07020157CITE' OF CUPERTINO
PERMIT
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BUILDING DIVISION
BUILDINr ADYRESS:
1U5y5 CULBERTSON DR
VARAS CONSTRUCTION
PERMIT NO.
07020157
PERMIT ISSUE DATE
OWNER'S NAME:
JING SONG
1529 CALIFORNIA DR
05/16/2007
SANITARY NO. CONTROL NO.
(650)375-14:07
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
fob Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
ADDITION • '-143', LAUNDRY ROOM, ENTRY, STAIRWAY, 2
in full force License Class d effect. Lie. n
BEDROOMS, :' BATHROOMS, & EXPAND FAMILY ROOM. 489'
Date Conractor
ARCHITECT'S DECLARATION
GARAGE ADD==TION, 33- PORCH ADDITION
1 understand my plans shall be used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
Law 9
Sq. Ft Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License (Chapter
Code)
$287000
(commencing with Section 7000) of Division 3 of the Business and Professions or
1 that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
Number Occupancy Type
;
not more than five hundred dollars ($500).
3 7 53 6 02 3`�,p
❑ 1, 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 docs nmt 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
sale.).
❑ 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 contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. _ . B & P C for this reason
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7
-� W ER'S CO TION 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 Workers 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 for one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit is issued. 1 shall not
employ any person in any manner soto btxo )ecu to the Wadcers' Cltmpenaation
Laws of California. D •(A'
Applicant
NOTICE TOIICANT:It, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
7 forthwith comply with such provisions or this permit shall be deemed revoked.
~ CONSTRUCTION LENDING AGENCY
01)
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.)
Lender's Name
7 Lender's Address
D 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.
y (We) agree to save, indemnify and keep harmless the City of Cupertino against
n liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGU�
�,/ A d
Re-roofs
Signature of icantlCContractorC- Dare
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
^,dc. Section 25532(a)?
All roofs shall lie inspected prior to any roofing material being installed.
C] Yes
If a roof is instilled 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 materials for inspection.
District?
❑ Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safcty Codc, Sections 25505, 25533 and 25534. I understand that if dre building
does not currently have a tenant. that it is my responsibility to notify the occupant of the
rcyuirementswhich met prior to issuance of aCettifcaleofOccupancy.
Signature ofAFplicant Date
1d'2-41
All roof coverings to be Class "Bn or better
Owner or authorized agent Date
JUN -06-2007 13:22 MARK THOMAS CUP
DISTRICT MAN AGER•ENGINEER
MARK THOMAS & CoMPANY, INC.
DAVID E, ROSS
DISTRICT COUNSEL
ATKINSON • FARASYN. LLP,
HAROL.O S. TOPPEL
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Kichen Remodel
Name: Modine Residence
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SE-AVICEN
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20833 sTEVENS CREEK BOuL.EVARD. SUITE 104
CUPERTINO, CALIFORNIA 950 t 4.2154
www.cupert7071 ino anitHONE A e ydi406) strict.ccmZ 173 FAX
Address: 1180 Crestline Dr
APN: 362-24-042
Permit No.07050049
4082535173 P.01i01
BOARD OF DIRECTORS
STEPHEN C. ANDREWS
WILLIAM A. BOSWORTH
JOHN M. GATTO
CURTIS B. mARRISON
WENDELL H. KERR. JR.
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File: CuSD —MOP
Building Dept. — Cupertino
.No additional conditions/requirements by the District.
Inspector: George Santos
•...• •...................•...........................................• ...................
Date: ... 06-06-2007 ...................
Sanitary Sewer Location:
cc: Property Owner
*TV Inspection waived.
SUPPLYING SANITARY SEWERAGE SERVICES FOR: CITY
OF Cu E It i , PoRTI RAT 0 AREAS CITIES OF SARATOGA, SUNWVALE, LOS ALTOS AND
SuR
TOTAL P.01