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07050052- PUB LL- U N O N rc 0_ U C Q 3 U y (U IML fu 0 1m�� u li �f� _I�i - Q S U U 0 LO Q W 3 U7 p CD W CS Lo W Q 0 L3 OL 0 W � x H U �4 H H H A �S H Pq4 U < p1 O w a' � F PG U] c - 0p 0 Z 0 0 S Q x SCE L3 w 0 w PO 0 m w0co U O N \ -7 O O ( z a) 9a O W LO M Li H P 'mow' qw r LL] S o _ co w S O iD 0q �-� H H N N u 2 LJ Z cn p a� to Qa- Td U ..J 21 U Q =D ...." =D Q U 1�1 0 LL- _0_O S C QQi J Cl xO T IcSI ISI ISI a a a n p 0 0 0 o n om _ _ g 3 0 0 1 U m Cl O J :2 O Q Ir m co w o a a_0 _ N ` y Q f -L, LL ppUJ Cwr N O ip � {— w ,w oc w ,D 3 0 3 0 � OD Co o cw N 0 0 3 3IL C3 Cl) p S p r Ln ti to p O 0 O r7 O Uo Q ai N ,`v a`� � 0a x x a a n, Q) :5a o _ �- j o v = rc xQl ~ U5, U w U o L° t LO �7 ai d xv, U p U v E fu C a p U U E _0 E _� AL E a`a a p o ui � o MA as w2`v �o o a 0 0_ p Q cn U ZD 0_ 0 0 a -� 0_ LO 0_ Q 0_ L_1 L_1 u a� CITY OF CUPERTINO # i BUILDING DIVISION PER* BUILTDDRESS: PERMIT NO. t5g SEPTEMBER DR TBD — TO BE DETERMINED 07050052 OWNER'S NAME: PERMIT ISSUE DATE CHING CAESAR T AND SUSANA M 07/09/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION Job DOSCiIptlOn p I hereby alGrm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Codc,and my license is ADDITION 10 0 6 ' —MA STERBEDRM,DINING RM,GARAGE in full force and effect.— ? License Class F Lia.a 92y 413 ' ,REMODEL 720 ' RELOCATE KITCHEN CHANGE GARAGE _� Date ARCHrr5.7rSDECLContractorARA -r)N TO LIVING, 2 BATHROOMS. I understand my plans shall he used as public records ' yV :L F' Licensed Professional � OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the n O following reason.(Section 7031.5,Business and Professions Code:Any city or county n which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement =ao that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or .._. $311481 .. 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 Number Occupancy Type not more than five hundred dollars(5500). 36214019 . ❑1,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 Contractor's License Law dors not apply to an owner of Required Inspections 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- builder will have the burden of proving that he did not build or improve for purpose of sale.). ` twigs owner of the property,am exclusively contracting with licensed contractors to et the project(Sec.7044,Business and Professions Code:)The Contractor's Li. cense Law dors 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 Contractor's License Law. ❑1 am exempt under Sec. ,B&P C for this mason OwneY`' WORKER'S COMPF�fS�'I70Nb�Cf:AtTION"'"�` I hereby affirm under penalty of perjuryone of dee following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Worker's Co—mp�ensationnIInsurrance carrier and Policy numher are- Cartier. /iT/ li f V Poliry No.: f'n•� CERTIFICATE OF EXEPTION FROM WORKERS' COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred-dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not em to an' rson in any manner so as to become sub'ect to the Workers Compensation vis ofCsf arm a Applicant NOTICE TO APPLICANT.If,after making this Certificate of Preemption,you should become subject to the Workers Compensation provisions of the Ichor Code•you must Z forthwith comply with such provisions or this permit shall be deemed revoked. . Q N CONSTRUCTION LENDING AGENCY r H I hereby affirm that there is a construction lending agency for the performance of the workfor which this permit is issued(Sec.3097,Civ.C.) QLender's Name '+ Lender's Address D Q I certify that I have read this application and state that the above information is COMM I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authmrne representatives of this city to enter upon the CI-) above-mentioned property for inspccuon purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against cn liabilities,judgments.costs and ex nses which may in an wa accrue a ainasaid Cit �� j g Pe Y Y Y g Y Z in consequence of the granting of this permit. "—� APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL,7N N-P INT Issued by:2��&kev Date SOURCE RE AnON - % e Re-roofs Signature of Applicant/Conuactor f D41c HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipa Code,Chapter 9.12,and the Health and Safety Code,Section 25332(a)? All roofs shall be inspected prior to any roofing material being installed. E]Yes Will the applicant are 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 J rued by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Ycs u I have read the hazardous materials requirements under Chapter6.95 of the Califor- niaHealth&Safety Code,Sections 25595.25333 and 25534.1undcrsmndthat ifthc building docs not currently have a tenant•that it is my res risibility to notify the occupant of the requiremcn ch must et peiorto i uanof a Ccnificatc of oc . Signature of Applicant Date Owner or authorized agent pre i All roof coverings to be Class"B"or better CITY OF CUPER'TINO CITY of PERMIT APPLICATION FORM CUPERT fiVO APN# �� k-- Date: 3 Building 0-ddp C-OF5014V CA q9D )+ Mailing Address (if different from building address): Owner's Name: Phone#: N Contractor: Phone: ate License#: Fax: Contact: Phone: 3°�,5 Cupertino Business License#: nA Fax: Building Permit Info: IN VE WF/4 WF/4IN I CAI Bldg 19 ' Elect Plumb Mech Job Description: plr(/N(j A0A What is being added? AW)N tj W041a 6ev 14 ftf V A+V14 60 6i�rr �E What is being remodeled? MOCA�5 6WM4 Q6 4A0"6 i b .0 Q//Al 4 A11VA o��L,tN rr THIo �A�N(�UMh Residential ❑ Commercial ❑ Remodel Includes Re-Roof: Yes 1, No ❑ Remodel Includes Structural: Yes,®. No ❑ Square Footage: Addition: l � I� �,5� Remodel: Jr1 ��yarage: Porch: Deck: X/0�.��— / Other: U6 , Cost of Project: ��o. Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard C�� Large ❑ Major ❑ *For office use only* ❑ Over the counter 1 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Building Department JOB ADDRES . ,8e- � m&,�r 2 , 070 OWNER'S NAME: (a,er ch i l PHONE # /1 GENERAL CONTRACTOR: 6L4jo4 �2 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 o� Oer/Contractor Signature Date