08020088 CITY OF CUPERTINO ^ .�at ' +,�'xp-*' - ``'
BUILDING DIVISION PERMITCONTRi1CTOR INFGQ MA =ION
I O PERMTf N
BUILO.
ITOW'EARRY WAY DAVID TSAI 08020088
§NFRS NAME: PERMIT ISSUE DATE
DAVID TSAI 10670 'LARRY WY. 02/13/2008
PHONE ., SANITARY NO. CONTROL NO,
ARCHT15CI7PNGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
Q 0
30o LICENSED CONTRACTOR'S DECLARATION t (� [�I lob Description
e Fj 1 hereby affirm Man 1 w Mounted under Psion es of Chapter 9(mmmencIng P
ASIC withSamoan 7")ofDivialon3ofNeBualtteaand PMtUDOmCad=,and mylicrosmis RMV BLDG MTERIALS, ELECTRCL,MECH, PLMBNG AS ND'D
orto full form,ted effect
jN,Z� wane Class Lk.0 FOR
cJ
0 Deu
ARCHITECTSDECLARATIONINSPC EXCPT EXSTNG FNDTN&ROOF.RETRN TO ORIG USE
1 undersand my plane"I be used as public m rends
� u HABITABLE SPACE PR 2007 CBC,CPC,CMC,CEC
y ltd Licensed Proessianai -
m OWNER-BUILDER mDECLARATION
i E 1 hereby eRw the 11. exempt form the Cssion ru License law for the
02 O following moon.(Smit t 7,131.4 Bminms and Profession Code:Any city m county
3 which mqulru a permit m mires,do der.improve,demolish,or e a sig any Nroctue
Zi, priwmiu iauemc,aBc require do applicant forisach ConummnitlUcmuugn=d Wum=nl
5< than M(coo"r t,Banwdpuwan„aNeofDiaiamarN eanWCNM1llcetueLaw(Chapm9 Sq.Ft. Floor Area ' 500 Valuation
2 Maths Is ing exempt
Section 70nd of land,fou,
of theeged assumption.
Any
Code)of
r3.. Net Section
t,damp,Nertfem and Ne burs for be alleged eemant to Any it penalty
ar
not
Man by airyapplicants ddollaran permit abject,the applicant acivil p=etty of �P Number Occupancy Type
tort mom than nae hundred dollar(SSroL 31602034 .'l7V'
❑I,u avert o!tik property,or my wployaa wIN wage u Ne'v ek mnpensstion,
will do,k.,it.and Ne structure,is not inu b ed oroffered for sa o(Sec.]UM,Busi.
and Profession Code:The Contracers Licem s Law dam ret apply W an owner of Required Inspections
property who buildsarimpmvm Nemen,andwho does uchwork himselforthrough his
own employees,provided that such improvement,tee not Intended oroffamd for ssle.If.
however,the building or improvement is sold within am year of eompletion,Ne owner.
budder will love the burden of of proving Nat he did Out Mid or Imprme for P.M.of
J
LO
1,m aweer ar Project
See'proppory.am exclusively. =neruskg with The
Contractors
U.construct the es not
(Sec.0 a x.Business rod property
who
CadaI Tk Contractors d
cave law door nm apply,m an owner of property who sed p rs Improve Nemasc and
who contracts for such project,with aconuec,or(e)limned pursuant a the Contru:eM1
License Law. -
❑Iwaemplu ee .B&PCIn,
N.,,u41
��w,,,mfasn '
nes Data- �
W ('$ N9 1 DECLARATION T `` __
1 hereby afBm under perulry,of perjury one of Me following declarations
❑i haw and will mainuin a CWBmu afCavem m elf-inure for Wohera Cwpen-
adan,u provided for by Sutton 3700 of Ne labor Code,for Ne performance or N=
waste for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance.u required by Section
3700 of No labor Carlo,for the performance ofthe work forwhich this Pewit is issued '
My Workers CompmmWm buunum,carrier and Polity number art:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aMlan need notbccampleted if N=permit Isrnrow hundred dollar(Slf)0)
or kSt)
I Un ly Met In Ne Pcrfomaom,of the work for which this Permit is imued,1091 no
employ any person in my counter an as ma sublaelm Ne Worked'Camp=madon
laws of califomia
APPliI to— ?v
NOTICE TO AP ,a�tci milting this eche.of Eempnon.you should
become nbjw an Me Workers Compc^a,ion provisions of the Labor Code,you mast
Oforthwith comply with such rroridov or Nd reis Permit Nail he domeedUct.
CONSTRUCTION LENDING AGENCY
[ti 1 hammy affirm that Nam Is a construction lending agency for the PMonesuo of
Ci> Ne work for which this permit t,issued(sec.3097,Civ.C.)
W�A Lenders Name
=z Landers Address
U 0 1 certify that I haw mad Ws application and sate Na,ho above information is
If. conecL 1 agree,o comply with all city and county uNinances and some laws miming to
.0 building convection.ted hereby anthorie representatives,of this city to enter upon Ne
4i7 anew-m=ndoned property for inspection purposes
6. (We)agree to save,indemnify and kmp havard.the City of Cup=nNo rgaim,
cA Iiabilitia,fudgment,.caW andeapemsm which.,in any wYacerue 4alnu and City - -
V z in Co.".of the granting of the.Permit.
"-' APPLICANT UH RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R�FA 'ATI NS, /
S Ltd z�/3�°s Re-roofs
S uurt ar Applrmn n,reno Ir Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the a Cupertino
no(Muni building e.Chapter
orhandleand M hmNau materiai
u dcOned by Ne Cupertino Municipal Code.Chapter 9.11.and 0m Health and Safety
d=,Smdon 15532(a)7
❑ �BNa/ All roofs shall be inspected prior to any roofing material being installed.
Ya
Will Ne applicant or future building ocempant use euipme^I or desist.which If a roof is installed without first obtaining an inspection,.I agree to remove
emit luimni us dr camwinanu u d=Oned by lire Bay Arta Air Quality Manag=mcn, all new materials for inspection.
District?
C]Y., QNu
1 have mad the huallom materials requirements under Chapter 6.95 of N=Califor.
ria)Na1N&SafuyCa -Smdw15505.25533u 25534.1uMcrsund NetifN=Wiling
dorm pm ve a lanan4 Nu its my responsibility to cotify,lire anmpant of de
mans whk m
1.mammals C=nificeuof Cempanry.
,, � Signature of Applicant Date
0.0-or.uthanp<d ss=n, -?-4 d All roof coverings to be Class"B"or better