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D
CITY OF CUPERTINO
BUILDING DIVISION Pg RI}
BUILTY MESS:
OODBURY DR
OWNER'S NAME:
KENNY FU
PHONE:
ARCHITECTIENGINEER:
p p LICENSED CONTRACTOR'S DECLARATION
at r -I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z w with Section 7400) of Division 3 of the Business and Professions Code, and my license is
a
in full force and effect -
License Class Lic.##
mDam Contractor
Lu ARCHITECTS DECLARATION
< 1 understand my plans shall he used as public records
�U
a
u, N Licensed Professional
y OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
pCpL following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
rn prior to its issuance, also requires the applicant for such permit io file a signed statement
Z < that he is licensed pursuant to (be provisions of the Contractor's license Law (Chapter 9
tx- t7 (commencing with Section 7(100) of Division 3 of the Business and Professions Code) or
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
not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner.
buildeyyy���vvvill have the burden of proving that he did not build or improve for purpose of
sale ,
I, as 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 does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a conumcior(s) licensed pursuant to the Contractors
License Law.
❑tam exempt un e;R1c
, B & P C for this rea on
Owner Dam
ER'S COMPENSATTON DECLARATTON
1 hereby affirm under penalty of perjury one of the following declarations:
❑ i have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of dee work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S10(1)
or less.)
I cenify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as tgbeFQ.ltt� subject to the Workcri Compensation
Laws of California. 0µS t
Applicant
NOTICE TO APP Cter kin is Cenifu:atc of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
ti
O CONSTRUCTION LENDING AGENCY
-r ►-� I hereby affirm that there is a construction lending agency for the performance of
Yi > the work for which this permit is issued (See. 3097, Civ. C.)
QLender's Name
Z Lender's Address
I certify that 1 have read this application and state that the above information is
y t correct. 1 agree to comply with all city and county ordinances and state laws relating to
D U building construction, and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
-y Q. (We) agree to save, indemnify and keep harmless the City of Cupertino against
ti t/) liabilides, judgments, costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGllL�
Signature of Applicant/ContractorDate
HAZARDOUS MATE LS DISCLOSURE
Will the applicant or future building occupant slorc or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section 25532(a)?
❑ Yes
Will the applicant or building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District? (�
C3 Yes '�
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements wh' st be me( rior o issu ruficate of q
Owner or authorized agent Date
KENNY FU
PERMIT NO.
07040225
PERMIT ISSUE DATE
05/08/2007
SANITARY NO. CONTROL NO.
BUILDING PERMrrINFO
BLDG ELECT PLUMB
Job Description
REVISION — TRUSS CALCULATIONS ORIGINAL PERMIT
#06070163
Sq. Ft. Floor Area
32645047`:
Issued by:
Re -roofs
Type of Roof
$0
-Required Inspections
Valuation
Type
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
CITY OF
CUPEk INO
C#T Y OF CUPERTTNO. "*
PERMIT APPLICATION* ION FORM
Quantity
''' ° Fee ID'
Fee Description
Fee Group
BMISCELL
Miscellaneous Fee
Y: .BIJILDING
BMITIGATC
Comm. Housing Mit. Fee
' ''-�BIJILDING
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BOVERTIME
Inspection Overtime
BUILDING
BPBACKFLOW.
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPFIXTURE
Pblg Fixture
PLUMBING
BPGAS
Gas Piping System Fee
PLUMBING
BPINTERCEP
Ind Waste Interceptor
PLUMBING
BPLANCHK
Plan Check Fee
BUILDING
BPLANCKADD
Plan Check Add Multi
BUILDING
BPLANCKREP
Plan Check Repeat Fee
BUILDING
BPREPIPE
Re i e Of Fixtures
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSPRINK
Lawn S rinklerBackflo
PLUMBING
BPSTORM
Storm/Rain Water
PLUMBING
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUNIBING
BPWATER
Install/Alter Water Pie
PLUMBING
BPWHEATER
Water HeaterNent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUCLDEVG
BREMACOVER
A/C Unit > 10,000 cfin
MECHANICAL
BREMArRHAN
A/C Units <= 10,000 cfrn
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL .
BREMFURNOV
Relo Furnace > I OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL.
BREMINHOOD
Installation of Hood
MECHANICAL
BREIVIMISC
Misc Apparatus'
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL .
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
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