07110065 CITY OF CUPERTINO � -
BUILDING DIVISION PERMIT . ��1�R� `��J���������`' `
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BUTLDING ADDRFSS: PERMIT NO.
20221 BOLLINGER RD LNB CON'�TRUCTION, INC 07110065 .
OWNER'S NAME: PERMTf ISSUE DATE
RAYMOND & SHUMING CHU 581 BEL]�EVLTE AVE � 11/21/2007
PHONE: SAMTARY NO. CONTROL NO.
( 415 ) 58:i-3884
.CHI'IECT/ENGiNEER: BUILDING PERMI'f iNFO
BLDG ELECT PLUMB MECH
0 0 0 0
� O p LICENSED CONTRACTOR Decuxnr�or, 7ob Description
� V U I lurcby af[irtn �hat 1 am licenscd undcr provisiona o[ Chaptcr 9(commcncing
_ z� wiu� Sccrion 70(x)) of Division 3 ot ihc Busincss and Profcssions Codc, and my Iiccnsc is REV I S I O] 1 — TRU S S CA L C S — OR I G # 0 6 0 8 0 0 51 N� NEW
�� y in full focce and effect.
� z(.icensc Clus Lic. K � � P ERM I T.
' M � Datc Contracmr �
ARCHITEGTS DECLARATION �
��< I undcrstanJ my plans shail bc uud u puhlic records
a
� u. y Licensed Rufcssional
n y � OWNER-BUILDER DECLARATION
I hcrcby al7irtn that 1 am cxcmp► Crom thc Coniractors Liccnsc l.aw for Wc
� < � act
y p O Collowing rcason. (Scction 7(Y! 1.5, Busincss and Profcssions Calc: Any ciry or counry
�$�i which rcquiccs a permit to consuuct, sltcr. improvc. dcmolish. or icpair any svuewre
� Z y prior lo i�s istuancc, alsu icyuires ihc appticant for such pertnit to filc a signnl slamment �,
< thai hc is liccnscd pursuant to �hc pmvisions oC ihc Conuactor's Liccnsc Law (Chaptcr 9 ,►q. Ft. Floor Area r O Valuation
Y F� (commencing wi�h Sccdon 7000) of Division 3 of Ihc Busincss and Profcssions Codc) or •�
y�� ihat he ia e�cempt the�cfrom and ihe basis for the allegcd exempuon. My violauon o(
Section 7031.5 by airy spplicant for a pem�it subjecu �he applicant to a civit pcnalty af e� Number Oeeupaney Type
�� m� m� r�� n � � a n a a o n� c s s o m. 3 6 9 3 5 0 2� Yl �
❑[, u owner o[ tt�e property, or my employcrs with wages u the'v solc compensaUon,
wi11 do Ihe work aed Uie stmame is not intended or offered for sale (Sec. 7044. Business Re uired Ins ections
and Ptofessiona Code: The Conuacwra License Law daes not apply W m awnec of �I P
propeny who buiids or improves thercon, and who das such wort himself or Wough his
awn employces, provided �a� such improvemrnts ue not imm�ded or o[fercd (or sale. U,
however, the building or improvement ia sold within ane year of completion, the ownu-
buiider will haw �he burden of proving �ha� he did not build or improve for pmpose of
sakJ.
❑ I, as owner o[ the property, am uclusively conuacting wi�h licenaed rnnuactors to
conswct ehe projea (Sec. 7044. Business and Professions Cade:) The Contracmr's Li-
ccnse Iaw does not apply to an owner of property who builds or improves Ihercon, md ,
who contracts Cor such projects with a convactor(s) Iicensed pursuant w We Convactors
Litense Law.
❑ I am eacempt under Sec. . B� P C for this rcason
Owner Date
WORKER'S COMPENSATION DECLARATION
16ereby affirm under penalty o[ peryury ane o[ the follawing decluations:
' I hsve and will mainuin a Cenificam of Consen� to self-insum for Workcrs Compen-
on, ag provided for by Section 3700 of the labor Code. (or the performance of the
,ic for which �his permit is issucd.
0 I have and will munwin Workers Compensatian Insurana, u �cquired 6y Sccdon
3700 oC the Labor Code, Cor thc performance of �he work for w6ich �his permit is issued
My Worke�rs C ln cr and Poliry number� •�
Cartier; ,�� /d �� C V)J / Policy No.: � �°
CE FiCATE OF EXEMPflON FROM WORKERS'
COMPENSATION INSURANCE '
(Chis section need iroc bc canple�cd i( the permil is for anc hundred dallus (5100)
or Icss.) '
I cenify that in thc perfo � cc of thc wor for which ihis pertnit is issucd. ! shall not
employ any person in any ncr so az W mc wbject w ihe Workers' Compcnsation
Laws of Cali(ornia. Da�c
Applicanl "
NOTiCE TO APPLlCANT: !f, aficr m in �hu CcrGGcatc of ExcmpGon, you should
become subjcct to 1hc Worter's Compc G n provisions of thc l.�bor Codc, you muu
� O forthwilh comply with such provisions or permi� shail bc dxmcd revoked.
z ""' CONSfRUCf10N LENDING AGENCY
(- � [ hcrohy a(lirtn �hat thcre is a consuuctinn Icnding agcncy for thc perfortnancc uf
p�., � thc xvrk for which this permit is issued (Scc. 3097, Civ. C.)
W� Q Lendcc's Namc '
� z Lende�s Address
V 0 I cenifY that I have resd �his applicuion snd sntc �hu �hc above infomiauun is
w �' cortcn. ! agrce to comply wiih all ciry and counry onfinances and sute Iaws reladng to
0 U building conswction, and hneby authariae reprcsentativcs of �his city to cntcr upnn thc
w aAovc-menGoned prtapcny (or inspecUan purposes.
a (We) agree to save, indemnify and keep harmlest lhe City o[ Cupertino against
�,,,� y liabiliues, judgm �s, costs and expenscs which may in any way accruc agains� said City
V z in consequencc ihe granting oC Ihis pcnniG // �/ _
�"� APPLICANC RSTAND AND WILL COMPLY WI7H AL NO -POIM Issued by: Date �
SOURCE REG L � ONS.
� � ° Re-roofs , �
Signuuroo[App t/Contracw Drtc .
HAZARDO MA7ERIALSDISCLOSURE Type of Rc►of
Will Ihc applicant or futurc building occupant storc or Nandlc harsrdous ma�cri�l
az dcfincd by the Cupertino Municipal Codc. Chaptcr 9.12, and �he Hcal�h and Safay
c� Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed:
❑ Ycs �No
�11 thc applicant or futwc building accupant usc cquipmcnt or dcviccs which If a roof is installed without first obtaining an inspection, I agree to remove
emi� ha•rardous air comaminants az Jcfincd by the Bay Arca Air Quality Management all new m�.terials for inspec[ion.
etrict?
❑ Yes �u
1 havc rcad ihe ha�ardrnu maicrisls �cquiremen�t undcr Ctup�cr 695 of du Califor-
nia Hca1tA & Safct Cade, Scctions 25505, 33 aml 25534.1 undctstand ihu iC buildin
Y g
does not curten�y ha a an4 ihat i� ia in responsibiliry w notify the acu t nf the
�cquiremcn�s wnich m be ' r 'ssu o[a Ccrtitca�c of Oc fyan .� Signature ��f Applicant Date
l �
oW���o�a��ho��.�aas��� „� All roof coverings to be Class ��8�� or better