07060187 7777777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT � RAT�R
BUILQj1yG r4gq(2ESLPERMIT'NO.
AS ONDAS WY XOTEK INC 07060187
OWNER'S NAME: PERMIT ISSUE DATE
ANN CHEN 3300 E CASTRO VALLEY BLVD. 06/22/2007
JNE: SANITARY NO. CONTROL NO.
(510) 5; 8-1987
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION lob Description
VI hereby affirm that I am licensed under provisions of Chapter 9(commencing
?Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE PLAC): WINDOWS LIKE FOR LIKE. NONE STRUCTURE.
y in full force and effect.
License Class Lic.fl
t-p Dam Contractor
ARCHITECTS DECLARATION
7 o�G< 1 understand my plans shall be used as public records
)0.0
'u.in Licensed Professional
H< OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
< (ii which requires a permit to construct,alter,improve,demolish,or repair any structure
aZ y prior to its issuance.also requires the applicant for such permit to rile a signed statement Valuation
T o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $7582
r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y 5 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 Number Occupancy Type
not more than rive hundred dollars(5500). 3 6 9 3 0 0�,6
❑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 fired Ins eCtl Oris
and Professions Code:The Contractor's License Law does not apply to an owner of q p
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
Vsalej owner of the property.am exclusively contracting with licensed contractors to
t 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.
❑[ empt under See _ B&P C for this reason
Owne - — Date 6 >�
WORKER'S ION DECLAItATION�
I hereby alum under of perjury one of the following declarations:
❑I 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 are:
Carrier: Policy No.:
CERTIFICATE of EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any m any manner so become su 'ct to orkcrs'Compensation
Laws of Calif '.Date
Applicant
NOTICE TO APPLICANT:If,after mak' this enificato of Exemption,you ould
become subject to the Worker's Com tion provisions of the Labor Code,you must
0 forthwith comply with such provisiotfs or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
(~r I hereby affirm that there is a construction lending agency for the performance of -
fYi the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
az Lender's Address
U C) I certify that 1 have read this application and state that the above information is
L4" correct.1 agree to comply with all city and county ordinances and state laws relating to
0 J building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
fn 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 b-/:
CE REGULAT
G zv" Re-roofs
g attire of Applicant/ContrJAr D te
HAZ US MATERIALS DISCLOSURE Type Of Zoof
Will the applicanWr 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 roof:.shall be inspected prior to any roofing material being installed.
C]Yes ❑No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new 1 naterials for inspection.
District?
E]Yes C]No
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
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requi n hichmust bein 'ortoissuanc 7a Gcamoroceupaney. Signatur:ofApplicant Date
All roof coverings to be Class"B"or better
Owner or' th ze agent Datc