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CITY OF CUPERTINO
t g�
BUILDING DIVISION PER
BUILDING ADDRESS:
PERMITNO.
20221 BOLLINGER RD TBD — TO BE
_1aTEE.MI11E1a__ 06020051
OWNER'S NAME: PERMIT ISSUE DAIS
RAYMOND & SHUMING CHU 01/09/2007
PHONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH
;�Z
0 0 0 a
O O LICENSED CONTRACTOR'S DECLARATION Job Description
u firm that I am under provisions of Chapter 9(commencing ADDITION 1003 ' –REMODEL 1588 —REMODEL GARAGE 440 '
with Section 70(K))of Division 3 ofthe
dre Busincst and Professions Code,and my license is
< in full force and effect-
2? Ciecnsc Class L;e.n GARAGE 440 ' X 37 . 21 = $16, 372 . 40
o Date Contractor REMODEL 1588 ' X 100 .75 = $159 , 991
ARCHITECCS DECLARATION
U I understand my plans shall be used as public records
a
Licensed Professional
ova OWNER-BUILDER DECLARATION
+� Z 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
K which requires a permit to consnct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to Glc a signed statement
's o` that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area rt Valuation
t✓ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $31377
9
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 9 3 5 0'2'0 . Number Occupancy Type
not more than rive hundred dollars($500).
❑I,as owner of the property,or my employees with wages az their sole compensation,
will do the work,and the structure is not intended oroffered forsale(Sec.7044.Business Required Inspections
and Professions Code-The Contractornss License Law does not apply to an owner of (l p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended oroffemd for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder wiB have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,az owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant m the Contractors ,^ ^,A \ Ph ^��
License Law. r 'ltTV"71VI\V1 [ ,
❑1 am exempt under Sec. ,B&P C for this reason 1_ ///��� '�/'f^
Owner Date Y 6 � ecr�&-t—
WORKER'S COMPENSATION DECLARATION la,/L 1' 1�..-
I hereby affirm under penalty of perjury one of the following declarations: /"�,A, i/'�� ,
❑I have and will maintain a Certificate of Consent to self-insure for Workers Com pen- U W/�/nEY 1` '
sation,az provided for by Section 3700 of the Labor Code,for the performance of the `—
work for and this permit is issued. 1 "�' Q)V :6,k /1 1 Y\
❑1 have and will maintain Workers Compensation Insurance,az required by Section 1 ,(-(�y/� � �(f�1
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF E3CEMPTION FROM WORKERS' �(
COMPENSATION INSURANCE ] '1Info
(This section need not be completed if the permit is for one hundred dollars($100) 1
or less.)
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 az to become subject to the Workers'Compensation
Laws of Califomia.Date—
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Z
I hereby affirm that there is a construction lending agency for the performance or
a! the work for which this permit is issued(Sec.3097,Civ.C.)
Iz7 Q Lenders Name
Z Lender's Address
U 0 I certify that 1 have read this application and state that the above information is
v. — correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives or this city to enter upon the
W ahove-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hr/) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this Permit-
APPLICANT
ermitAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of Applicant/Contractor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,S lyes ❑No
25532(a)?
❑ All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
1 have read the ha72rdous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
docs not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a certificate of occupancy. Signature of Applicant Date
Owner or authorized agent Dare All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
,y
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
a-2,1
OWNER'S NAME: utl-- PHONE # —
GENERAL CONTRACTOR: LkJ6 i c .FAX # S S .0
I am not using any subcontractors:
Si ature ate
PIease check applicable subcontractors and compete the iollowing,information:
60 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
T'
W
Owner/Ct actor Signature Date