06080188 CITY OF CUPERTINO (�t
BUILDING DIVISION PERMIT \.� TT
BUILDING ADDRESS: PERMIT NO.
21088 TAMARIND CT HE$ITA('
OWNER'S NAME: A
STEVE KWAN 13622 SARAVIEW DR 01/12/2007
,NE: SANITARY NO. CONTROL NO.
(408) 867-6881
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
� 0 0
O o LICENSED CONTRACTOR'S DECLARATION Job Description
=U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is 2 STORE' S FWDL-1ST 2899 ' , 2ND 1634 ' GARAGE 751
y in full force and effect
Z License Class Lic,p
3 F O Date Contractor
ARCHITECTS DECLARATION
a I understand my plans shall be used as public records
�yU
4 C rn Licensed Professional
n OWNER-BUILDER DECLARATION
+�<2 1 hereby affirm that 1 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
rL which requires a permit to construct,alter,improve,demolish,or repair any structure
_Z prior to its issuance,also requires the applicant for such permit to file a signed statement
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $1014081
y 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 ofNumber Occupancy Type
not more than rive hundred dollars(5500). 3260801 8 . l7V
❑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'snse LiceLaw 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 arc not intended or offered for We.If,
however,the building or impmvement 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.)
I,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-
ccnse Law does not apply to an owner of property who builds or improves thereon,and,
who contracts such projects with a conuactor(s)licensed pursuant to the Contractor's
License Law.
❑I am exem u r Sec. ,B&P C for this reason _
Owner Date
ER' ON DECLARATION
I here nn under penalty of perjury one of the following declarations:
wimaitai❑Ihsveand nn a CcniBeato of Consent toself-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.
❑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. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 100)
or less.)
I certify that in the pe o ncc of the work for which this permit is issued,I shall not
employ any person in ne to me subject to the Wp crs' lyn sation
Laws of California.Da t v U
Applicant
NOTICE TO APPLIC :If,after making this Certificate of Exemption,you should
become subject to Ih is Compensation provisions of the Labor Code,you must
,J O forthwith comply with provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
(~-r►�+ I hereby affirm that there is a construction lending agency for the performance of
f Y,> the work for which this permit is issued(Sec:.3097,Civ.C.)
W A Lender's Name
az Lender's Address
U 0 1 certify that 1 have read this application and slate that the above information is
U. correct.1 agree to comply with all city and county ordinances and state laws relating to
C V building construction.and hereby authorize representatives of this city to enter upon the
(Sl above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judg costs and expenses which may in any way accrue against said City
U Z in consequent f th granting of this permit. �`
APPLICANT ND STANDS A L COMPLY WITH ALL NON-POINT Issued by: Date 4 A z—�
SOURCE REG A NS.J,�-
1 60 o Re-roofs
Signature ofAppli Contractor Date
DOUS MATERIALS DISCLOSURE Type of Loof
Will app ant or future building occupant store or handle hazardous material
as defined by Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
code.
QYes z 2(a)? / All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof:s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as dcrrncd by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes C34
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hca Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
docs cu ntly have, uma,ffia't ff r3rgy responsibility to notify the occupant of the
rcyuirc n firist be mel prior to issu cc of a Certificate of occu ancy Signature of Applicant Date
ownor horizcQagent oto All roof coverings to be Class"B"or better