07030114 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ��t `I��iGTt?It INFURMIION:
BUILD S: PERMIT DR TBD TO BE DETERMINED
ffS07030114
'R'S NAME: PERMIT ISSUE DATE
CHANG CHIN C AND MA N 03/15/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
F__1o p LICENSED CONTRACTOR'S DECLARATION
ev U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
t withScction7000)ofDivision3oftheBusincssandProfessionsCode,and liccnscis KITCHEIS/BATHROOMS REMODEL NON STRUCTURAL TONG
7 y in full force and effecL
Licerts¢CI Lies CHEONG CONSTRUCTION CO. PAID FOR BL 3/15/07 .
F p Date AlContractor
-3 ARCHITECTS DECLARATI
OL 414
U l understand my plans shall be used as public records
y o y Licensed Professional
H-aj OWNER-BUILDER DECLARATION
1 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
<m CE4 which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant Cor such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 i .Ft. Floor Area
ix c P P ( P q $28800 Valuation
H a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 2 8 8 0 0
L 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 A
not more than five hundred dollars(x500). 36651008 . 8v Number Occupancy Type
[11,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 Prttfassiortt-Code:The Contractor's License Law does not apply to an owner of - _. Required Inspections -
Qroptirty whd builds or imprbvds therbon,and who does such work himself or through his
awn employees;provided that such improvements are not intended or offered for sale.If,;
however,the building or improvement is sold within one year bf completion,the owner.
buil4erwill have the burden of proving that he did not build of improve forutpose of
sale.).
< - 1,as-owner of the property,am exclusively contracting-with licensedcontractors 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 acontractors)licensed pursuant to the Contractor's
icelise Law..._
_ - _
I 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: 7--
have and will maintain a C¢rtifijtte Of Consenulo self-insure for Worker's Comport,
I an;asvfor by Section 3700 of:the Labor Code,lbr•the
Proided.� performanccof:the
woAcfoi which,this permitisJswcd ,..::
$3�I live and will mainWn Worker'l Compensation Insurance,as required by Sectioq
7b0 of ihb Labor Code,for the petfofmancc b(the work for which this permit is issued.,
MylVorker C mpensatlpq Rice and Policy,number —
_
I Catndr. =PHlicy No: G'C
ERTIFI TE OF-E LMPMPTION FROM_ ERS'
COMPENSATION INSURANCE
('this-50911.9=40900 completed if the pe4mit is foronc hundned 0aliais,ES1Q0)
or,lcss) tt
P pe Y f the work for which this permit is issued,I`shalY'not
haws'af Califorma.Dak�anco 'so to to bCCoidc subject to the Workers'Corttltensation
e�t1 (b aiiy pctshn to an manner
ApptI4ht. 0
p t
NOTICE TO APPLICANT If after maklh this Cc i/icate of)xemprion you reltould
__. .
Eccome subject to the Wtirkgrs Chtnpensation provisions or tii i Uboe t6de ynti°must
- ..
Q ibrthwrth complywith such rovisions or this
p permit shall be deemed revoked
CA e , CON§TRUCTION'LENDUVG AG1rNCY
-+`r r Ihctchya[ritmthattttgfats}constr}rctionrlcndingagcncyforthapc¢umtarKxaC
> ttlC work fuf,which t ,pent is iss4ed(Sec.Q097,Civ,C.)
4riders Add
J
'-I certify the I have read city ctiont and
�at the above i 6miation`is.'
Y,(~ agreecomply Y y ordinances and state laws relating to
building construction,.andhcreby auptgo7e,reprc nuLivcs of ibis city,to cnta611pno tbcl
W above.mcmiu>!cddroperty for impegtion purposes
y CL (Wej agtge to save,indottuuify and keep harmless Uro Ciky of,Cupeniho:agaiost
�-m V) .4alirli4-,judgrtcnts,costs andt-xpeoses which may is any way accrucagalnst•said City
tn,gppsCqucnce of the granting of this permit. �}--
APPLICANT UNDERSTANDS AND W1LL,CO.MPLY WITH ALL NONiPOINY Issued by: Date � tl �i
SOURCE REGUL NS ' l
Re-roofs C7
Signature of Ap rc9ri Contractor Date '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazatdo)rs matenali
dc%by the C16knino Miihicii1l Codi:CNapicr 9.12;and'iFuc Health and$areii
v,Section r1554T a"')» , ., ..:: �
_ p All roofs shall be inspected prior to any roofing material being installed.
uvill ut¢ bean(or future building occupant,use If a roof is installed without first obtainingan inspection,I agree to remove
� �P g p equipmcrft or.dcvtccs,which P g
1a..arco�a ate contamrrants as defined by.me Bay,Arca Air,Quality Manasementi
Dtsinct? all new mat;rials for inspection.
,, .a::•:pyo v`:. L]_Nu ,_._ _ ;
I have read the ha7ai'dtttis malerials iequfremcros order Chapter 6.95 of the Califor-,
ria Health&Sakty Code,Sections 25505,25533 and 25534.1 ugdcrstand that if the blWing
d riot c'rirtenlly have'a rcnaht,drat it is my responsibility to hoary the occupant flhc�
j'rL utrements whic ust be metpr�6to,swance of a certificateof Occupant. Signature of Applicant Date
'�"�"`" 1i `-•�
C(wnef g
All roof coverings to be Class"B"or better
or,au ni pgcnl_ - DatC