08050112 CITY OF CUPERTINO
BUILDING DIVISION PERMIT aCONTRAC�"TQR INEORMATIf11Y�,`.
BUILDING ADDRESS: PERMTr NO.
22450 SANTA PAULA AVE TBD - TO BE DETERMINED 08050112
W HER'S NAME: PERMIT ISSUE DATE
PAUL CHIU 07/17/2008
PHONE: SANITARY NO. CONTROL NO.
AR CHITECT/FNGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION
a Job Description
I hereby affirm WI I an limited under provisions of Chapter 9(commencing
with Secdon 7")of Division 3 of that Business and Profrssiona Codoemd my license is LANDSCAPNG, ARBOR, BLT-IN BBQ W/GAS GRILL, SNK&
'p ES in full forte and effect.
�L, clerr D ELECTRCL OUTLETS. HILDERBRAND LANSCAPING PD FOR
AL
<F++�ARC�HT'IECTSDECLARATION BUS LIC 5/13/08
�a< isteed wand mY Pkns NallhauseduPWlk raoNs L-417JO$ IN
�dV IL
k G Lironmd Professional
5 OWNER-BUILDER DECLARATION
x 1 hemhy alram that 1 am exempt from the,Contractors Licenm law for the
C 00 following mason(Section 70 31.5 Betimes and Pmfeuions Cade:Any city or county
$ which mquiw a Permit w eanstsstet.alta.hapmw,demoltah.Or repair any struclum
price to its issuance,also maluires tW applicant for such Permit to file a sighed aratemenl
ss< NuheulicensedpurusnitathepmvishomoftheCanracuKslJmme,Law(chapter9 Sq.Ft. Floor Area Valuation
y F$
(commencing witho Section 70
00)of Division 3 of ft 9contest and Profcuions Code)or $30630
`<— test he is exempt therefran and she basis fe the alkgrd esemp tom My violation of
Section 7031.5 by my,applicant for a Permit mbjeta the appOcatt to a civil Penalty of Number Occu ane Type
not mceo duo five humired dollan(S500). 35705023 . P Y YP
❑I.na of Negopaty,mmyrmplaymwiNwageautlmirwlec mpenutm.
will do the work and thounaare 0 notimanded eolfered for sale(Sec.7044.Business Required Inspections
and Pmfeadans Code:The Cowmmes License Law dm not apply n m
an awr of q p
properly who boom or ire prom waren,and who dm such wark himself a thmngh his
own enploym,provided deal such improvements tie not intended aoffored Retain If.
hwevv,dee WiWinGaimprovememesmld within ore yw ofcempWiat dee ower- .
builds wN haw Ne Nuden of pmHng that k did int build a improve fa puryoe of
❑1.as omen a the Property,sen exclusively eonusetng with Reacted aontram e,n
comtsmt dee Project(Sec.7044,Businm and Professions Cade)The Conram es Li-
comes law dm not apply n an owner of propaty,who builds or improv t enter.and
who contracts for such psojeets with a canuacmr(s)licensed pumuant an the Contractors
Liceme law.
❑lanaemPlunda See ,BRPCfethtsrtmemO
-
v Due
WORKERS COMPENSATION DECLARATION
1 baeby alfim ander Penalty,of Pedury arc of the following shreluatiarec -
❑1luve W will maintain a Cerufomte of Consent In self-imus faworkers Camper
a.do..u provided for by Seed..M of dee Labe code.far the parfmma ce of dre
work for which this pcmit is issued.
❑I ban and will trainers Workers Compcnstdon Insurance,at tcyuired by Section
3700 of the Tabor Code.for the penamana of the work for which this permit Is Issued.
My WorkS&ComPensauon lnar`trce crier and Policy�membery K: m
Grtkr: c^ct'EcFurF EXEMPTION
ROMWOa7�I�
GEKDFlCAOE OFSA71ONI FROM WORKERS
COMPENSATION INSURANCE
(Thr so men std not be completed Jwe Ismail It fearc Ilandmd dollars($100)
of kat)
1 certify that in the Performance of dee work for which this Permit is iaved,l shall not
employ any person in any mannerm u to became subject to tic Worker'Cmnpensaton
Laws of California.Date
Appllcatt
NOTICE 7O APPLICANT:If.after making this Ccrt fiam of Exemption,you Nauta
became Nbjttl to the Workara ComponYtion provisions all we labor Cade,yon mad
.,z forthwith comply with each Provisions Or does Permit Nall be deemed revoked.
z y EN
CONSTRUCTION LENDING AGENCY
F�- 1 hereby aflim that deem is.conmatim kndmg.gancy for the performanceor
C> we wont fa which this Permit Is iced(Ser.3077,Civ.C.)
Q Lander,Name
U z Lenders Address
U O 1 certify that I have mad this application W state Nat dee shave iWammon I. ._.
Ta. F cams 1 agra In comply with all city and county aei.Imd state laws relating to ,
WWilding constmcvon,and hereby aurhonce represcatatives of this city n anter upon the
m..rac auomd Properly for inspection purposes,
I%)agree m an.indemnify sad loop hamleas Ore City of Cupertino against
fn liabilities,judgments.eons and expetres which may in any way amus against said City
U 2 in conmquemm of we granting of this permit.
r
APPLICANT
UND ONS.NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date'7j�Pzh
SOURCG"� 7�t Re-roofs J
Sigmtum of ApplicamO'ContrommarHAZARDOU Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the aCupertafutao Wilding acvPact platomorand hasadoud Safety u OcOmd by tae Cupenim Municipal Cade.Chapter 9.1;and ton Health tub Safely
.Section 255324)7 All roofs shall be inspected nor to an roofing material being installed,Rrfa
' Wall the apPliant or future Wilding occupant use equipment Or devim which If a roof is installed without first obtaining an inspection,I agree to remove
coil huaNnus air contaminants u de0ncd by rte Bay Area Air Quality Management all new materials for inspection.
District? tp�.
❑Yes rl!
a
I have mad the ha»Nous materials.,lomamew under Chap c,695 of dee Ulfa-
ntsHealth hSafayCodc,Sottas,25505.25533 and 25534.1 undersand that ifdec Wilding
dm not Carmody low a tenant.Wt it Is my revomBdlity m miry the occupant of tic
require nrwhathmo,WmeIpnornes.nmaaofacaurlbefQ;Owy Signature of Applicant Date
wm�—� ��� �� All roof coverings to be Class'1?"
0 eranuthori>ndagcnt Dan" g or better