06110017 777,
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
��N'I'gtAGTC)R IpRMATION:,
PERMIT NO.
BUILDING DDR� DR
TBD — TC BE DETERMINED 06110017
2 0 i 1)9
PERMIT ISSUE DATE
OWNER'S NAME:
2105/2007
ALEX LIM SANITARY NO. CONTROL NO.
jNE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p Zo LICENSED CONTRACTOR'S DECLARATION Job Description
UF I hereby affirm drat 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 ADD—114 f 1 ' ,MS TR BDRM,M STR BATH, 1 BDRM,FAMILY RM
>>y infulleorecandeffect. Lc.
GARAGE: 456 ' ,REMODEL-1000 ' KITCHEN,DINING,LIVING
j ? License Class
ruracitir3 t'w Date
Contractor
ARCHITECTS DECLARATION NEW PORCH COVERED 1801
j a.�
< 1 understand my plans shall he used as public records
)aU
'u.y Licensed Professional
OWNER-BUILDER DECLARATION
1'>4
a f 1 hereby affirm that 1 am exempt from the Contractors License Law for the
p o following reason.(Section 7031.5,Business and Professions Calc:Any city or county
`e which requires a permit to construct.alter,improve.demolish,or repair any structure
a N prior to its issuance,also requires the applicant for such permit to file a signed statement 3q.Ft.Floor Area Valuation
-Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $480000
ti F (commencing with Section 7000)of Division 3 of the Business and Professions Calc)or
Q 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 326301 8:3 ( Number P y yp
not more than five hundred dollars(5500).
0 I,as owner of the property.or my employees with wages as their sale 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
ownemployees,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.).
I,as owner of the property,am exclusively contracting with licensed contractors to
c swot the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs 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. ,B&P C for this reason
0 lam ex i der Sec. C�
Owner w l' Date ,
WORKER'S MPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 i have and will maintain a Certificate of Consent to self-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.
0 1 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 Workees Compensation insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit is for anc 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 1b�1Qc�r�Cc1 t9 tJ Workers'Compensation
Laws of California.Daic i O� -
Applicant On 4 SQe L'athi
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
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z- CONSTRUCTION LENDING AGENCY
(�14 1 hereby affirm that there is a construction lending agency for the performance of
p�> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z L.cndees Address
U 0 1 certify that I have read this application and state that the above information is
LLE correct.I agree to comply with all city and county ordinances and state laws relating to
O V building construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
>4 a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Cn 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:
SOUR E R LAT S.
7 Re-roof:
Signature of Applicant/Contractor DateT of Roof
HAZARDOUS MATERIALS DISCLOSURE ype
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)7 All roofs shall be inspected prior to any roofing material being installed.
0Yes PINo
If a roof is 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 defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes 41 No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant.that it is my responsibility to notify the occupant of the Date
rcyui cn hich must met pri to�issoance of a certifw4m of OccuPanry. S ignatu•e of Applicant
All roof coverings to be Class"B"or better
Owner or authorized agen , °are