07070236 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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— PERMIT NO.
BUIL[311�,P[1 Tk BERRY DR TBD - TO BE DETERMINED 07070236
1 J 4 L PERMIT ISSUE DATE
OWNER'S NAME:
WEI ALLAN WANG & HELEN C LIN 09/24/2007
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p o LICENSED CONTRACTOR'S DECLARATION Job Description
U51 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADDITION 709 ' FAMILY,LIVING,MA S T ER SU I T E,
r'N in full force and effect. KITCHEN
License Class Lic.#
h Dam Contractor
J
ARCHITECTS DECLARATION REMODEL—NO ROOF.
i a< I understand my plans shall be used as public records
)yU
U.y Licensed Professional
:o a OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
:00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
�,0,Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
z} prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor s license Law(Chapter 9 q $151988
e.is (commencing with Section 7000)of Division 3 of Ute Business and Professions Code)or
u 9§ that he is exempt therefrom and the basis for the alleged exemption.Any violation of MON
p Number Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 6 2 0 4 0 5 C V
not more than rive hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered 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.IL
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.).
I,as owner of the property,am exclusively contracting with licensed contractors to
c tract 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 Contractors
License Law.
❑1 am exempt under Sec. B&P C for this reason
a
C Date G
Owner -
RK 's COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑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.
❑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. Polity 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 certif-v that in the performance of the work for which this permit is issued.I shall not
employ any person in any mann s as t5b me sub'i;to the Workers'Compensation
Laws of Califom' re i7
Applicant .t a
NOTICE TO APPLICANT:If,after making t is Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
a 7 the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
a+ Lender's Address
U 0 I certify that I have read this application and state that the above information is
IL E" correct.I agree to comply with all city and county ordinances and state laws relating to
.�U building construction,and hereby authorise representatives or this city to enter upon the
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
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOU E GULATIONS
9 r"'�6-0 Re-roofs
aturcofApplicant/Conuutor Date 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
Code,Section 25532(a)? All roofs hall be inspected prior to any roofing material being installed.
❑Yes �No
Will the applicant or future building occupant use equipment or devices which
If a roof i s installed without first obtaining an inspection,.1 agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
❑Yes IK No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.l understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requ)rc encs which must be mel rior IO i:: ce of a ccrtirrcate efoecupaney. Signature of Applicant Date
�Z. 9��-o All roof coverings to be Class"B" or better
Owner or authorized agent Date