08100098CITY OF CUPERTINO
BUILDING DIVISION PERAUT
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BUILDING ADDRESS:
PERMIT N0.
22271 KENDLE ST
JEREMY MAO INC
npinnnCIQ
OWNWS NAME.
PERMIT ISSUE DALE
CONTROL NO.
(408) 449-9942
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
UCENSED CONTRACTOR'S DECLARA71ON
Job Description
1 booby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full face and effect y
REVISION ADD STRUCTURE BEAM AT FAMILY RQOM
Daasa' c�untnaar
ORIGINAL PERMIT # 08040186-NO NEW PERMIT
t ARCHrIEC-IS DECLARAT I
I understand my plan WWI be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following nssson. (Section 7031.5. Business and Professions Code: Any city or county
which Rgdres a permittoconstruct alter. improvedemolish, or repair any ftrtreluro
prior to its iss^ancr also requires the applicant for such permit to file a signed statement
that. he Is licensed pursuant to the provisions of the Contractors Limme Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
10 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Seaton 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (SS00)
32613105 . 0 0
❑ L as owner of tiro property, a car employee with wages as their sole compensation,
Required Inspections
Will do the work and the moctum is not intended or offered for sale (Sec. 70K Business
and Professions Corr; The Ctmmctoes License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himsellor through his
we employees, provided that such improvements are not intended or offered for sale If.
however, the building or Improvement is sold within arse year of completion. the owner -
builder win have the burden of proving that he did not build or improve for purpose of
sale).
❑ L as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cale:) The Comuaetoes Li-
ccrose Law does not apply to an owner of property who builds or improves theRmn. and .
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt. under See B k P C forthis reason
Owner Due
WORKERS COMPF-NSA710M DECLARATION
1 hereby affirm under penalty of pm jtry ate of the following declarations
❑ 1 have and will maintain a Certificate of Consent to self-lasurc for Waters Compen-
sation, a 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of Use work for which this permit Is Issued
My Waters Compensation Insurangcarricr and Policy number all:
'' /, - Ov
Cartier. �i Policy No.:
CERTIh7CATE OF EXEMPTION FROM CFRS'
COMPENSA71ONINSURANCE
(rhis section need not be completed if the permit Is for one hundred dollars ($100)
or leas.)
I ccnih, that in the performance of the work for which this permit is issued I shall out
employ any person in any man= so as to become subject to the Workers' Compemaiat
Lam of California. Due
Applicant
NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you should
became subject to the Wbrkcrs Compensation previsions of the Labor Code, you must
forthwith comply with such provisions or this pc !nit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hemby affirm that there Is a construction lending agency for the performance of
till work for which this permit is Issued (Sec. 3097, CIv. C.)
Lenders Name
Lenders Address
I certify that I have read this applkauon and sum that the above Information 11
corecL I agree to comply with all city and county ordinances and am laws Mining to
budding construction, and hereby authoria representatives of this city to eater upon the
above-mendaed property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Iiabiiides, judgments, costs and expensea which may in any way accrue against said City
in can sxp= a of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date Z '
SOURCEREGLI.A NS O� Q
Re -roofs
Type of Roof _
Signature ofA oHAZARRDDOUS MATERIALS DISCLDSURE Duo
1
Will the applicant or future building occupamtstom or handle hazardous material
as derfned by the Cupertino Municipal Code. Chapter 9.12. and the Health and Sakq
c°d`• p 2=1)?
All roofs shall be inspected prior to any roofing material being installed.
No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuuue building occupant use equipment or devices which
emit huArdous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes No
I have nsad the hazardous rnteriaLs Rquimmems under Chapter &95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 2M4. I understand that if the budding
does not currently have a tenant. that It is my responsibility to wdfy the occupant of the
requirements which maw be met prior to is of a w or occupa y-
Signature of Applicant Date
All roof coverings to be Class'j�r or better
Own�authonrrA agent Date