07010068 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT
GINT GC)R IN. F.O. TION
PERMIT NO.
BUILDING ADDRESS:
10321 BRET AVE ALL QNa_EEMDDFJ"LNG--- a:701 0062
PERMIT ISSUE DATE
OWNER'S NAME:
ROGER & COC TONG 219 DEMI=SEY RD 01/11/2007
SANITARY NO. CONTROL NO.
'E: (408) 94E-4744
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
j O O LICENSED CONTRACTOR'S DECLARATION Job Description
e m P I herebyaffirm that I am licensed under provisions of Cha to m
9(comencing
=z with Section 700)of Division 3 of the Business and Professions Code,and my license is 315 ' ICC PATIO ENCLOSURE WITH ELECTRICAL ON AN
?may in full force and effectEX I STING, CONCRETE PAD ICBG
v�Z License CI. l ic.i
t p
Date contractorgld(a.±±Sif!cmrgmlamg!gp-
ui
ARCHITECTS DECLA TION
12.-, 1 understand my plans shall be used as public records
a
O11 Licensed Professional
n y, OWNER-BUILDER DECLARATION
<M 1 hereby affirm that 1 am exempt from the Contractors License Law for the
COO following reason.(Section 703 1.5,Business and Professions Code:Any city or county
t rL which requires a permit to construct,alter,improve,demolish,or repair any structure
prior w its issuance,also requires the applicant for such permit to file a signed statement Valuation
_Z> P P ; .Ft.Floor Area $17560
that he is licensed pursuant to the revisions o[the Contractor's License Law(Chapter 9 q
XF=-$ (commencing with Section 7100)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 3 7 510 0 2 C, APN Number Occupancy Type
not more than five hundred dollars($500).
❑I,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.).
❑1,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-
cense law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby al<rm under penalty of perjury one of the following declarations:
L3 I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
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 am:
Carrier. ��'� Policy M.:
CERTIflCATE OF EXEMPTION FROM WORK S'
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 person in any manner so as to become subject to the Workcrs'Compensation
Laws of California.Date—
Applicant
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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
F~t rr I hereby affirm that there is a construction lending agency for the performance of
py> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
�Z Lender's Address
U C) certify that I have read this application and state that the above information is
I relating to
[t.E t correct.1 agree to comply with all city and county ordinances and state laws
O U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
0" APPLICANT UNDERSTANDS AND L COMPLY WITH ALL NON-POINT Issued by:
SOU GULA4
Re-roofs
Signature of Applicant/Coter Dam
HAZ Type of Roof
DOUS LOSURE
MATERIALS DISC
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 roofs shall be inspected prior to any roofing material being installed.
❑Yes A(M)
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
.nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes IgNo
1 have mad 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 n . rrently have a tenant,that tl is m responsibility to notify the occupant of the
reyui me is which must be prior once of a Certificate of Oc pansy. Signaturf of Applicant
Date
OwAll roof coverings to be Class"B"or better
ner orautbarircd agent ogle