07070082 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CINTRAGTCIR I} ORMATION
PERMIT NO.
BUILDING ADDRESS:
7512 SHADOWHILL LN TBD — TO BE DETERMINED 07070082
PERMIT ISSUE DATE
OWNER'S NAME: 08/30/2007
YUN LIN & DAN MEYBERG SANITARY NO. CONTROL NO.
_JNE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 Z LICENSED CONTRACTOR'S DECLARATION Job Description
0
W p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD 303 ' BEDRM/BATHRM, REMODEL 1100 ' VALULT ING
`H in full force and effect
r�z
License Class Lic•ri CEILING, RAISE FLR, LIGHTING. 1100 X 100 .7 =
t-G Dam Contractor
ARCHITECTS DECLARATION 110, 825
I understand my plans shall be used as public records
ma
aU
U.in Licensed Professional
o a OWNER-BUILDER DECLARATION
a1 hereby affirm that 1 am exempt from the Contractors License Law for the
p o 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
prior m its issuance,also requires the applicant for such permit to file a signed statement q Ft. Floor Area Valuation
z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $175779
5$ (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 �p{� Number Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 6 2 3 0 0 9 . V
not more than five 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 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.).
J-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 lam exempt under ec. B&P C for this reason
Owner Date
KER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Conscnt 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 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 as to become subject to the Workers'Compensation
Laws of California.
Applicant
NOTICE TO APPLICANT:If,after r9aking is 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.
OZ CONSTRUCTION LENDING AGENCY
H
�►�-. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(See.3097,Civ.C.)
Q A Lender's Name
Z Lender's Address
C) I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize representatives of this city to enter upon the
y W 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 j r
Zin consequence of the granting of this permit. Date
APPLIjRREGUNT UN RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU O S. SQ
Re-roofs
Signatureol'A Ii Contractor Date Type,of Loof
HAZARDOUS MATERIALS DISCLOSURE
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.
0Yes IR No
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection, agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? qt
C3 Yes u
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safcty C ,Sccuons 25505,25533 and 25534.1 understand that iC the building
docs not currently h a tenant,that it is my responsibility to notify the occupant of the Date
rem ns w'c must be met prior to issuance of a Certificate of Occup cy. Signaturc of Applicant
n All roof coverings to be Class"B"or better
Owner or aut '•zed agent Date