06010059CY OF CUPERTINO
BUILDING DIVISION ]PER_=,iiT
BUILDING ADDRESS:
10030 HILLCREST RD
OWNER'S NAME:
STEVEN LAM
PEliMI-I NO. 06010059
PERMIT ISSUE DATE
04/25/2006
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: I O BUILDING
G PERMIT
PUM O
BrCH MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing P
with Sccuon 70(Mi) of Division 3 of the Business and Professions Codc, and my lie is
thfullforceandClTecL U REVSION--ADD BALCONY (2ND FLR. /BACK)
Licensee? :% Lie-• 3 NO NEW PERMIT ISSUED ORIG. 305090021
Date Contrac nr �"' /
ARCHITECT'S DEC A N �j��j S y �N rIJ E / „
! undcrstanJ my plans shall he use public records / G�f'
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, hnprove, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
chat he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of thc Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.3 by arry applicant for a permit subjects the applicant to a civil penally of
not more than five hundred dollars ($500).
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 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 -
builder will have the burden of proving that be 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 Code:) The Conuactoes Li -
cease Law does not apply to an owner of property who builds or improves thereon, and
who contracts far such projects with a contractors) licensed pursuant to the Contractor's
License Law.
O 1 am exempt under Sec B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hen:bya(finn under penalty of perjury nnc of the following declarations
❑ 1 have and will maintain a Certificate or Consent th 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
I have and will maintain Workers Compensation Insurance, as required by Section
3700of the Labor Code, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number arc: /
Cartier. - - " Policy No.: —:713 C C
CERTIFICATE OF PXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred douars ($1011)
or less.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Codc, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a comer ucuion lending agency for the performance or
the work for which this permit is issued (Sec. 3097, Civ. C-)
Lender's Name
Lenders Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building conswclion, and hereby authorise representatives of this city to enter upon the
above -mentioned property for inspecuon purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, jndgments.costs and expenses which may in any_wayacc -."1said City
in consequence of the granting of this
APPLICANT UNDERSTAND&. 1V LY WITH ALL NON -POINT
SOURCE REGULATIOKI
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hayardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safey
Code, Section 2.5532(a)?
Yes �<No
Will the applicant or future building occupant use equipment or devices which
emit hayardous air contaminants as defined by the Bay Area Air Quality Management
District?
0 Yes t4No
I have read the ha7mdous materials requirements arider - 5 of the Califor-
nia Health & Safety Code, Sections 25505,.?S533and T3534. Fafi6rssirn�at if the building
does not curtcndy have a terlan4 thdfit is�.,responnsihility to notify the occupant of the
requirements w ' M0 be met ' Issuance of a Certificate of Occu Fancy. /
!� �(
owner ru aunhnn�ed aorniT41.1
Sq. Ft. Floor Area
326160 .00
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy
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