06020019 F//POWNER'SNAME:
F CUPERTINO ��• `��
DING DIVISION PERMIT = CC51�1,T'.Rr�C:T�12•�Tl ��'qq(}�R1�'1.r' (;) ' '
Y • ixz.;` + wif4a• swV§' "��y t t$ .Cx-l..
DDRESS: CHRIS LEI.', PERMIT NO.06020019
5 WUNDERLICH D
PERMIT ISSUE DATE
HRIS LEE
Ee SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3o j LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 70M)ol'Divldon 3 of the Business and Professions Code,and my lcem is
+� in full fame andoffOcL ADDITION-1252 ' /GARAGE-4001 -REMODEL 814 '
(qz Datc Ceausescu
REMOVE EXISTING GARAGE
Dam ComDECL
ARCHTfELT3 DECLARATION
1 I uMeaund my pow shall M used u public scorn
>yu
s n
Licensed Professional
bD5 OWNER-BUILDER DECLARATION
N
1 hereby alarm Net 1 1. exempt from Nc Cssions o s:My c Law for dm
coo following moon. awl,i 7031.5.Business and sae.dw ons Code:My oily m canny
$tbi
which aequims• .a]mcnnmdow almsntPmsudeermiti me asiranysuuaum
-Zoe
prior miuissuence.alwmquimatheaPPliemtfmsuchpertnitmfileasignedaWemml Val 158702
m N
E C Nat he k licensed pumas e pmrisions of theU �
Connector's ceLaw(Chapter 9 Sq.Ft. Floor Area
a�g (commemmngwim Secdon700o)of Divisien3af Ne Buin Md Profotl..Code)or
e .. Nu he is exempt themfrem and Ne basis for the alluged caempdms.My violation of ppN N robe
Section 7031.3 by bury applicant for a permit subjets m cthe applicant a civil penally Of 3 7 57 6(�10 T 0 0 Occupancy T lrpe
not mare mafive n hundred dallus(1700).
❑11 u owner of die Pope".or my CmPloyeca with Wages u then mm eompmaum,
will do the west and the suuerure is not intended es ofread for saw(SOC.7044,B"= Required Inspections
and Professions;code:The Contractors Liana m rom m Ieaw door apply owner of q P
property who builds aim pores Neeson,and who does such west h'voeelf m through he
awn employes,provided dot such impuowmcets am tot intended wallowed for sale.B.
haweva,the building or improvement is Mld within arc you of eemsktim.tlm owmr'
modes WE haw dm a ndrn of proving that be did not build Or bnprvw for purpose of
.is J.
u awes of out propcn,am u4udwly cmuamfng win ResosW contractors to
Com us Ne pmjea(Sec.7044.Bum=mod professiam Code)The Coemaors Lt.
emu lea.4.sot appy an as owns of Property who build or improves Neeson,and.
who Coeouu for such Projects NN a contrawas(U demand Possum,in me Cmtrumh
Lice.low.
I was uempt under
Se. � �.q ,B d P C fm Nu mssan
Owner
�[ K ( /L.G Date •/ O
WORKBRT COMPENSATON DECLAat ON
1 hcmby aWm under penally o(paimy arc of tie,following dee moc
ba re and for
by aCe 3100 of ComermCode.forefm Wmam Co Of ft
udm,u providedthi(Pe mi Satin 3700 a(Um labor Cada for Ne peoformmce of dm
wart for which this permit is issuer
❑1 have and will msinuk Work es Compensation Issuance.u mquired by Section
3700 of the Mbar Cade,for the performance of the wank for which lois permit is blued.
My Workers Compensation ire.camicr and Policy number tie:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
r
TlhisscNess need mrbecompteted one permit Is forme,hundmddauan(11001
or less)
I certify,mat in the perfmmanee of the work for which this permll Is issued,I Ndl not
employ any person in any manner We�S m�lecfame suGiutm de Workers'Co.pcdw
LA.of California.Dam p
Applicard �r/A -f
NOTICE TO APPLICANt;IL after making this CediBcate of Exemption,you Mould
become"hies an tom Workers Compensation provisions of the Mbar Codc.you most
rJ O forthwith Comply with such provisions or this permit Nall he domed revoked.
z CONSTRUCTION LENDING AGENCY
EI amomyaDbm mu Nem u a mauucdnn lending agency for the perfurmanm of
> the work for which this permit is issued(Sm.3097,Civ.C.)
CQ lenders Name
0 z Landers Address
U CD I certify this 1 have mead this applicWM and sum that de,above Information is
IL F coratt 1 agree to comply with all city and county Ordinances and sum laws relating to
O[) building eonswction,and hereby allthCom repmsmutivCS Of this city to enter upon me
r~0. oborcmendonad property for inspection purposes.
F (We)agree to caw,indemnify and kap Morrow the City of Cupertino against
rp laabilidic judgments.caw and expenses which may In my way game against asid City
U z in consequence of the griming of this permit
'•" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J J
SOURCE EGULATIONS. � D/
L� JJ I/ V Re-roofs
Sigmmm of ApplicandCoOmhor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIB the applicant or forum building Oceupmtstoro or handle bMeartlou material
u defined by tie Cupertino Municipal Code.Chapter 9,11.and the Health and Safety
Cade,Section 2533z(e)7 , All roofs shall be inspected prior to any roofing material being installed.
Oyu blNa
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
huurdnu air contaminants as defined by the Bay Area Air Quality MMagcmcm all new materials for inspection.
Imict7 {��—
❑Yes CrNu
Ihawmadthehaurdrws mdalsmpylwmantsunder Chapmr6.95ofdmcabfao-
ma Hcol"Safmy Codo:See m25505.73pSmd23534.lundenundthmlfmc building
dao not currently _ nL nn vSAy mapomm Occupant lbility noddy the cut of the
.
ropA On m'pe 1/6at p Ian aaf.c.nifCm p a/ Signature of Applicant Date
°k�
nE ant ar'vm est Dam All roof coverings to be Class"B"or better,