07050193 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT ' GTC'II�INFtQMTION
BUILDMTEsDPERMIT NO.
DOROTHY ANNE WY CRAFTSIIENS GUILD INC 07050193
OWNER'S NAME: PERMIT ISSUE DATE
MR. & MRS. CHEN 10566 S DE ANZA BLVD 05/21/2007
)NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BUILD A PARTITION WALL IN BLDG ELECT PLUMB MECH
C7 D O D
i Q a LICENSED CONTRACTOR'S DECLARATION
v E I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing --^-- - ^^-^ --^ -- �eSCrlptlOn
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and effect ca
.� l
? License sS Lic.ff
t-w Datc Contractor
ARC ITECT S DECLARATION
J ode a I understand my plans shall be used as public records
)0.0
U.H Licensed Professional
< OWNER-BUILDER DECLARATION
> I hereby affirm that I am exempt from the Contractor's License Law for the
j
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m ff which requires a permit to construct,alter,improve,demolish,or repair any structure
u Z y prior to its issuance,also requires the applicant for such permit to file a signed statement t Ft. Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �rq
4 H$ (commencing with Scction 7000)of Division 3 of the Business and Professions Code)or
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 APN Number Occupancy Type
not more than five hundred dollars($500).
❑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 oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of 9 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
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 Contractors
License Law.
❑1 am exempt under Sec B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insum for Workees 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 am:
Cartier: 1,".4-,- C GPolicy No.: c I"I
CERTIFICATE OF XEMPTION FROM WORKE S'
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 person in any manner so as to become subject to the Workers'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
O forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
E-r 1 hereby affirm that there is a construction lending agency for the performance of
(� the work for which this permit is issued(See.3097,Civ.C.)
QLender's Name
Lender's Address
U C) I certify that I have read this application and state that the above information is
t- correct.1 agree to comply with all city and county ordinances and state laws relating to
building construction,and hereby authorise representatives of this city to enter upon the
l->a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
►+ APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULA S.
Z( D7 Re-roofs
Signtiture of Appli ontractorDa*
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino M;rN.ipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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 contamina7N.defined by the Bay Area Air Quality Management all new mi terials for inspection.
District?
El Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 75505,25533 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
requirements yAich musA met prior to issuance of a Certificate of Ac pancy. Signature t rf Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent a