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06120004 CITY OF CUPERTINO BUILDING DIVISION PERMIT Co R INRMTI©N• PERMIT NO. BUILDING ADDRESS: 7698 RAINBOW FIR C14ahl, RNRU PERMIT ISSUE DATE OWNER'S NAME: CHAN, HENRY 01/23/2007 SANITARY NO. CONTROL NO. .ONE: BUILDING PERMIT INFO ARCHITECTIENGiNEER: BLDG ELECT PLUMB MECH j p p LICENSED CONTRACTOR'S DECLARATION Job Description 4 V C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing =Z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is REV I S II\G WINDOW OPENING a in full force and effect. ; z License Class Lic.# ORIGINPL PERMIT #06060132 F-2 Dam Contractor I ARCHITECTS DEC LARATION a< I understand my plans shall be used as public records �,U U.I— Licensed Professional CA OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county K m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure y Z y prior m its issuance,also requires the applicant for such permit to rile a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area 0 %F (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36611028. Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages az their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business i 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.). a4 as owner of the property,am exclusively contracting with licensed contractors to i'bnstruct 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 under.' B&P C r this on Owner r-,— Dam I 11AJ WORKER'S COMPENSATION DECLARATION 1 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 Worker's Compensation insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTiON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc 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 az P bcco subject a th��o. y Laws of California.Dale Applicant NOTICE TO APPLICANT:If,after making this Ccrtifieatc o become subject to the Workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of �. the work for which this permit is issued(Sec.3097,Civ.C.) a A Lender's Name Lender's Address U C i certify that 1 have read this application and state that the above information is LL " correct.I agree to comply with all city and county ordinances and state laws relating to rJ Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. W W (We)agree to save,indemnify and keep harmless the City of Cupertino against En 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 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL Issued by: SOURCE REGULATIONS. ( n/_� ,[107�, � ( y Re-roof.; Signature of ApplicantDam Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material az 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 Q'No 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? ❑Yes 16No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.).understand that if the building does not currently have a tcna that it is my responsibility to notify the occupant f ahe requirements which t I>c t prior to issuance oCa crtifrcatc of Occu ancy, Signatul e of Applicant Date c All roof coverings to be Class"B"or better Owner or authorized a t Date