06070183 CITY OF CUPERTINO .x
BUILDING DIVISION PERMIT nTCONTRACTOR INFORMATION
BUILDING ADDRESS: v CHRIS LEE PERMIT No.06070183
OWNER'S NAME: PERM1717 MUEDATE
CHRIS LEE
E:
SANITARY NO, CONTROLNO.
ARCHI TECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iOp LICENSED CONTRACTOR'S DECLARATION
Job Description
w 1 thereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
�Z� wiNSccdon7")af DiAsion3afthe Bu4w WdWofcWomCode,andmylic is
!�„ infallfwaandeffee REVISING ADJUSTMENT. TO PROPERTY LINES
'23 F; License Class Lt.A
F p Dam C.mactOs
CH I'll DECLARATI
�rc tun rndmyplashallbcuscdupublicrccords
wmORIGINAL PERMIT 406020019
ryU
G
LiccmeJ PmfeSsional
3 OWNER-BUILDER DECLARATION
1 hcrehy.11B.Not I am egempi from Ne c(mumctors License law for the
:o O following mason.(Section11031.5,Business and Profeuiom Core:Any city or county
i m which requires a Permit to construct,slur.impose,demolish,or repair any structure
,mss p6aroi6Lssuance.aL uimstheapplicantforsuch permit m file a signed sulcmenl
.x
Nat W is licensed pursuant o the povifions of the Contractors Liecnse Law(Chapter 9 Sq.Ft. Floor Area Valuation
,F C (commencingeaexempt Section]00 d of basis f r the
the Busalleged
anW on.Any
Core)w
$ Nat he is exempt Nertlmm end the Esso for the alleged eumption.Any violation of $458702
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nut more Nan five hundred dollars(SSW).
1,m owner of the property,or my employees with wager as their sole compensation,
will do the work and the vo cmm is at intended or aQeasi for sale(Sec.]Oso,Business
and Prefessions Cada:The Context License Law does not apply to an Owner of Required Inspections
property who Wilds or improves therrnn,and who does such work himself err through his
awn employers,provided than such improvements arc not intended oroRere l for We If.
WwOver,Ne building or improvement is mid within am year of completion,the Owner.
builder will bars the burden of proving Nat ha did Inst build or improve fa pu pme of
sale.).
(D 1,as most of the prepeny,am exclusively contracting with licensed anuanors to
omounct Nei dices(Sec.7054,Business and Pofmsfom Cade:)The Conmacter's U. _
come Law does not apply to an owner of property who Wilds or improves dureon,and
who contracts for such projects with a adtractor(s)licensed pursuant to the Cnnuaomrs
L
[Ilandxen pt uneSee
.B&PC fw Nu mason l�`•1's!`�l_l�
Owner Dau
WORKER'S COMPENSATION DECLARATION r\
1 hereby aim under penalty of perjury one of the following reclacations:
I haw and will maintain a Certificate of Consent m rel6insum for Waracer C.,.- v/"1
ration,as provided for by Section 3700 of the labor Code,for dm perfo man of ft
work
(`-•t/C�J—
work for which this permit is issued.
❑I have and will maintain Workers Compensation Imuran,as mquimd by Section
3700 of the Labor Cede,fordo performance of the west for which this permit is issued
My Workers Compensation Insuran artier and Policy number are:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu mesio^need not W completed Aft permit is We.hundred dollars(5100)
tar less.)
1 certify,Nat in the performance of the,work for which this permit is issued.1 shall not
employ any person in my man.; t a c bje m keri Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICAy L ;id a crop anyouadmid
become mbjeer m Ne ore ' ompcnsation provisions of the Labor Code,you must
.J ,Z forthwith comply with povisiam w this permit Shall be domed revoked.
zO CONSTRUCTION LENDING AGENCY
(•+4 1 hereby aRrrn that there is a construction lending agency for the Performance of
a the work far which of.permit Is issued(Sec.3(197,Civ.C.)
d0 Lenders Name
7 z Lender's Adds
V 0 1 certify that I haw read this application and suis Naz the above imarma0un u
I, E-^ correct.l agree m comply with all city and county oNinencesand state laws relating to
.JU Wilding construction.and hereby SuNorim represenutiws ofthis city to enter upon the
r 0. abovemajudncd popc st far inspection purpuwhich e:
(We)agme to saw,indemnif d keep harm) c City of Cupcaino against
wry N in
and which may wayattnu agafm,said City Ir
V z In comequnuc of the grumi this permit.
^ APPLICANT ER S AND WI COM L WITH ALL NON-POINT Issued by: Date
SOUR GUL
Re-roofs
Sib ApplicmUCon or te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
will the applied,w future Wilding weupan,s,One a handle hazardous material
az refined by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
Cak,Section 25532(0)?
❑Yes ❑Na All roofs shall be inspected prior to any roofing material being installed.
Will the applicant w future building occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazard—air com mimnu as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yesu
T
ante Ne m ubrequlreme oder 0hapterb.95afthe Califor.
not".
l"
uHol" Safc)y Cadc 505.25533 534.IunMrsundthnifNc Wilding
dcesnatcu nlyh situ ponsihilitymdodlydeac actor Ne
require tsw et pri r Ccrufma f u
Signature of Applicant Dale
o O,m(Imnedagcm, D,te All roof coverings to be Class "B"or better