05110154 CITY OFCUPERTINO +"'� '` '( ( "
BUILDING DIVISION PERMIT eulOi�'„T,yOcwpq¢3 ,'g.;t T�';Kg
BUILDING ADDRESS: HERITAGE CONSTRUCTION AND PERMIT NO.05110154
10340 GLENVIEW AV
aNEIts NAME: PERMIT ISSUE DATE
LUCIA & FRANCIS NGAI 13622 SARAVIEW DR 11/29/200r;
PIR NE: SANITARY NO. CONTROL NO.
(408) 867-6881
ARCHf1EC(ENGINEER: BUILDING PERMITINFO
SLOG ELECT PLUMB MECH
t� t�
lo$
LICENSED CONTRACTOR'S DECLARATION JobDescrition
I bemby.Him Nat 1 an licensed under provisno of Chapter 9(commuting p
with Sao d70M)of Division 3 of the Business a d Prolcu mu Code.and my Iicaus is
+� mOlo=mul.nca REACTIVATION OF ORIG. #04030040
;
z Llcenm Clasa Lk.d�� Daw canuacwr NO NEW PERMIT ISSUED/PAID 1/2 ORIG. PERMIT FEES
ARCHr1ECTS DECLARATION
I underrated my plum shall be used u public records
s� Licensed Pm(essiond A
203 Oat I am
DECLARATION
• p 1 mea .nim that I am eumPt Rum do Cfc=m a 1 IXmlm law for
tbo
3 p ff following moon.(Seeman Icons.5,Buaft er. and Te.dere lL Code:Any city ar county
$ which sequba u perch re construct,alter.m tarso demolish.a repair ed atromum
_iy thit he its issuance,alsotap tre do spplkw far aohpem)tw Rlea L..(Chapter
951thatMIaIICCNNpSecdon7thre")ofiNONOIthe ofWeB�MessadProfession,
nmLJw(ChaQm9 Sq.Ft. Floor Area /C Valuation 0
951 (Commencing he is ing wird wonfro 70W)ofbthDivision 3 of al eg Business ad Pm(w violation or
Nu he t,wempt 1Mm(rom and Ne buss for the alleged aempriau My violation of
Semon 7031.5 by any applicant for a permit Subject,the applicant m a civil penalty of ppN Nu ,� Occupancy Type
set mart Nan Bap W
hundred da1a(5300). 3 6 9110
0 LOS owrcr ofW property,or my emplayeo wIN wage u Neo ick ampemamm,
will do the work and thestmctme is tet intended woffered remain(Sec.7044.Ismancs t quiff Inspections
wM PlafeWOm Cade The ConnClMe I Wage Law dean WI appy m a homer 0( 1 g
property who Wildsorimproe,Nerese.mlwha doessuchworkhimt,eifardrough his y�q /�
awn smpioyvn.provided Wt Such improvement,on set Intended or offered for sale If. �tJV1;y�j�
luras.mr,We building ar improvement Ia mid within am year efmmphdan.Ns amour- y'
builder and bans the When of peeving that he did sea build ea improve far purport of
oak.).
1.u acommuning swan of ern property.am exclusively cmuning win Licensed communm
es
ern Use projea(See.7044,Business aha Profession Cade:)The Comments U.
mems law does oat appy in a owma of property who WIIda or improves theme n.ame.
who connect,for such project,with a eomocwr(O licem ed Famous w lie Comtraloes
Lkeme Law.
❑Ism sumps uncia Sm. B&P C For this moon
Dan
WURKERB COMWESSATIUM DECLARATION
1 hemby alum under penalty of penjuy can of the following da1uN)ma
1 have and w01 mantan•Ce IfcSW of Covent w self-lsure forWorkers Compen.
Minn.as provided for by Soman 3700 of the Labor Code,fa No perfaman¢of Ne
work for which this permit is bound.
0 I have aha will mdnWn Workers Computation as required by Section
370E a(Nc labor Cade,for the Par=...I W work far such Nis permit is honed.
My Worker,CompeoWon Nservance carrier and Policy number am:
Carrits, Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Irht,sectioand Out W completed Lithe permit lfmoe,hundred do0.m(SIM)
lir leu)
1 atdfy that in the performance of Ile work for which this parch is housed.l shall an
co an rmainan maorcr ern � C�j�b Ins Cmn oatlm
Owe of California.Dale ^& �-"r
Applicant
NOTICE TO APPLICANT:If,after maksilit this CeARaw of Exemption,you Mould
become subject no the Wo Sces Compensation provisimu of do law Cada,you mut,
.J O forthwith comply with Both provisions or this permit"I W deemed mvmad.
z0 CONSTRUCTION LENDING AGENCY
PlBarneySri.and nemlaconumthmleading agency for Neperformance,or
Ix > Nn work far which this permit is issued(sum.3097.Civ.C.) i
W�Q
Latices Name
P Z Leaders Addreas
V O I Roily that I hank mad this application and slain Na ft above ialalllladeet N ,
LL,^ emmet 1 agree m comply with all city and county oMurces and Boo lave misting;w
Wilding construction,and hucby mthorin mprcaenuthra of this city to enter upon Ne
DJ alave-mandom d property for nspecdm purposes-
f�y1 (We)agree to save,indemnify and kap Instantiate Ne City of Cupmemo against
jy W) IIabIIIlIm.jWgmemB.mOBLL aha"pen fp whkhmaylmmy Myaameagainstudi CIty
f,z
v7
APPLICANT UNDERSTANDS
NDERSTANDS permit
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE0.EG�U.ATIONS. Re-roofs
Signature 6TApplin onum I, DOW �f
HAZARDMS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum Wilding oceuput Bwre ohandle hwtdoo material
u&flrwd by Ne CupeNtm Municipal Code.Chapter 9.13,aha Ne Health and Safety
Samoa 35532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu ONo
Will the applicant or future,Wilding occupant are egmpmot erdcvhcet which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air canumiunu o defined by Ne Bay Amu Air Quality Management all new materials for inspection.
District)
Oyu ONo
I have mad the board.material remim nen s underClupe,05ofNe Cables.
Me HcalN&Suety Cade.Secthma25505.25533 and25534.[understand"Ifthe Wilding
data eel currently have a tenml Nm It Y my mapan.IMlity Be notify IAC aaapml 0f Ne
mquirmcns who must be mel prior to lamWa of.Cmdnate of Signature of Applicant Date
Owaatur
atomized apelt(���' /1� oc. . - All roof coverings to be Class"B"or better