05100187 CITY OF CUPERTINO *'%r'^°�+' °'�R' "� '�"' r
BUILDING DIVISION PERMITQhN,'TRACTQI2 TN 'ORMATIOIVI, r:
BUILDING ADDRESS: PERMIT NO.
JONATHAN SU 05100187
O"Ja9AME:ELENDA DR PERMIT ISSUE DAM
SANITARY N L NO.
ARCHrMCT/ENGINEER: BUILDING PERMff INFO
BLDO ELECT PLUMB MoECH
t� t
ip
LICENSED CONIRACIOR'SDECLARATION JobDescri tion
j I hereby afllrm that 1 am licensed under provisions of Chapter 9(commencing P
with Section 7001))ofDlWsion 3 orthe Business and Professions Code.and my liccnze is
t in full force and effect.
Iz LkensuClms LM.MSFDWL-2 STORY 3900 ' LIVING
Dau Comncror
i ARCHITECTS DECLARATION GARAGE 456 . 75 '
i I understand my plans shall w used as public records
I
Limnscd Four..ional
v OWNER-BUILDER DECLARATION
i F I bunchy aRrm that I am exempt from tiTe Convenors License taw for the
e D following Mason.(Section 7131.5,Business and Profceduns Code:Any city or county
3 which requires a permit M cnnswct,attar.improve,demolish.to repair any structure
print M its Inume.,dsonuitires the applicant forsuoh permit M file•signed comment Valuation
i< that he Is licensed Pommel tothe provisions oftioConuaeter'sLimnalaw(Chapter 9 Sq.Ft. Floor Area
(commencing with Section 7000)of Division 3 of she Business and Professions Code)or $861795
that he Is exempt Nemfmen and the basis for the alleged excmpdom Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 a Civil Penalty of APN Number Occupancy Type
not more Nan five hundred dollars($5004
❑I.as owner or the property,or my employees with"Sea al their sole compensation.
will do Ne work and lhemocture LL not intended or offered for sals(S.C.7044.Business Required Inspections
and Profession,Coda:The contractordace and,Luense taw daant apply M an owwa of q P
property who builds or improves tirtmmt.ate who doessuch week himself M though hit
own cmPterm.provided that such Improvements are notinunded on oRaed fntsale.If.
however,
the building or improvement is sold within arc Far of romPIMCM.the corm
-
Wilder and Use the burden of proving Out he did nm build Or Improve for purpose of
VIG1,a owner of the property,,B exclusively cormanting Cod licensed convenors I.
ecom La the project(gee.n a n.Business roti Professions Code:)The Contractor's LI-
mese law dos not jean owner of property who sedwildsp or improve thezeon.and,
who Lt..Lacu for such projecLL with•conuacmr(d limned pursuant M We Cantramra
Lt..law.
❑lam exempt under,Sec ,BAPCfar this ncsson
Owner.
DECLARATION
I 1 hereby inn under penalty of perjury one of the following decluations: '
❑I haw and will maintain•CenlfimM ofCansenuo salf-imum farWorkersCompen-
mine,as provided for by Section 3700 of do labor Code.far tiM performance of use
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Iabur Code,for du pmronnmee of the work forwhich this permit Is Issued.
MY Workers Compensation Insursnee artier and Policy number am:
Ceokr. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrhis unto need not wcompleu d If the pemnit is fm os hundred dollars()1001
or Ise.)
1 mnify that in the performance of the work for which this Permit Is issued.I shall not
employ any
Certificate th Exemption.you should
become subjectComply
M the Wortero Compcosstios provisione of Ne LeM1nt Code,you muss
QfoMwiN romPly with such provisions w this permit shall M OecmW revoked.
CON=UCOON LENDING AGENCY
1 wmhy anion that there is a eanstsuctinn lending agency for the perfoonancc of
the work for which this permit Is issued(Sex.3097,Co.C.)
zLenders Name
Lender's Add..
Q 1 certify that 1 hive read this application and state that the above Information is
comm'
I.I egzee to comply with all city and county ordinances and state hers relating to
building construction.and hereby authorize representative of this city to enter upon the
Wdove-mentioned property for inspection purposes
(We)agree M rave,indemnify and kap harmkas this City of Cupertino egainsl
N liabilities,judgments,costs and expose which may in any way nerve against said City
in consegmnce of the granting of this perm's
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG ` �
Si ure 16fAppt o mama Y DU, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as deOned by the Cupertino Municipal Code,Chapter 9.13,and the Haltit and Safety
Core,section 35533(.)7e All roofs shall be inspected prior to any roofing material being installed.
13 Y.
ern In,applicant or Comm wilding occupant�equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
n Mrs imm air Contaminants a defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
OYU tpu
I have mad the bmardousmaurlals"u umems under Chapter6.95of The C.lifor.
ni.Halth tit SdctyCmc.Sce0ons35505,25533 md25534.IundcrsLLnd lhB if the wilding
does not
D.¢6 All roof coverings to be Class "B°or better