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CITY OF CUPERTINO
BUILDING DIVISION PERNM
:SROWN
BUILD NG ADDRESS: PERMIT NO.
0475 BEARDON DR TBI5 - TO BE DETERMINED 08040082
OWNER'S NAME: PER16M ISSUE DATE
T7EKING ROCKY CHAN 07/08/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHrrECT/ENGiNE3at: BURNING PERMITINFO
NEW 2 STORY SFDWL, 4556SQ BLDG o PLUMB 0
!O p LICENSED CONIRACIOWS DECLARATION Job Description
0o licensed hereby affirm that I am lised under provisions of Chapter 9(cost g
with Section 70011)of Division of the Business and Professions Cgde�pt(+rty cense is
7 H in full font and offer Q b ( Q
, z Lice ass [.ic.•
Dao Contractor
CHI18 ,It DECLARA'n N
( t 1 understand my plans shall be used as public records
0
: .
o Licensed Professional
OWNER-BUILDER DECLARATION
I hereby alarm that 1 am exempt from the Contractor's License Law for the
00 following nxson.(Section 70313,Business and Professions Code:Any city or county
2 m r which requires a permit to construct,alter,improve,demolish,or repair any structure
_ prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the Waged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the appliont to a civil penalty ofAPN Number Occupancy Type
not mote tato five hundred dollars(S500)
❑I,as owner of the property,or my employees with wages as their sok compensation,
win do the wort,and the stoctum is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's I Icense Law does not apply to an owner of Required Inspections
proper wbr builds or improves thereon,and who does such work himselfor through his
awn employees,provided tint such improvements are not intended or offered for sale.If,
however,the bolding or improvement is sold within one year of completion,the owner-
builder wW have the borders of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Coda:)The Contractors 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 Contracos
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑I Its"and will maintain a Certificate of Consent to self-insure for Workers Compen-
sadon,as provided for by Section 3700 of the Labor Code,for the performance of the
wort for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor code,for the performance of the work for which that permit V'
My Workers Co pugation race and Policy number am:
O D 0
Cartier r�( L. Poi-try No.: -713
CERTIPICA7 OP EXEMPTION FROM 0
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars(S 100)
or lest)
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 Worimrs'Compensation
Laws of Califorola Date
Applicant
NOTICE TO APPLICANT:If,atter making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
O forthwith comply with such provisions or this Permit shall be dmmcd revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is p construction lending agency for the performance of
Y. > the wort for which this permit Is issued(Sec 3097,Cn.C)
QLenders Name
= Z, Landers Address
;)Q 1 Certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and stare Laws relating to
>` building camwucf.n.and hereby author re representatives of this city to doer upon the
vol 'love-mentioned property for inspection purposes
y pry (We)agree to save,indemnify and keep harmless the City of Cupertino against
L..4 to liabilities,judgments,costs and expenses which may in arty way accrue against said City
7 in consequence of the granting of this pdmiL
r7 APPLICANTIND STANDS A W COMPLY WITH ALL NON-POIKr Issued by: Date
SOURCE REGU NS.
Signature ar liant/Contractor Due Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant or future building occupant store or handle hawdous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
cede, en25s3z(')7
0 Yes XNo All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future buildingoccupant use equipment If a roof is installed without first obtaining an inspection,I agree to remove
emit harardons air contaminants as defineb the Ba Area Air ent or Mast anent
r r r g all new materials for inspection.
Disuitt7
❑Yes S0 No
I have
ari
mad the hrdous materials mquimmcnts under Chapter 6.95 of the Califor-
nia Health&Safety Cade.Sections 25505.25533 and 25534.1 understand this if the holding
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requhemcnts which must be met prior to issuance of a Ccmficatc of Occupancy. All roof coverings. ( D Signature of Applicant Date
o o 4 s to be Class ''or better
Owner or authorr7�ent ate g rt
401/1Ov45�
CITY OF CUPERTINO
NEW SINGLEIMULTI FAMILY DWELLING
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
0 ()
Building Address:
119479- 6
Mailing Address (if different from building address):
Owner' Name: Phone# OD
Contractor: Phone#:
Fax #:
Contractor License#:
Cupertino Business License #:
Contact: C. �j�/� Phone#:
'D " � �!' " " 1 Fax #:
Alternate Contact: Phone#:
Fax#:
Single-Story ElTwo-StoryThree-Story El Basement ❑ Hillside El
Multi-family ❑ Apartment ❑ Condo ❑ Townhouse ❑
Sq.Ft. Living Area(Including Basement & Attached Garage: Sq. Ft. Garage(Detached Only):
Valuation:
Job Description: `'� ��vr �y/L/�,9 N
y
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-lHR ❑ 11, 111, lV V-N 3
Project Size: Standard [g/ Large[] Major❑
Green Building: Must attach completed Green Building Checklist to the plans
Green Building Points Achieved:
For help, contact Build it Green at www.builditgreen.org
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUINO
Building Department
JOB104-7-� �� PERMIT# oY00a,2--
OWNER'S NAME: PHONE #
GENERAL CONTRACT FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/C tractor Signature Date