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CITY OF CUPERTINO
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tON 'jaCTR NFORMATI
BUILDING DIVISION PERMIT
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BU" G OR 5:
/i .:. JTANETTE CT
TBD - TO BE DETERMINED
PERMITNO.
08080016 '
09/03/2008
PHONEi"�'
SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
I lionud ni of China 9 (commencing
lob Description
p
1 hese% afRm Nal w cas
under and P
with Stum 3afthc Buttress aM Professions Code.Intl mylicen¢is
ADD 262SQ, 1 BEDRM & 1 BATHRM. NO ROOF/NO
Limil tome and tryout.
Class Lim.
STRUCTRAL
Dam
Dam Contractor
ARCH DECLARATION
1 unrse be he band as public rtcords
denJ my putts shill
Licmved Professional
OWNER -BUILDER DECLARATION
1 hcrtby affirm mel I am exempt from the Conuanors License law for the
following mason. ($¢tion 7W I.S. Bud. and Pmfossiov Code: Any city or county
which mquircs a pomit to eowree . Sher, improve, demol W, or mpur my structure
prior in its issuance. use oquires me applicant for such permit in rile a signed se¢mem
that he is licensed punwm to me pmudons of can Contractor's Uncrac Law(Qapor9
Sq. Ft. Floor Area
Valuation
(commencing with Section 1800) ofDisvion 3 of the Business and Professors Cock) or
$50000
mat he is exempt themfmm and the basis far the alleged emmptial Any Huauoa of
Section 7031.5 by my applicant fora permit subjects the applicant re a civil penally of
3 62 17 0 3 2 Number
Occupancy Type
not maremm Ova hnndw mn.n (gSBB).
.
p y
I,u owner of tie popeny.amy mopl%tees with ngnesstieb ale compcnauan,
willdothe andmeswctumismlimmndedmaRemdforsale(Sec.]014,Busiress
and profession, cane: The Contractor. Lisuc Law don act apply in m owner of
Required Inspections
property who builds a ire proses sheen. and who donesuch wort Mmmif or through his
own cmPlayces, provided mnsmh impmsemems are not intended orofferM for sale a,
however, me building or improvement issuld within one your of completion, the owner.
builder will have the burden of proving that he did net build or improve for poryose of
sale -
1, m .. of the Property, am eaGutivcly ceahacGng with Eccmed contractors to
covhucl the project (Sec. ]Oda, Business and Professions Code) The Coomctm's U.
come Taw does not Imply to an owner of property who builds or imposes thereon, and,
who concocts for such projects wit a conmacmr(s) licensed punuanl in the Contractors
Wcene law.
❑tom esempt undo c .B&PCf mason
nu Dam 3 d
DECLARATION
i herobY aBhm uMer pmWry of perjury aro of dm (olbwini dOclaratimsc
of a
❑ T haw and w0l moor mCode,
rur the Performance
scion, provided four by e tion 37e the Let
section 3]00 or the labra Code, fm de performana of the
ce of the
r
wart for which this permit is issnel
mi
1 have and will maintain Worleces Compensation Insurance, as required by Section
3700.f me labor Cade, fa On prrrmmma of me wort for which this permit is issued.
My Worker. Compeneadmi Ivusana carrier and Policy number are:
'
Camra Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This anNm need on, he completed if the permit is forum hundred dollars (5100)
or mans.)
1 artily, that in mo performance of me work Tor which this Permit m issued, 1041 not
employ any person in any sumer an me subject to the Workm'Compevauon
Laws of California. Dam /]
App0anl
NOTICE TO APPLI 'ng mu ou
Certificate of Exemption. you shld
became Subject m the 'kers Compenuuon previsions of the labor Code, you most
formwi,b comply with such povisinv or thus Ined Shall W domed enkcd.
CONSTRUCTION LENDING AGENCY
1 hescby affirm that then U a costswnimn lending agency fer me perfmmano of
the work fur which this permit in issued (So. 3(19.1, Civ. C.)
Lenders Nm c
Lenders Address
I certify that 1 base mad this Implication and sate mat the above information is
come cl Mom ree he comply with all city and county omnanem
iural see tan relating he
Wilding construction, and hereby authoris epraentsdves of this city to enter upon the
propene for harmed. purposes
slave-menua.
(We) agrte to save, indemnify and mop harmless Ile City of Cupertino again,
dgW
expeves which they In my way mine vgaivtcud City
IivbImsomerom
17nnt.e, nuoand
inconsequence of the Granting of this pc
APPLICANT UA iD WIL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Issued by: Date y .✓
''/31dd
Re -roofs
Ssgwurt rf Appl'can on or \ a—Dan
HAZARDOUS MA A(S DISCLOSURE
Type of Roof
Will the appliesnt v fmum bWlding Ocapmtuoo or IUMle hevrdov mleriu
as defined by de Cupertino Munidpal Cade. Duper 9.11, and me Health anJ safety
Section M532(.)?0yees OrNa
All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future bonding Occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit or comermants declined by Bay Atha Air Quality Management
Oistrint]omv air me
all new materials for inspection.
❑ Yes
I hats read the hasardents materials onph cmmu under Chapter 6.95 of the Califv-
niaHealth hSafciyCodc,Sum= 25M5.25533 and 25534. I understand nus ifde Wilding
does rot cummdy haw a eimnL mat' mY'eaporuihi hit, m sadly ma recover, of me
mquimmenu whichm ,mei oro aanm are cemfa,te arca
Signature of Applicant Date
9
All roof coverings to be Class';?." or better
Owner m mthm; dMent am