors
trust the project (Sec. 7044. Business nt to die
cense Law docs not apply to an owner of proPe licensed pursue
who contracts for such Prolects with a contractors)
B & P C for this Ma4O"
License Law.Se� L, `
I am eXxeunderr �s / — Date.,
26153
Area
Required Inspections
9C gg'S_C0T7"_- ons:
,order penalty Of periury one of the hollowing dectaran ComPen'
I ' reby aft nt to self-insor frit W�ftrmance of the
Section 3700 of the labor Code.for the Pe
j jw+e and will aintain a certificate of once
cation, as Provide for by Sec section
snit is issued• as uired by
work for Which this pe Compensation Instuance, as this permit is issued
will maintain Worker'sdormance of the work for
I have and Code. for the Pe and Policy number are=
3.1 of the Labs nsatian Insurance carrier
MY Workers compo Policy No.:
CERTIFICATE CF EXFMFv I`ION FROM WORKERS'
Carrier.
COMPENSATION INSURANCEh is for one hundred dollars (5100)
(This s-cuon need not he completed it the am
rmit is issued. f shall not
or less.) rs PeWorkerd Compensation
I certify that in the performance of the work for which
t10the
employ any petson in any manner _ — �p
Soroia te of Exemption, you should
Laws of CalDale Code. You must
ApPna
eamt I ter making this ions of the Labor
NOTICE To APPLIC Wor ComPeasstin rmit shall be deemed revoked.
become subject h rovisions or this pe
Z, forthwith comply with sue
� � CONSTRUCTION LENDING AGENCYagency for
the perCorrnarree of
I hereby t there is a construction lending C
affirm that
309'1. Civ. .)
7
the Work for which this Permit's
issue
Lenders Name
0 Lenders Address d this applicMion and
state that the above inform
is
I certify that I have rex and county d statences and state laws relating to
U
Q correct I agree to comply with all city fesentatives of this city to enter upon the
O V building construction, and hereby authorise rcp Cupertino against
rty for inspection Purposes, the City oC Cupe d Cit
above-mentioned Prop' and kecP m any way accrue agatnst said Y
W (We) agree to save. indemnifyan
which may'
liabilities. judgtAemIs costs and o(t�his Permit'
WITI.1 ALL NON -POINT
in consequencc of the granting WILL
COMPLY
ANDS AND
V ►Z-+ APPLICANT UN A S
SOUR ULA Date
ar APPIi t/Contractor ALS DISCLOSU odic hazardous material
Sign HAZARDOUS �pantStore ofha dSafety
ilding 9.12, and the Health an
Will the ncant or future bu al Code. Chapter
as defined by Cupertino Municip
.ic, Section 532(3)7 rdNo
O Yes `7/�� a ui ment or devices which
Ijcant or future building occupant use equip Management
Wi11 the app
taminants as defined by the Bay Area Alf
Quality
emit hazardous air con
District? rJ(No
Dyes T� to 6.95 of the Califor-
uirements under Chap d thatif the building
ardous materials req 1 understand of the
I have road the
$eCtions u505.25533 and to noufy rte Occupant
nia Health & Safetyhave a tenantt� s it is my
responsibilityt a C� of Oc
docs not currently met prtor W issuance
requirements which mhrstbc // <7Date
Date
Issued by'
Re -roofs
'Type of Roof material being installed.
Inspected prior to any roofing agree to remove
All roofs shall be an inspection, I
If a roof is installed without first obtaining
all new materials for inspection.
Date
Applicant s to be Class "B" or better
Signature of App All roof covering