07090092CITY OF CUPUIr1INU
BUILDING DIVISION PERMIT
BUILDJNH4P6ESSsTOKES AV
=R'S NAME:
AARON CHOU
PHONE:
ARCHITECUENGINEER:
led oFCI
LICENSED CONTRACTOR'S DECLARATION
U hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z tion 7000) of Division 3 of the Business and Professions Code, and my license is
t y force and effect
t v� ZClass Lc
i y Contractor
ARCHITECTS DECLARATION
a< understand my plans sha11 be used as public records
a. hd Professionalo aOWNER-BUILDER DECLARATION
aI hereby alTirm that 1 am exempt from the Contractor's License Law for the
g reason. (Section 7031.5, Business and Professions Code: Any city art eoumy
quires a permit to construct, alter, improve, demolish, or repair any structure
J "? N prior to its issuance, also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractar's License Law (Chapter 9
2 t=- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
11 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
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
and Professions Code: The Conuactoes 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. X.
however, the building or improvement is sold within one year of completion. the Owner-
builder
wnerbuilder will have the burden of proving that he did not build or improve for purpose of
sale.).
K, as owner of the property, am exclusively contracting with licensed contractors m
I
true( the project pc. 7044. Business who
buil
and Professions
Li-
cense Law does not I to an owner of property improves thereon. and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License law. B & P C for this reason
0 I am p'pt under Sec
er \ — -- _ Date a
OR CO P ^ SA'=4 DECLARATION
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AARON CHOU
PERMIT NO.
07090092
PERMIT ISSUE DATE
10510 STOKES AVE 09/14/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG7 EO PLUMB
Job Description
KITCHEN REMODEL, NON—STRUCTURE
Sq. Ft. Floor Area
32648002:
I hereby affirm under penalty of perjury ane of the following declarations:
] I have and will maintain a certificate of Consent to self -insure for Workers Carnpen-
ation, as provided for by Section 3700 of the Labor Code, for the performance of the
fork for which this permit is issued.
] I have and will maintain Worker's Compensation Insurance, as required by Section
700 of the Labor Code. for the performance of the work for which this permit is issued.
4y Workers Compensation Insurance carrier and Policy number are:
.arrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (SIOU)
)r less.)
I certify that in the performance of the work for which this permit is issued. I shall not
;mploy any person in any manner so as to become subject to the Workers ComprntaziOn
Laws of California., m;
Applicant - f 1 �
NOTICE TO APP : If, after making this C erti nate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code. you most
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lenders Name
Lenders Address
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
building construction, and hereby authorize representatives of 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
in consequence of the granting of this permit.
APP 1 -ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
S R E REGULATIONS.
SkAdure of Applicant/ "tractor Dale
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
is defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
de, Section 25532(a)?
0 Yes No
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
District? —
❑Yes o
1 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
dgqeess not currently have a tenant, that it is my responsibility to notify the occupant of the
2.3irements which must be met pyo* issuance of a Certificate 0fOcc5upancY r
Owner or authorixcd
Issued b)
Re -roofs
Type of Roof
umber
$12000
Required Inspections
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,.1 agree to remove
all new materials for inspection.
Signator,: of Applicant
All roof coverings to be Class "B" or better
Date