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07050238 CITE'OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUIL1�Ir�G�.9g1'kARRETT CT NC LTR WORKSHOP, INC. 07050238 l j (� PERMIT ISSUE DATE ,R'S NAME: 06/21/2007 PONY WONG 20587 MUl(ANO C I R SANITARY NO. CONTROL NO. PHONE: (408) 646-7362 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MSE-C_JH p LICENSED CONTRACTOR'S DECLARATION Job Description UI 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 REVISION-DELETE A COAT CLOSET, CHANGE DOOR ­0 a. LlullforceandcfCect '1D @BATHRM, RELOCATE CRAWL SPACE ACCESS. ORIG License C Lam• :—Z Dam RCHlTEC1SIDacto ECLA AT #07010013 . NO NEW PERMIT. CUST CANCELED ORIG a VI understand my plans shall be used as public records ,a u,l- Licensed Professional O a OWNER-BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Calc:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation prior w its issuance,also requires the applicant for such permit to rile a signed statement S Ft.Floor Area -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 a $0 tiF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 7 5 2 6 0 2 2 not more than five hundred dollars($500). ❑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 sad.). ❑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 contractors)licensed pursuant to the Contractor's License Law. ❑[am exempt under Sec. B&P C for this reason :r Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- 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 Wo is Com ens ion tIn'suD ce carrier and Policypgber are Cartier: ry Poliry No.:`` ((yy CERTI CATS 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,I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O 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.) W A Lender's Name aLender's Address V 0 1 certify that I have read this application and state that the above information is v. correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City o[Cupertino against Cn liabilities,judgments,costs and expenses which may in any way accrue against said City ''T / V Z in consequence of the granting of this permit. Date C O- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGU ATIONS. 2-t191— r" Re-roofs Signature of Applicant/ tractor Dare T of Roof H RDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material -defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety �t. tc,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes t'No If a roof i 3 installed without first obtaining an inspection,I agree to remove 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 all new IT aterials for inspection. District? VN ❑Yes u I have read the hazardous materials requirements under Chaprer6.95 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 Date requirements which ust be met prior to of a Certificate of oe u ey. Signature of Applicant f1� ' All roof coverings to be Class"B"or better Owner or authorized agent D