07100066 CITX OF CUPERTINO ` �
BUILDING DIVISION PERMIT ��1�TR,� 1���J�"��������� •
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BUILDING ADDRESS: PERMIT NO.
7565 BOLLINGER RD UNIVERS�L CONSTRUCTION 07100066 .
dER'S NAME: PERMIT LSSUE DATE
WONG STANLEY H AND BARBARA P 18870 B.�RNHART AVE � 11/15/2007
PHONE: SANITARY NO. CONTROL NO.
(408)25�-8894
ARCHITECT/ENGINEER: BIJiLDING PERMIT INFO
BLDG ELECf PLUMB MECH
� 0 0 0
u p p UCENSED CONTRACfOR'S DECLARATTON IOb D2SCflPt10I1
� V C I hcrcyy �rm Wat I am licenscd undcr provisions of Chaptcr 9(commcncing
z�� wi�hSecdon7000)ofDivision3ofihcBusincssandProCcssionsCodc.andmyliccnscis REVSN-KITCHEN/FAI�lILY-PSL BEAM RELOCATION�
'� y in full force and clla�
�,�z LicenscClass �•�► , 3 S� ORIG #0 70501�0 NO NEW PERMIT
± f, � Daic ConuacWr
� A CH1TECfS DECLARA770N
� I undcrstanJ my plans shall be uud u public rccorda
�pW,U
4 O y Liccnsed Prufessional
y � OWNER-BUILDER DECLARATION
' I t�crcby uf[irtn �hat 1 am czcmpt from �hc Coniractor's Liccnsc Law for thc
� ` � ac
y p O Coliowing rcason. (Scc6on 7U31.5, Busincss and Profcssions Catc: Any city ar county
K,° Pi which rcquires a pcmiit to consuvct, altcr. improvc. dcmolish. crc re�wir my uructure
y,Z y prior to i1s issuancc, alw mquires �hc applicant for such permit to filc a signcd summen�
� s � lhat hc is liccnscd pursuant lo thc pmvisions of Ihc Comraclor's liccnsc Law (Chap�cr 9 ; iq. Ft. Floor Area r O Valuation
y H $ (commencing wiW Scction 7000) of Division 3 oC ihc Busincss and Profcssians Codc) or •�
y �� that he is exempt Ne�cfrom and the bssis for the allegcd exemptlon. My violauon ot
Section 7031.5 by a�ry appiicant (or a pertnit subjecu ihe appiicant to a civi] pcnalty o[ Number Oecupaney Type
�o� �oR m�, s� b�a,�a aou� cssoo�. 3 5 9 2 2 0 3 9`.
❑[. u owner ot the propaty. or my employcm with wages u their solc compensatlon,
will do the work. snd ihe stcuctuce is not intended or offe�ed for sale (Sa. 7044. Busi�u �te uired Ins ections
and Professions Cade: The ConuacWrs Licenae Law does not apply in an owner of 9 P
p�operty wdo 6uilds or improves thereon, and wM daes such worlc himxlf or iheough hu
own employces, provided Uwt such improvemen�s are not inten�d or o[Ceced for sale. IC,
however, the building or impmvement is sold wi�hin oro yeu of compietion, the owner-
builder will have �he burden o[ proving �Aat he did not build ar improve tor purpose of
saleJ.
❑ I, as owner of the property, am enclusively controcting wi�h licensed rnnuactors ta
wnsnuct the penject (Sec. 7044. Business and ProCessions Code:) The Convacwr's Li-
cente Iaw daes oot apply w an owner of propeny who builds or improves �hemon, and ,
who rnntncts for sucd pmjec�c wiih a conuutor(s) liansed pursuant to ihe Comracwr's
Licenae Law.
� 1 am uempt under See. . B� P C fw thia rcawn
.� Date
WORKER'S COMPENSATION DECLARATION
1 hereby �rm under penalty o( perjury one of the following declarations:
❑ I hs+e and will mainuin a Cutificate of Conaent to xl(-insure (or Workcrs Compen-
saGon, u providcd far by Secdon 3700 of che labor Code, for the performancc ot the
work [or which Ihis pertnit is issued. -
❑ I havc and will maintain Workcr's Compensation Insurana, u �cquired 6y Scction
3700 oC the Labor Code, far ihe pedormance of the work for which �his peemit is issued.
My Worket's Compensa�ion lnsu[ance csrticr and Policy number arc:
Cartier. Poliry No.:
CFIYfIFICAI'E OF EXEMPI'ION FROM WORKERS'
COMPENSATlON INSURANCE '
(['his seclion necd not be completcd if the pumit is for onc hundred dollars (S 100)
or Icss.) '
I cenify that in thc performancc of �he work for which ihis pertni� is issucd, I shall not
employ any pecson in any manncr so u to bcc e wbject pentatlan
Laws of Cal' �e
Applicant
Ll : If, alYc mg �his Ccrti6cate of Eccmpdon, you should
become subject to c orkcr's Compensstion provisions of Nc Labor Codc, you must
� z forthwith comply ' such provisions or thia pecmit shall bc dccmcd mrokcd.
z O CONSTAUCfION LENDING AGENCY
(- i-�+ I hc�e6y alfirm iAat there is a consuuctian Icnding agc�y for thc perfurmana of ,
p�., � ihc work fur which ihis pertnit is iuued (Sec. 3097, Civ. C.)
W� Q Lendcr's Namc '
] z L,ende�s Addmss
(� � I certify Ihat 1 have resd this applicuion and s�atc �at thc above informauun is
w� cortcc�t. l agrce w comply wiW all ciry and counry onfinancu and suk Iaws relaung w
0 U building consuuction, and haeby authorix represen�ativcs of Uiis ciiy to cn�cr upon �hc
� w ahovc-mcntioMd property foc inspenion purposes
Gy (Wc) agree to save, indcmnify and kecp harmless the Ciry o[ Cupertino against
�� liabilities,fudgmcnu, cacts and expenscs which may in any way ucn�c against said City
V z in consequence of tAc gnnting o( this permil. Date
�" APPLICANT UNDERSTANDS AND WILI. COMPLY WITH ALL NON-PO1NT Issued by :
SOURCE RE ULATIONS.
Re-roofs
o App onuxtor '� Type of R�of
HAZARDOUS MATERIALS DISCLOSURE
wll pplicant or futurc building accupant storc or handle ha•rardous mamrial
9cfined by Ihe Cupertino Munieipal Code. Chaplcr 9.12. and the Hcallh and Safety
:�. Scction 25532(a)? All roofs ::hall be inspected prior to any roofing material being installed.
❑ Ycs ❑ No
wil thc a�licant or fuwre building accupant use equipmcnt or dcvices which If a roof i:: installed without first obtaining an inspeetion, I agree to remove
cmi� ha•r.ardous air coniaminanu u dcGncd by the Bay Arca Air Quatity Managcmcn� all new m iterials for inspeccion.
District?
0 Yes ❑ No
I havc rcad che hvaedews ma�crials �cquiremcnLC undcr Chaplcr 6.95 of Ihe Califor-
nia Flcalih & Sakty Codc, Sectiatt 25505, 25533 and 25534.1 undctuv�d that iCthc building
� daes no� curtcn�ly havc a tcnant, iAat it ia my asibiliry w noufy ihe occupant of the
� rcquimme�ch must be met priorto i ara c�r� ar a�,�ry. Signature of Applicant „" Date
Owncr ar autho ' agcnl o„� All roof coverings to be Class B or better