Loading...
12080015 CITY OF CU13ERTINO BUILDING PERMIT BUILDING.ADDRESS: 10294 S STELLING RD CONFRAC'FOR:T D ROOhING PERMITNO: 12080015 OW'NER'S NAME.: LU JAMES D AND LIN CHIN 675 TULLV RD DATE ISSUED:08/03/2012 OWNER'S PHONE: 4084836305 SAN.IOSE.CA 95111 PHONE NO:1408)892-8872 ❑ LICENSED COY fRAC`fOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Clercs Lie.H RIECII r RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE WOOD SHAKE INSTALL 30 YR COMP (commencing with Section 7000)of Division 3 of the Business&Professions OSB,AND 15N FELT-30 SO Code and that my license is in full force and effect. 1 hereby affirm under penally of perjury one of the following two declarations: I have and will maintain a certificate of consent to self insure for Worker's Compensation,ac 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 provided for by Sq.Ft Floor Area:0 Valuation:$11000 Section 3700 of the Labor Code,for the performance of Ow work f m%khich this permit is issued. APNNumber:35913093.00 OccupmwyType: API'LIC,\N'I'CF.12'I'IFICA'I'ION I certify thin I have read this application and sous that the above intima:tion is correct,I agree to comply with all city and county ordinances;ad state laws relining to building construction,and hereby authorize representatives ofthis city to enter PERMIT EXPIRES IF WORK ISNOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indenmify and keep harmless the City of Cupertino against liabilities.judgments. WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the Igo DAYS FROM LAST CALLED INSPECTION. graming of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Date ❑ OWNER-BUILDER DECLARA'T'ION RE:ROOFS: All roofs shall be inspected prior to my roofing material being installed.If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law fur one of installed without first obtaining an inspection,1 agree to remove all new materials for the follolOug two reasons: inspection. I,as owner of the property,or try employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business S Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business& Professions Code). ALL ROOF COVERINGS TO IIF,CLASS"A"OR BEYI'ER hereby affirm under penalty of perjury one of the follmving three declarations: IIA%ARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate ofConsent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 ofthe Labor Code,for the California health S Safety Code.Sections 25505.25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Iludth S I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health S Safery Code.Sections 25505,25533,and 25534. not employ any personin any manner so as to become subject to the Worker's Compensation laws ofCalifomia. If after making this certificate ofexemption,I Owner or authorized agent: become subject no the Worker's Compensation provisions of the Labor Code,I must Date. forthwith comply with such provisions or this pemnil shall be deenned revoked. CONSTRl1C1ION LIiNI11NC AGENCY APPLICANT CERT]FI CATI ON I hereby affirm that there is a construction lending agency for the performance of nwrk's I certify that I have read this application and state that the above information is for which this permit is issued(See.3097,Civ C.) correct.I agree to comply with all city and county ordinances and stale laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indenmify and keep harmless the City of Cupertino against liabilities,Judgments, costs,and expenses which may accrue against said City in consequence of tilt granting of this permit.Additionally,the applicant understands and will comply AIiCI II'I'I?C.I"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 1 understand my plan shall be usedas public records. 9.18. Licensed Professional Signature Date.