07010187 CITI'OF CUPERTINO
BUILDING DIVISION PERMIT � T � 1� `
PERMIT NO.
BUIL�y,&gWEsGARDEN GATE DR CK WONG & TIM LUI 07010187
11 b 1111 PERMIT ISSUE DATE
5R'S NAME:
_'K WONG & TIM LUI 02 09/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0
p a LICENSED CONTRACTOR'S DECLARATION Job D05CilptlOn
v— I hereby affirm that I am licensed under provisions of Chapter 9(commencing
(10)of Division 3 of the Business and Professions Code,and my license is
z with Section 70REV I S I OT DORMER SUPPORT FOR ROOF
t M H in full force and effect Lie OR I G I NAI PERMIT: 06050170
j v�Z License Class -
Contractor
y w Date
� ARCHITECTS DECLARATION
j < I understand my plans shall be used as public records
5wu
U.H Licensed Professional
C a OWNER-BUILDER DECLARATION
10.4
I hereby affirm that l am exempt from the Contractors License Law for the
nO 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 structure Valuation
''A prior m its issuance,also requires the applicant for such permit to rile a signed statement t;q-Ft.Floor Area
-
K;-- Ural he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $813269
4 t=-G (commencing with Scction 7000)of Division 3 of the Businccs and Professions Code)or
i that he is atempt therefrom and the basis for the alleged exemption.Any violation o[ Occupancy Type
Section a exe by any applicant for a permit subjects the applicant to a civil penalty of 3 2 6 3 0 01 Number
not more than five hundred dollars(S500).
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.).
as owner of the property.am exclusively contracting with licensed contractors to
tract the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
eense taw docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contiactor(s)licensed pursuant to the contractor's
License law.
❑I:arm
exempt der Sec
B&P C f reason
Date
yAATION
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.
Q 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. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is fa 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 bject to the Workers'Compensation
Laws of California.Dat
Applicant
NOTICE TO APPLIC NT if,after making this Certificate 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
F rte-. I 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 A Lender's Name
04 Z Lender's Address
U C) I certify that 1 have read this application and state that the above information is
LI. correct 1 agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against
M� 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 —
O• APPLICANT U E D AND WIIt1.COMPLY WITH ALL NON INT Issued b: :
SOURCE REGUL S
P Re-roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of:Zoof
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
Ic,Scction 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
0Yes $No 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 I naterlals for inspection.
District? `2
D Yes i4Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the Date
requirements hich m met priq[w issuance of a Ccrtificate q;n Signature of Applicant
V' / All roof coverings to be Class"B"or better
Owncr or authorized agent Date