06090080 CITY OF CUPERTINO
BUILDING DIVISIONCITgtAT('1R INE}RMT �N:
PERMIT
PERMIT NO.
Bt IILDING ADDRESS: CH CONSTRUCTION CO 06090080
190 LOCKWOOD DR
PERMIT ISSUE DATE
,.,vER'S NAME:
Il CHUAN WANG & CINDY SHEN 1271 WASHINGTON AVE PMB E38 10/09/2006
SANITARY NO. CONTROL NO.
I SHONE:
(408) 655-9488
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0
O p LICENSED CONTRACTOR'S DECLARATION Job Description
My, I hereby affirm that I am licensed under provisions of Chapter 9(commencing
2 Z with Section 70W)of Division 3 of the Business and Professions Code,and my license is
=y in full force and effect REMODEL-MASTERBED/BATH, LAUNDRY RM, CLOSET
;�?
License Class tic.# v:z v� 4 WINDOWS-RELOCATE FURNACE/REPLACE WATER HEATER
t o Date Contractor %
ARCHITECPSDECLARATION ELECT/MECH/PLMB .
a< I understand my plans shall be used as public records
?yU
U.H Licensed Professional
H OWNER-BUILDER DECLARATION
1 hereby a1Trrm that I am exempt from the Contractor's License Law for the
o O following reason.(Section 7031.5,Business and Professions Code:Any city or county _
a=ff which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance.also requires the applicant forsuch permit to file a signed statement Sq.Ft.Floor Area Valuation
othat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
aF• (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $18000
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).
❑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
sale.).
❑I,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 Contractofs
-nse Law.
am exempt under Sec. B&P C for this reason
owner 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 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 c rticr and Policy number are:
Cartier: olicy No.:
CERTIFICATE OF EXEI ON FROM W RKERS'
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 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
Q!> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
2 Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL ►" correct.I agree to comply with all city and county ordinances and state laws relating to
O Ubuilding construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
W
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
H1Z liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL,,04MPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION .
�l C �� i7i� Re-roofs
Signature of ApplicanUConttactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
Jcfncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
,ode,Section 25532(a)? > Ne 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 contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I 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
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must jr_ et rior ' u fancc of a��c of Occupancy. Signature of Applicant Date
K
All roof coverings to be Class "B"or better
Owner or authorized al;6 arc