06100030 CITY OF CUPERTIlNO
BUILDING DIVISION PERMIT
PERMIT NO,
BUILDING ADDRESS:
PERMIT LSSUE DATE
OWNER'S NAME:
ALLEN & CINDY HSU 01/18/2007
SANITARY NO. CONTROL NO.
4E:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MMECHH
ed C LICENSED CONTRACTOR'S DECLARATION Job Description
U,P I 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 NEW S FD n1L- 1ST STORY: 2485 ' , 2ND STORY: 1292 ' ,
"'0 y in full force and effect. Lic.x GARAGE: 442 ' ,
COVERED PORCH: 382 '
? License Class
h Dam Contractor
99-,,
ARCHITECTS DECLARATION GARAGE 442 ' x 56 .38 $2 4, 919 . 9 6 --SEE BELOW
i C-U 1 understand my plans shall be used as public records
�y
U.y Licensed Professional
OWNER-BUILDER DECLARATION
a1 hereby affirm that I am exempt from the Contractor's License Law for the
L
co 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 swaure
u'y prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation
S Ft.Floor Area $849306
?< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 q
x (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 357 14 015 Number
not more than five hundred dollars($500).
❑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
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.).,
tkf/as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a comractor(s)licensed pursuant to the Contractor's
License Law._
❑I am exempt}nder See. B&P/C for this reason_
Own
WORKS 'S C MP�E SATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION 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.I shall not
employ any pc�son in an manner so u to to the Wo Compensation
Laws of tyalifo a Da (��'&Cog
Applies r! -_v��—
PP
NOTICE TO APPLICANT:If after taking this erti icate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O forthwith 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
(Y> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
04 13 Lender's Address
I certify that I have read this application and state that the above information is
V. correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorizt representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (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
V Z in consequence of the granting of this permit. Date (�G
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b V:
S E ULATIONS.gg / n
���t_ d�_.— C�k( v / Re-roof:
� Date I
�gnaturc of ATT AZ rector Type of Roof
!�!HAZARDOUS MATERIALS DISCLOSURE YP
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 roof;shall be inspected prior to any roofing material being installed.
❑Yes No
Will
a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
,it hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection.
LDiwict? cse read the hazardous materials requirements under Chapter 6.95 ofthe Califor-
Safety Code,Sections 25505,25533 and 25534.I understand that if the building
rrntly have a tenant,the ' is my responsibility to notify the occupant of the
ts is mttst bemet p to issuan of a Certificate of OccupancyySignatuia ofApplicant Date
' ( All roof coverings to be Class"B or better
oth ro agent Date