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CITY OF CUPERTINO_577—==779'<?:.�a.I'M
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BUILDING DIVISION PERMIT
CUNTR4C2'QRIMPtOR�M�ATION
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BUILDING ADDRESS:
CHEN LIN
PEaMITNo.06070069
'60380 STERN AVE
R'S NAME:
Fail L%UE DATE
CHEN LIN
PHONE:
SANITARY NO, CONTROL N0.
A0.CHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUM
O
LICENSED CONTRACTORS DECLARATION
Job Description
1 barely M. that 1 w IkemW under pmvisiam of Chapter 9 (cemmencly
nu�utvimanlotthoBuainmandPafcsdonsCodc.aMmyllecnuu
ifall
ADDITION 9201, REMODEL 1030', ADD GARAGE 432'
License Clans Lk. N
Dau Conuanar
ARCHITECTS DECLARATION
REMODEL 1030' X 100.75 = $103, 772.50
1 understand my plans shall W used u public accords
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm, that I am comps from the Contranafs License Law for the
fallowing mason, (Section 703 1,5, Business and Professions Cade: Any city of county
which uquirca a permit a construct, almr. Improve. demolish, or mpmr soy structure
prior m its issuance, aisle mquhm Me.ppllam far such permit to file. signed wlemcntValuation
Uceme, law
Sq. Ft. Floor Area
Nat he a licensed pummund W Me provisions of tomConvector's (Gapur9
Section 7000) of Division 3 of ate Buaineuad Profruifw Cade) of
"ry
$325349
(commencing wish
Nat he ts eaemPl IbCmfrom and ths basis for Ne allugcd eaemptiom Walation of
Section 70313 by any applicant far a Permit subjects the applicant m a civil penalty of
APN Number
Occupancy Type
.at mart that five humdmd dollars ($5007.
0 1, u .war nide psopctty, ar mY employes wIN vngn u Neo vele eompewtin,P
7c;1 IlA9F, AM
Required Inspections
q P
will Me Ne work, and the sanctum ts not marveled oranered farade(Sec. 7044, Bninrss
an .r of
and Profession Cade: The ContaCtO s Liven Law dors not apply a wa
property who builds or improves Mercer, and whodoeaauchwmkhhotelfor Waugh his
awn employes, provided that such impmvemeran am not Intended aroacted for ads R.
however, Ne building or Improvement is old within an year dcompletiun. she owner.
builder will have that burden of proving that W did at Will or Improve for purpam of
eau.).
0 1, an awar of Ne property .m eulatively canuacting with licensed ceaut. to
construct the project (Sec 7044. Baines and Profo admin Cade:) TW Cmera mr's U.
-
cane Law does ant apply As an owner or pmprny who Wilds or improves Ncman, and,
who contracts for such projects with a mmacto (s) licensed parnunt to the Contractor's
License Law.
am As� p))�un.¢der{vr�$$,ap1 B&.PCF Wes mason
r (1�((,GIVI.f Dam=
WORD ER'S COMPENSATION DECLARATION
1 hereby afNm under penalty of perjury bac of the following declmntio us,
71 Iheve rad wlllmainuinaCestiOcau of Conumeulf-InumforWarketaCompen-
sation, an provided for by Section 3700 of the labor Cade, for the performance of Ne
work for which this perm, is issued.
0 1 lava and will maintain Worker's Compensation Insurance, As equlmd by Section
3700 of the Labor Code. far the performance of the work for which this permit is Issued.
My Wadu es Compensation Wurancc artier ad Policy numWr ae:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Clhh section need not W completed ifft permit Is farone Woman doBats (SIM)
at less)
1 cattily that in the performance of Ne work for which Nls permit is issued. I shall nut
employ any person in my m res mbttome subje whow rope u0 n
Laws of California.Dau
Applicant
NOTICE TO APPLICANT: If. after king this Certificate of Eumption. you should
become subject to the Worker's Compensation previsions of Ne labor Code, you mat
v forthwith comply with each previsions or this permit hall In, dammed revoked.
CONSTRUCTION LENDING AGENCY
1 Washy drum that them is a convention lending agency far the performatee of
Ne work for which this permit is issued (Sec. 3097, Civ. C.7
`
Lendees Name
Lender's Addles
P
D I certify that 1 haus read this application and sou Nat Ne above idommlun is
toren. l agree u comply with all city and county odlnaaes and sum laws relating to
building convection. and hereby authar m epresenutives of Nis city to enter upon Me
.hove-mcmiuned properly for inspection pu,pases.
y� (We) agree to urs. indemnify And keep harmless Ne City of Cupertino against
q liabilities,judgments, costs and expenses which amay in any way me= against aid City
e of this ph.
in consequee of Nerm
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APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date /y z
/
SOURCERRGA,
7-�fi
w P^ J�" %/Q
Re -roofs -
Type Of Roof
Sigmeof Applian mDate
mnter
HA2ARDOUS MATERIALS DISCLOSURE
Will the applicant of future Wilding occupantsum m handle harafdaus mamrid
egad by tW Cupenia Municipal Code. Chapter 9.13, ad the HeaIN and Safety
.Sedton21533(a)?
All roofs shall be inspected prior to any roofing material being installed.
Dues AZN.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future Wilding occupant tau equipment or d:vica which
emit handlous air conu,ninants u dermad by Na Bay AMA Air Quality Management
all new materials for inspection.
Distdct7
Dyes �No
1 he. mad the hanadas materials requirements under Chaper6.95 orMc Califor.
nia Hcal"SdctyCoM, Section 35505, 35533 and 21534, 1 undctsund MatifW Wilding
does not currently have a unanL that it is my responsibility a natiry tlm occupant of Me
myui mcnuwhihmulthemmpnarjgasnuma. f.ecrifeme foc�yap�`''
Signature of Applicant Date
"�� —
All roof coverings to be Class "B" or better
Ov0peref authododepotalta