07020110 -7777
CITY OF CUPERTINO
BINE
BUILDING DIVISION PERMIT C� � CIIiMiTI�N
BUILDING ADDRESS: PERMIT NO.
10491 WUNDERLICH DR TBD - TO BE DETERMINED 07020110
OWNER'S NAME: PERMIT ISSUE DATE
CHING HUI KAO 03/02/2007
ONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0
o p LICENSED CONTRACTOR'S DECLARATION Job Description
,V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REVISION: TRUSS C ALC S
m in full force and effect.
License Class Lic.N ORIGINAL PERMIT: 06100208
E Date Contractor
ARCHITECTS DECLARATION
7 C< 1 understand my plans shall be used as public records
)aU
mI- Licensed Professional
y< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
< which requires a permit to construct,alter,improve,demolish,or repair any structure
o Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;iq.Ft.Floor Area
4 tz (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $84033
W that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
not more than five hundred dollars(5500). 3751605-- .q61-
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
1,as owner of the property,am exclusively contracting with licensed conuactors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sea B&P C for this reason
Owner { r Dazs f?_/_-
WORKER'S S COMPENS TION DECLARAI`IOt3—
_
I hereby affirm under penalty of perjury one of the following declarations:
L]1 have and will maintain a certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for anc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant ✓
NOTICE TO APPLICANT:If,after making this C&tifilatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Cade,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z"'" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Set:.3097,Civ.C.)
W A Lender's Name
0 Lender's Address
U 0 1 certify that I have read this application and state that the above information is
VT 0- correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize rcpresentatives of this city to enter upon the
W above-mentiuncd property for inspecuon purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
►•t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE REGULATIOVSS.
//JJ &2-16 7 Re-roofs
Signature of lcant/Contractor I f Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs Shall be inspected prior to any roofing material being installed.
❑Yes 4 No
Will the applicant or future building occupant use equipment or devices which
If a roof i;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for Inspection.
District?
❑Yes ITNo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which must be et ' r to is5 sate of Occupancy. Signature of Applicant Date
!2�
O All roof coverings to be Class"B"or better
Owner or authorized agent Date