06050002 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �1TQI�� Mx4 ��
BUILDING ADDRESS: PERMIT NO.06050002
7593 WATERFORD DR
'ER'S NAME: PERMIT ISSUE DATE
YUH-JIA SU 1 2006
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm that I am licensed under provisions of Chapter 9(commencing
lZ E with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full forec and effect. KITCHEN REMODEL-NON. STRUCTURAL
)2z License Class Lic•B
—in
Date Contractor
ARCHITECTS DECLARATION
rJ, < I understand my plans shall be used as public records
)yU
'tV in Licensed Pntfcssional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
o O following reason.(Section 7031.5,Business and Professions Code:Any city or county
Z 0! which requires a permit to construct,alter,improve,demolish,or repair any structure $30000
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
f- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L 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 TXPWffil7A&r U U Occupancy Type
not more than five hundred dollars($500).
0 I,as owner of the property,or my employees with wages as thew sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
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.).
N 1,as owner of the property,am exclusively contracting with licensed contractors to
tonstroct 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
License Law.
01._exempt �drec, B&P C for this reason
er �� K^ , �/
7 G. Due,
ORKER'S PENS TION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workces 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 arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
z
(ibis 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.I shall not
employ any person in any mann so to bee a bject to the Workers'Compensation
Laws of California
Applic Z4, 4 `
NOTICE TO APPLICW.rf,Mcr m ng this Cc thea of Exemption,you should
become subject to th orker'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
1 hereby affirm that there is a construction lending agency for the performance of
(Yi> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q L.entices Name
az Lender's Address
U C) I certify that I have read this application and state that the above information is
LL►'" correct.1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorise representatives of this city to enter upon the
W
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
p..4 l,,fj 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-POINT Issued by:
el
SOUR U S. _
`1 `�w Re-roofs
Signatu IApplican ontractor Dare Type Of Roof
H OUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
-s defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
ie,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
C]Yes WNo
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?
Q Yes No
1 have read the hazardous materials requirements under Chapter 6.95 oldie Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand"if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which Must be me Plies rssuance err hiftcate of Occupancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorize a crit Dare