Loading...
07030128 77 CITY OF CUPERTINO � (" BUILDING DIVISION PERMIT TC)R I } TION: i PERMIT NO. BUILDING ADDRESS: 21151 HAZELBROOK DR TBD - TC BE DETERMINED 07030128 PERMIT ISSUE DATE OWNER'S NAME: LI-ZEN TING & CHII-LUH CHEN 05/02/2007 SANITARY NO. CONTROL NO. AE: BUILDING PERMIT INFO ARCHITECTIENGINEER: B© ELECT PLUMB MECH i p o LICENSED CONTRACTOR'S DECLARATION Job Description J ur1 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 HOUSE DEMO >>y in full force and effect. License Class Lic.It p Dam Contractor m ARCHITECT-S DECLARATION �a< 1 understand my plans shall be used as public records )dU m i7 Licensed Professional y 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 Calc:Any city or county <m which realter,improve,demolish,or repair any structure gdims a permit to construct u N prior to its issuance,also requires the applicant for such permit to file a signed statementc q,Ft.Floor Area Valuation -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $17500 Y F (commencing with Section 7000)of Division 3 of the Businccs and Professions Cade)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32628052 . Number not more than five hundred dollars(5500). 0 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 Ele) orsowner of the property,am exclusively contracting with licensed contractto 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 Lie Law. exempt unde�Sa B&P C for this reason V 1/1 Owner 1/ -�fi" it r� WORKEE 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 Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers 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.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner to the Workers'Compensation Laws of Cal' Applicants NOTICE TO APPLIC :I,after making jF[­s(:ckt ncau fofEE.xemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z►'4 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of fx.� the work for which this permit is issued(Sec.3097,Civ.C.) kl ALender's Name az Lenders Address [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 0 V building construction.and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. GL (We)agree to save,indemnify and keep harmless the City or Cupertino against to liabilities,judgments,toss and expenses which may in anyway accrue against said City V Z in consequence of the granting of this permit. Date ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULA ONS. -�-�/ -2�--�. Re-roofs Signature of Applicant/Coo tutor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes NXI. If a roof is 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 conWninantt as defined by the Bay Arca Air Quality Management all new rr.aterials for inspection. District? �N/ ❑Yes ° , �) 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 J docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements which must met priorto ousuancccoofaCertificateOfOccullmmy. Signature of Applicant J .. - - --- All roof coverings to be Class"B"or better Owner or authorized agent are