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08010019 CITY OF CUPERTWO * = * "BUILDING DIVISION PERMIT �Gdl1�ITRAC,TORI '(.?RMATIDN''; u saw.�:..�"?...<•aAu.�G,.'...e *rc�< ;. r.v>sbe ..�:. BUILDING ADDRESS: PERMIT NO. 19998 HOMESTEAD RD C ACTIVE SIGN CO 08010019 OWNER'S NAME: PERMIT ISSUE DATE WAYNE GONG 1365 E TAYLOR ST 01/03/2008 PHONE: SANITARY NO. CONTROL NO. (408) 297-6640 CHITEC IENGINEEK: BUILDING PERMIT INFO BLDG ELELT PLUMB MECH 0 0 0 0 fop LICENSED CONTRACTOR'S DECLARATION lob Description r� I heroby,affsrm Net 1 am licensed under provisions of Chapter 9(commencing Z wsthSttdon70110)of Division3ofmcBusinwandpefessio. ode,and my license is INDIV ILLMNTD PAN CHANNEL LETTER 4 "SUBWAY" Es In m full foam County —''0"_' �NZ License ClassLic.g -'R/ 18"X8"X5" Jt- Dam ` Conueemr ARCHI7ECCSDECLAR ! I underssend my plans shall he used As public records p��0 yssd Licensed Pmfomio.l OWNER-BUILDER DECLARATION C O 1 hnmhy oilirm on I em exempt from to fesntonal Co :Anse Law for the i O O following rens.".(Section](13"5,Business and Professional Calc:Any oily or county $(vs which requima a pmmit to anssme"elms imPmw.dem.itsh,at.pair any snmure Zy prior he its Waseca,clan requires theapplicant far such Permit a fileaalgnedscumem < Net he is licensed pursuant to the provisions,a(the Contractors License Law(Chap=9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 ofthe Buslneasond Probations Code)or 1450 .- that he is attempt therefrom and the basis for the alleged exemption.Any violx6n of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of N Number Occupancy nnotmoa than fin hundred doll.($500). 31603044!C P Y Type ❑1,s,s Owner of the property,or my employees with wages As their sole compennum, will do theworkand decantation is noHntended or arrested for We(Sm.M".Business ns Required Isections and Profess..Code:The ConusemYs Liana Law dean not apply m an owner of - q P property who bui Ids or im prover thereon,end who does such work himself.through his awnemployv;merited thmsuch Imprisonments ase resin anded croRered for sale,If. however,Ne building Or improwman is sold within am your of compledon,the owner- builder will have the burden of proving that M did not build or improve for purpose of sale.). ❑1,as Owner of the property,am exclusively contracting with licensed contrm as in construct the preject(Sec.70".Business and Professions Cade:)The Cormacmis W- sease law d=not apply As an Owner of pmpeny who builds,or improwa thrown,and, who contracts for such pmjettx with a contrecut licensed pursuant in me Contractors Llcerue Law, ❑I oro exempt under See B&P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 b rchy affirm under penslty or perjury am of me fallowing declmations: I how and will maintain a Certificate of Consent to whNnsum for Workers C"mpen- on,an provided for by Section 3700 of the Labor Cade.for the performance of me it for which this permit is issued. ❑1 have and will maintain Warker9 Compensation Isu name,u required by Section 3700 of the Labor Code,for the performance of the wart f.which thin Permit Is lasoed. ' My Workers,Compensation Insurance arts A Pto number Carrier, 'alley No.: .E CATE OF EXE. ON FROM WORKERS' COMPENSATION INSURANCE (ILO s"tai"n need not he Completed ifthe permit is for one hundred dollars(S 10 r) or]a=) 1 certify that in me performance of ale work for which this Pat is intend,l"I not employ any person in any manner an u to become subject to the WMI(Car CO IAMIMIen Laws of Califomts.Dam Applicant NOTICE To APPLICANT:If,after making this Cenifoca a of Exemption.you should become subjca in the Worker's Compensation previsions of me Labor Code.you must ,'Z forthwith comply with men provisions O this permit shall ue darted mwked. z CONSTRUCTION LENDING AGENCY F I hemby aRrm mss them Is a Construction lending agency for me performanceof iY. the work for which man permit is issued(Sec.3097,Cih,C) L17M Q Lender's Name 7-. Lender's Addreas C)Q I certify that 1 have mad this application and sum the the show information is correct.I agme An comply with all city and County ordinances and sum laws relating as building construction,and hereby authorise mpmaenudves of this city to Orientation the LL7 elmve-mentioned property for inspection purleses G (We)agree to saw,indemnify and keep harmless the City of Cupertino"run ti VI liabilities,judgement,costs and expenses which may in any way accrue against said City V 7 in commitu.e of the Swung of this permit. r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATTI/IONS. �^-�© - Re-roofs Signuurt o(Applicaact Dorm HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dmapplicant or future building e.Chaptstore2. addle Health And C defend by dee Cupertino Municipal Code.Chapter 9.13.and me Heslm and Safety Code.Section ❑Na 25533(x)? ❑ All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building occupant um equipment Or devices which If a roof is installed without first obtaining an inspection,,l agree to remove II Immotnus air contaminants As delned by to Bay Amo Air Quality Management all new materials for inspection. ict7 ❑Yes No 1 ben mail the hasamous matcrials requirement untie,Chapter 6.95 or the Califor- nia Healm&Safety Conn.Scetio.25505,25533 and 25534.1 undearsmnd then ift a building ' does not curmmy hew s enan4 mm it is p m bit ly m notify the oaupant"r the mme.romnm which tan mints <ancc.Il Camfic.m.roCt,manry. Signature of Applicant Date 6 wrier rOri tl agent Data All roof coverings to be Class"B"or better a ' '