07050149 CITY OF CUPERTINOA.
BUILDING DIVISION PERMIT � tQR I } M �IQ �
PERMIT NO.
BUILI),IIYG„PODRES$t;ILSON AVE TBD - TO BE DETERMINED 07050149
1�$y b 4 l PERMIT LSSUE DATE
OWNER'S NAME:
MARY & CHI WONG 09/27/2007
SANITARY NO. CONTROL NO.
jNE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p z0 LICENSED CONTRACTOR'S DECLARATION Job Description
w P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
ZuUi with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD/REMODEL ENTRY WAY AND FAMILY ROOM
M- in full force and effect
NEED C014TRACTOR INFO
rnZ License Class
p Date Contractor
FLu
ARCHf[ECTS DECLARATION
I a< t understand my plans shall be used as public records
.a.
wy Licensed Professional
:O a OWNER-BUILDER DECLARATION
}.�
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
pO following reason.(Section 703 1.5,Business and Professions Code:Any city or county
m 64 which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant Cor such permit to file a signed statement Sq.Ft.Floor Area Valuation
Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $50000
t F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 37509012 . Number
not more than rive hundred dollars($500).
0 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 docs 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.N.
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.).
14 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conawtoes 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 exem Oder Sec ,B&P C for this
Owner Date -
O K^ COMPENSATION DECLARATION
1 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 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 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:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
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 asbe b'ct Workers'Compensation
Laws of Calif �te �
Applicant
NOTICE TJ APPLIC :If,fftcr 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
Fr 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.)
W Q Lendces Name
Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
CL. correct.I agree to comply with all city and county ordinances and state laws relating to
.J U building construction,and hereby authorize representatives of this city to enter upon the
nWi above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City �f
U Z in consequence of the granting of this permit. Date C ��
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
SOU REGULAT NS. 01
Re-roofs
Signature dApplican, ontractor ate Type Of hoof
HAZARDOUS MATERIALS DISCLOSURE yP
Will Ore 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)? ,fivo All roofs shall be inspected prior to any roofing material being installed.
C]Yes
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
District?
0 Yes "P-No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
rcquiwhich must be met priorto' once of Certificate Signature:of Applicant Date
Gf/ All roof coverings to be Class"B"or better
O ncr or au ori-rcd ag t Date