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07040236 CITY OF CUPERTINO BUILDING DIVISION PERMITQ BUILD N�� ESS: PERMIT NO. M1 WUNDERLICH DR TBD TO BE DETERMINED 07040236 PERMIT ISSUE DATE OWNER'S NAME: CHING HUI KAO 05/31/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB METH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description v !hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 70(X0)of Division 3 of the Business and Profe 'a91 Code,and my-cense isREV I S I OI1—TRU S S CALC S D H in full force and effect (iC1, r Z License Class_ Lic.# :y w Date _7i ti Contractor l�✓ ARCHITECTS DECLA ATION i a a I understand my plans shall be used as public records )yU W y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the .00 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 z prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation c= that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q• O t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ARb1 Number Occupancy Type not more than five hundred dollars($500). 3 7 5 1 6 0 5 L v ❑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.7041,Business Required Inspections and Professions Code:The Conuactor'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 contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors 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 Sec. B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑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 Worker's Compensation insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Phis section need not be completed if the permit is foranc 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 Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY E-+CA I hereby affirm that there is a construction lending agency for the performance of Q!> the work for which this permit is issued(Sec.3097,Civ.C.) Ifa Q Lender's Name az Lender's Address U 0 1 certify that I have read this application and state that the above information is IL t-" correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned properly for inspection purposes. (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. APPLICANT UNDERSTA S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �- SOURCE REGULATION Re-roofs Signature of Applicant/Contractor DareT of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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 .._ If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mi Lterials for inspection. District? ❑Yes BNu___ 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which mu be met can c of a Certificate of Occupancy Signature�)f Applicant Date Alk, � �`��I 7C 7 All roof coverings to be Class"B"or better Owner or authorized agent Date