07020059 CITY OF CUPERTINO
BUILDING DIVISION PERMIT e� R 4 ItRM1T�€)1 '
PERMIT NO.
BUIL(�IpfCy/�gR"A"ERMOSA AV SLK CONSTRUCTION 07020059
GG 11 Z�S`�y 11 j� PERMIT ISSUE DATE
"tER'S NAME: 02/09/2007
>TEPHEN LIU 952 KENNETH AVE
SANITARY NO. CONTROL NO.
PHONE:
(408) 206-6742
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
p p LICENSED CONTRACTOR'S DECLARATION Job Description
V1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z witb Section 70W)of Division 3 of the Business and Professions Code,and my license is MODIFY nVINDO i OPENING I N BONUS ROOM. REPLACE LIKE
v in full force and effect.
j z License Class Lic.x FOR LIKE 2 WINDOWS, 1 FRENCH DOOR
—G Date Contractor
t ARCHITECTS DECLARATION
j cz< 1 understand my plans shall he used as public records
)aU
G y Licensed Professional
.y n OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
cc 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
"y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
o that he is licensed pursuant to the provisions of the Contractor's Uccnse Law(Chapter 9 Sq.Ft.Floor Area $4575
ii t (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Li 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 357160-/4 .
Number Occupancy Type
not more than five hundred dollars($500).
0 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 We.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.).
0 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 contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am 7cmpt under Sec. B&P C for this reason
er ,ta PJB — - Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 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.
0 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 for one hundred dollars($101)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in anyman er sp as to become subject to the Workers'Compensation
Laws of Calif i
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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
H►�-� I hereby affirm that there is a construction lending agency for the performance of
G�.> the work for which this permit is issued(See.3097,Civ.C.)
W A Lender's Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL r-" correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
V) liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of Use granting of this permit. Date
APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by:
Sou CE V�EGU''LATIONS.
lJ� ,lam- 1*11/'tRe-roof;
Signature of Applicant/Contractor Dare 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
+e,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes Jallo
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?
0 Yes �No
I 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 ten t,that it is my responsibility to notify the occupanf f the
req/71 ts whichC^be et prior to issuance of a Ccrtificatc of Occup Signatu:e of ApplicantDate
All roof coverings to be Class"B"or better
Owner or authorized agent Date