06100208 CITY OF CUPERTINO - ` - ..x
BUILDING DIVISION PERMIT CO TRAGTOR INFORiVIATIOIV
BUILDING ADDRESS: PERMIT NO.0 610 0 2 0 8
10491 WUNDEIRT-TCH DR
EWS NAME: PERMIT ISSUE DATE
CHING HUI KAO
PHONE: SANITARY NO. CONTROL NO,
ARCHITECLFENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB
LICENSED
MECH
0 E 0
�Op LICENSED CONTRACTORS DECLARATION Ib Description
i U I xmby affirm Jut 1 un lkxacd under pmva Ions of Chapter 9(commenO05COP
cing
with Scnimn]qsU)of Division torr Usc Husincssnd Im a mmo Cade,and my liccnu is
in full fame andeffca ADD 3921 -NEW KITCHEN/DINING RM-RELOCATE KITCHEN
s z Lieensc Class Lie.as
ro Dam Convaetor REMODEL, BATHRMS/CLOSETS-SANITARY SUNNYVALES SUR
ARCHITECTS DECLARATION
w U 1 understand my plans shall x used u ds
public records, -
GIn Licensed Pmfcasmnal
OWNER-BUILDER DECLARATION
E 1 hereby affirm than I am exempt from Ne Contractors License law for the
a O following mason.(Section 11D 1.5,Business and Professions Cole:Any city Or County
m which requims a pemtit w emonmei.abed, demolish, a
harrow. or acpir any stmm
etu _
.ai prior m its issuance,also mgdims the applicant for such permit in file a signed aocmcm-� ®fQ 033 o that he is licensed pursuant m the pronsiomof the Common's Licerue Law(Capital 9 Sq. Ft. Floor Area Valua$
(commencing wit Section 7000).(Division Sof the Business and Prefuusions Coal
Q
at he is eaemrt thucfrom and the baso for Ne alleged eaempdom.Any violation of
Section 7031.5 by any applicant for a perea t subjects the appTxnua a civil penalty of APN Number Occupancy Type
act mom don fsw handled dollars(S-'Wk 37516051 . 00
dI,as owner of the property.or my employes with wages as their sole compensation,
will do the work and the aammum is Out intended oraRered(oracle(Sec.70",Buama<.
ald Refesrlmu Code:The Contsnots License Law dos rot apply m an MOO,of Required Inspections
property who builds or improv theme,and who deessuch work hiroWforduough his
own employee,provided thatsvch implawmats sum not tolerated aroQered forsale B,
however,the building or imptenment is sold within one year of completion.the owner-
builder will haw du burden of playing that M did Out build or improve for puryae of
sale.).
(a 1.to awrcr of the property,am eselaiwly contracting with liansed contractors to
cnnstmct the project(See.7064.Business ass Profastloa Cade:)The Contsacmr's Li-
tonse Law does nos apply to an..of property who Wild..,implawa thereon.and,
who commea far such projects with a conlacmKs)licensed pursuant in the Contractor's -
L' o law.
lam aempt under See ,B&PC for this won
r/ 4a Dam /2—/—D6
WORKERrs COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury 9rc of the following declandnns: _
❑Ihaw and will mainuina Ccrtifism ofConsenue self-insula fa Wmrtrrs Campcn-
sedan,as provided for by Scminn 3]00 of the Labor Code,far the pevtorrama of the,
work for which this permit is issued.
Q 1 ban ars will maintain Wortrrs Compensation Insurance,as acquired by Section
3700 of the Ichor Code,for Ne performance of the work for which this permit is Lssad.
My Workers Compensation Insuni cx carols es Policy number are:
Carrier. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(rhusectiun s sd rot be completed if Ih permit is fortune hundred doll.($100)
or las.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an as in become subject in the Worker'Compensation
Laws of California.Dam
Applicant IU
` i
NOTICE TO APPLICANT:If,after making Nis Certificate of Eremp ion,you should
become subject as the Workers Compensation previsions of the Labor Castle,you mat
0z forthwith comply with such provisions or this permit shall W dcemcd rewired.
z O CONSTRUCTION LENDING AGENCY
(--� I hereby affirm that there is a construction lending Agemy,for the performance of
C
We work for which this permit is issued(Sec.3097,Civ.C.)
W� A Lender's Name s
D z Landers Albanese
U O I eerufy that 1 haw mud this application no sate that the above infom,auun is
f"' cortem.I agree to comply with all city and county on invvs and aux laws mlaung to
0 building construction.and hereby authorkm mprescnatiwe of this city to enter uponf
W ahovc-mcmdgracrmed s.c u for inspcNon purposes.
F gy (We).9.0 to save,indcmniry and keep bumless the City of Cupertino against
fq incansopmeceofthecannaor this uwhich May in My way attne against said City
U z in UNDERSTANDS
Sthis permit XON /' G
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. �" ��
.7 fyti(!d. "'�+� f1-I- o� Re-roofs
Signature p(ApplicandContractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or fumes building occupantsmre in handle hvardoa material
as defined by thc Cogitation Municipal Cade.Chapter 9.12.and the Hnith and Side,,
c.Section 25532(il] � All roofs shall be inspected prior to an roofing material beim
[D Y. 06.
P P Y g g installed.
Will the applicant or future building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emit haaardna air contaminants as defircd by the Bay Area Air Quality Managcmem all new materials for inspection.
Disvict]
❑Ys No
1 haw road the harasoamawHals mWimmena under Chapter 6.95 ofthe Califor-
nia HcalN&Sarcty Code.Sauna 25505,25533 ars 25534.1 undcmmd Wtif thc building
does not currently ham a tenni.that it is my rupanaibility to unary tle necuprot of do
mgaimmana which mat x met Our in i.e.ora Cmdreate or aapaney. Signature of Applicant Date
H LlA L' i2- ate All roof coverings to be Class "B"or,better
Owner or mthorisd agcm Date" -