08100102 CITY OF CUPERTINO ,kmmmxi €mu.,r,va -res a r -r "•sfi,•�' r. ,v _
BUILDING DIVISION PERMITCONTRACTQR INT ORNIATI01 :
BUILDING,(�DD0.F55: n PERMITNO.
7975 FOLKESTONE DR TBD — TO BE DETERMINED 08100102
R'S NAME: FERMTT ISSUE DATE
JMWANH & LAPLE DANG 10/20/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o p LICENSED CONTRACTOR'S DECLARATION
uC 1 hwby affirm thn I we licensed under provisions of Chapter 9(c.a menial Job Description
�W with Section 70110)of Division 3 ofthe Business and Professions Code.snd my license is ADD 240 SQ FT TO PATIO AREA
in full force and effect
j Z License Cow Lm.L
r
Data Contrater
ARCHITECTS DECLARATION
1 urndereast my pleas shall he used As public recaNs
�yU
aG Licensed Professional
OWNER-BUILDER DECLARATION
v� E I hereby affirm that I am exempt from to Cuntracam's license Law for one
COO following reason.(Section TBD 1.5,Business and Profusions Code:My city or county
e
w Vi. which rtquitu.permit to eonvrml alum.impwe,demnlah,Or-pail any saucmc
ii prim to is issuance.alt.requires the.,lmam ralsmh permit an fileasicned wumum
< IhnheiSlicensed pursuammthe Provisional Ofdon ConuxarSLaanselaw(Clapur9 Sq.Ft. Floor Area Valuation
PO (eammaneing wide section 7000)of Division 3 of the B".and Pamessinu Code)or $6000
that he u eumpt terdnam and the basis far the alleged exemption.My Aided, of
Section 70313 by any applicant for a pewit subjects the applicant an a civil Penalty of Number Occupancy Type
was mart Nan five handled dollar(55001 3 62 07001 .V84
I,uowrer of die propory,almy wployma with wga seer sole eompewton,
will Pr thewom ands:The m b LMW s Law do fmum(sec.1 0as,Busimae
and enyw W Cade:mW Commutes=n,Lm.•w Law dace,sat appy lf co mums or Required Inspections
ownerty wW Wiprovided dart a sh impr atnd whodmssuch walkhirnselral through hH
awn emPloyw,ding ocithat such set Is mimats arenoteas of completion.
forsetheO e.Owner.
ImarevWilder theWilding.den of pmcntVsaltwithin arc you ofMimproefor theose of
Wilder wi0luva to Wad.of proving that k did rot Wind m improve for purpose a(
nmJ.
❑Las armor of the Property,And exclusively contracting with Banned con.ntms m
construct to pmjem(Sec.7014,Business and Pro eassiam Cade:)The Cmtrawfs U.
care Law does not apply he an owner of property what builds or improves thereon.and,
who conuacu feesuch projects with•mmmcmn(s)licensed Formula m the Comrawfs
Liame Lar.
Iweaumpruadm See .Bl PC lm Nu rearon
on -
1111111
WORKER'S COMPENSATION DECLARATION
1 hereby.T.motor penalty of Perjury arc of the following daclaramm:
Q Ihsw end will msinuin•CerdfTate ofConsentteself-inartfm WorkeYs Compen-
sation,As provided rte by Section 1700 of the Labor Code.fm the perfomumz of the
walk for which this permit is ismer.
Lapkfnave and will mainuin Wallace,CompcnsNon Insurance,u required by Senior
3700 of the Jabal Code,for the perfowance ofte wart for which this permit is lnmd. '
My War .� —
CC_oomp��ensation War usac crier and Polis,number ere:
Cartier. I/�``` Polity No.: 0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This remount need untbecwplomd Bthe permit Is For oun hunAW dollars(5100)
or lest)
I codify that in the perean.nee of the wart fm which this Formlt is inued,I shall nm
employ ams,person in any mareer an u as became subject In to Worker'Compevatian
Applilawsca Califomit Due
t
NOTICE
NOTICE TO APPLICANT:ft Worker'.
IL allm making this Cef.Of co Exemption,you should'
bceome eco mt y the Worke roCwpemation provisions of tle Item Cade,you muss
.J O forthwith comply with such provisions m Nu permit shall be dcemrnd rooked,
Z v" CONSTRUCTION LENDING AGENCY
[-i I hemhy air,.than NeTIm in. londingageney for the pmfmmanceuf
CL.�. the work far which this permit Is sound(son.D(19-1,Civ.C.)
GQ Landes Name -
Z:) z Undcfs Address
V 0 1 coldly that 1 have rad this application W suss that to above informadon is
LA ^. comm 1 agree te comply with all city sand county ordinances and sum Ins relates to
0 kS.^! Wilding emuvunlon,and herby aoNoriss mpmacnutvea of this city ro error upon the
Gil move-mentiara d prepeny,for Inspection purposes t
(We)agree to um.indemnify and keep hamtlen to City of Cupertino against
IA Ilabilitiu,Judgments,casts atd expenses which may in any way mcre agalmt said City
V z in conscgmnce of the grouting of thin pewit.
^t APPLE UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R ON
/ ? Re-roofs
SipaturemApplicantlCon c Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fmum Wilding accvpaoLnom Or h e&Mvnmmus material
fired by the Cupertino Municipal Code.Chnpter 9.12.aril the Health and Safety
.Session 25532(a)T W111161All roofs shall be inspected prior to any roofing material being installed.
r]Your
Will We applicant I.furore Wilding byOccupant Say
equipment or Mona which
If a roof is installed without first obtaining an inspection,I agree to remove
emitict? I,..I. dbytoBayMaAir Quality Mavgement all new materials for inspection.
DistricrT
oYu u
I have orad the hnaNnus materials tiquirem.ts vodka Chapm6.95of Ile Califm-
nuHalthkSafctyC.dc,SmWns25505,25533sau125534.1u .dOaifthe Wilding
dean not currently ham•tenuL that It u my responsibility le unify to m cupset Of the
an'ttlacalt—narXitichmtwxmnPnartoinammafaCemnateofan,p.my. Signature of Applicant Date
All roof coverings to be Class'n""or better
Owner m mthmimd.gem Data" g