07100107 CIT�' OF CUPERTINO ������..���� �����������. ;
BUILDING DIVISION �ERMIT < :
: . . _ . . :;._ .
PERMIT NO.
BUILD t ����� ESS CASTINE AVE TBD - TC BE DETERMiNED 07100107 .
pERMIT LSSUE DATE
�ER'S NAME: ,
MICHAEL & AMY YIN 10/31/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDiNG PERMIT iNFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMH MECH
� � � 0
� p � LICENSED CONTRACTOR'S DECLARATION JOb DeSCI'lpt1011
� V�', [ hcreby affirm ihat I am liccnscd unJcr provisions of Chaptcr 9(commcncinS
; z� with Scciion 7000) of Division 3 af thc Busincss and Profcssions Code, and my �iccnsc is REV I S I OT �- REV I S E F LR F RAM I NG AT 2 ND F LR B EDRM NEAR
!� y in full fotce and effect L� J FRONT . OF.I G 0 6 0 8 017 0
� v� z Licensc Clazs ��• �
p Date Conuumr � �r
: t" � HI'CECI"S DECLARATION
i a Q 1 undcrstand my plan shall bc uscd az public rcconls
)aU
� w y Liccnsed Prufcssional
: a a OW NBR-BUILDER DECLARATION
j Q� f hcrcby aC6rm that 1 am cxcmpt Gum ihc Contractofs Liccnsc Law [or ihc
: p O (ollowing rcason. (Secuon 7031.5, Business and Profescions Code: Any eity or coumy
� ,°, � which rcquims a pcanit to canswct, alur, improvc, dcmolish, or rep•rir any suucture
_ Z a prior u� i�s issuancc, also rcquires �hc applicant for such {xrmit to filc a signcd s�aicmcnt S a . Ft. Floor Area Valuation
� x � that hc is liccnscd pursuant to thc provisions of thc Conuactur s Liccnsc Law (Chaptcr 9 � O
� t- �(commcncing with Scction 7000) of Division 3 oC �hc Busincss and Profcssians Cadc) or
,�, �., �hat he is ezemp� �hemfrom and the bazis (or the allegcd exemption. Any violation a( OCCUI7111Cy Type
Section 7031.5 by any applicant fw a pecmit subjects �he applicant to a civil penalty af 3 2 6 410 3 E��� Number
not more than five hundmd dollars (5500).
❑ I, as owncr o! tt�e property, or my employces with wages as their salc compensadon,
will do �hc wQrk, and Ihe st[uctu�e is not intended or effe� far salc (Sec.7044, Butiness Required Inspections
and Pmfessions Code: The Conuacar's License Law docs not aPP�Y a a" �� of
propeny who builds or improves thercon, and who does such work himseltor Uwugh his �
own employccs, provided that such improvements are not imm�ded or oRered for sala I[, �
however, the building or improvement is sold within one year of completion, �he owner- �
builder will have the burden of proving �at he did not build or improvc for purpose of �
sa1eJ.
❑ 1, as awner oC the property, am uciusively conUacting arith licensed conuactars w
consuoct Uu pmject (Sec. 7044. Business and Profcssions Code:) The Con�ruwrs Li•
tense Law does nol apply w an owner of propeny who builds or improves �heeeon, and .
who convacts for such projec�s with a conuactor(s) Iicensed pursuant m ihe Convactor's
t icense Law.
am ezempt under Sec. , B 8c P C tor this muon
_.�ner Date _. .
WORKERS COMPENSATION DECLARATION
I hercby afCirm under penalty of perjury onc o! the (ollowing declarazions:
❑ I Iwoe and wili maintain a CeniLcam of Consent to self-insure far Workers Canpcn-
sation, as providcd for by Secrion 3700 aF thc Labor Code, far thc performancc oC Uu
work for which this permic is issued.
❑ I havc and will maintain Worker's Compcnsation Insunncc, u required by Section ,
3700 of the Labor Code. Cor thc performance o[ �he work (ar which �his permit is issued. —r/
My Wor� Co pensaypn I;uc?!ice carrier and Poliry nu ��.� � J J �
Camer. , i� T df" � Policy No. ��
G � EMPI'ION FROM WORKERS'
A1'!ON INSURANCE
(This secaan nccd not bc completcd if tlre permit is for anc hundred dollars (S 100) ,
or Icss. )
I cenify ihas in thc performancc of thc work for which ihis permit u issucd, [ shall not
emplay any person in any manncr so az to bccoma subject to the Warkers' CompcnsaUon
(.aws of Califomia. Datc
Applicant
NOTICE TO APPLICANT: lf, aftcr makin� �his Ccrti[ica�c of Excmptian, you should
bccome subjcct to thc Workcr's Compcnsadon pmvisions of ihc Labor Codc, you must
� O forthwiih comply with such provisior� or this pccmit shall bc dccmcd ccvakcd.
z � CONSTRUCTION LHNDING AGENCY
(� r. 1 hcrchy aCLrm �hat thcre is a canswciion Icnding agcncy Cor thc perfortnarkc o� �
�, � ihe work Cur which this permit is iuucd (Scc. J097, Civ. C.) ,
W Q L.endcr's Namc
� z L,cnder's Address
(� � 1 ccrtify �hat I have rcad this applieadon and statc ihat thc abovc infortna�iun is
�►-� cocrect. 1 agcce to comply with all city and county ordinances and sute laws mlating to
r� U building conswction, and hcreby authori�e represcntativcs of ihis ciry to cntcr upon ihc
� W abo�c-mcntioncd property for inspccuon purposes.
a (Wc) agree to save, indemnify and kecp harmless �hc Ci�y o[ Cupcnino against
�� liabiliaa.judgmcnts, costs and expcnscs which may in any way acccuc against said City
U z in consequcncc oC thc granting of Ihis permit. D3CE
�--� APPLI AN'C UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR�E �iULATIONS. A, � � `� Q �
� - � � Re-roofs
SignaturcofApplicantl onuacwr �'� T e of R �)Of
HAZARDOUS MATERIALS D[SCLOSURE YP
Will ihc applicant or futwc building occupant storc w handlc harardous matcrial
cfincd by thc Cupertino Municipal Codc. Chaptcr 9.12, snd thc Hcalth and SaCcty
.�Ac. Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
�y� �No .
If a roof i: installed without first obtaining an inspection, I agree to remove
Will ihc applicant or future building accupant usc cquipmenl ar dcvicct which
cmit harardous air conuminan�s az dcfincd by the Bay Arca Air Quality Managcmcm all new m iterials for inspecrion.
District? `�
Q Ycs �Ttu
/\
1 havc rcad the hvardous maicrials rcquiremcn�s undcr Chaptcr 6.95 of �hc Califor-
nia Hcalih & Safcty Codc. Secaoivs 25505.25533 and 25534. I uncfcrstand ihu if �hc building
docs �o� rren�ly havc a tcnan4 �at it is my responsibility to noufy tlx oaupant n( �hc
rey�irc n� hichmusibcmet ' issuancco[aCcnific� tOc3pa�cy Signature ofApplicant Date
t � All roof coverings to be Class "B" or better
Owncr or authori•r.cd �nt ���