03010048 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CWT RAC TOR INFORMATION
BUILDING ADDRESS: PERMIT NO.
J! 1455 ASTER LA03010048
OW NER'S NAME: APPLICATION SUB DATE
YUNG-TE & CHARN-JANE LAI 01/08/2003
'ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oo LICENSED CONIRACOR'S DECLARATION b DCSCTIp II00 ��
V 1 herby affirm mal I am licensed under provisions of Chapter 9(commencing JOA E®
With Session 70[111)M Division 3Of the Business and Professions Code,and in,license is
1—�ur
in full fore and effect. 8 ' FENCE
0�ga
License Cl.. Lie.It
JAN .� 1 2003
ser Dar Comracror
F— ARCHITECTS DECLARATION
1 undcrsnnd my plans shall he used as public records
W G
Licensed Pnrlcssinnal
OWNER-BUILDER DECLARATION BUILDING
DHy I hereby reaso affirm on 1 am exempt(nam the cssions o Licence Law for the
i 6II O fallowing reason.(Semon 7031.5,Business and Improve,
de inns Code:Any city or County
x$ which requires a permit m rnnvrucL alcor,improve,demolish or repair any suumur,
to Prior to its issuance,also requires the applicant for such Permit to file a signed moment
mat W is licensed pumum,ro[be provisions of me Constrictor'sLicense Law(Chapter 9 Sq. Ft. Floor Area $2VQ&tion
NO (commencing wish Section 7001E of Division 3 of the Business and Professions Code)or
la that he,is exempt therefrom and the basis for the alleged exemption.Any violation of
Session 7031,5 by any applicant for a permit subjects the applicant to a civil penalty ofOccupancy Type
not mor man five hundred dollars tS5([E.
❑I.as owner of me property,or my employees with wages as their sole compensation.
will do me.,it.and me swcture is not intended or offered for ale(Sec.7W,Business
and Professions Cade:The Coronaries License Law does not apply to an owner of 102 - PIER ;quired Inspections
property who builds or improves thereon,and who does such work himselfor through his
own employees,provided malmch improvements are not intended or offered for sale.If, 103 — UFER
however,the building or improvement is mid within one year of completion,me owner. 1O4 — REBAR
builder will have dr burden of proving met M did not build or impress for purpose of
ale.). 105 - ANCHOR BOLTS
Ak I.as owner of me property,am exclusively contracting with licen.W comracrn to 106 - SEWER & WATER
consumer me project(Sec.7014,Business and Professions Code:)The Contractors Ib
cera law does not apply to an owner of property who builds,Or improves Nero.,and, 202 — UNDERFLOOR PLUMBING
who co Lnce Law.contracts for mh prolate,wimaconmclogglicensed purswntmme Contractorsacsor. 203 - UNDERFLOOR MECHANICAL
who
❑lam exempt undef gee. �B�&PC for sen re.On. 204 — UNDERFLOOR FRAME
alT to 205 - UNDERFLOOR INSULATION
ORKE scoM s N ECLA r1oN 301 — ROUGH PLUMBING
Iherchyelfimt under penalty of perjury one of me fallowing dcdaralinnc 302 — TUB & OR SHOWER
❑l have and will maintain a Certificate of Consent to.elf-insure for Worker's compsn. 3O3 — ROUGH MECHANICAL
.tion,as provided for by Section 3700 Of me labor Code.for the performance of the
wink for which this permit i.issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Workers Compensation Insurance.as nquird by Section 3 05 — FRAME
3701 of me labor Cade,for due performance of the it for which mis permit is issued.
My Workers Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS
Camim. Policy No.: 307 - INSULATION
CERTIFICATECOMPENSATION INSURANCE1ON FROM ORKERs' 308 — SHEETROCK
(Thissaairm necdnolbecompleredlOhepermil isfor-one hunmeddollars(SI1[) 309 - EXTERIOR LATH
"rlea`) 310 - INTERIOR LATH
1 eInirr sent m me Per ,rman.of the work for which flus permit is issued,I man not 311 - SCRATCH COAT
employany Pers", n m an .u�.m�comg suhjec' xWorkers'Comnumation
law.of Caliro a O [ 313 - ROOF NAIL
Appliffant LI y
ftO[gC sTOcttot A LCompen Ira eemaea of Exemption,rutsu aid 501 - FINAL ELECTRICAL ENERGY
L7 zM ithcomnotheWorhfr'simmsorthonprovitshallftheLabin nted. ked. must 502 - FINAL PLUMBING ENERGY
forthwith comply with such pmvisiom or this permit M dcemcd revnkeJ.
zO 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
t..4 1lumhyalfirmmmft.isocomwctinnlendingagenryImdoperformmosof 504 - FINAL BUILDING ENERGY
a > me work fnrWhich this permit isissued(Sec.3M7.Civ.C.) 505 - FINAL ELECTRICAL
W 0 Lender's N.
Lmde,f Address 506 - GAS TEST
UO 1 certify mat I have read this mplicninn cad mile that in,above information is 507 - FINAL PLUMBING
{✓ti erred.1 agree to comply with all city and county ordinances and star laws relating In
building construction.and herby amhnrias represemetivcs of this city to trete upon the 5 FINAL MECHANICAL
Wah.ve-menrnned property for inspection purposes. O 9 F I N
Ity^ (We)egret to ave,indemnify and keep hermlca me City of Cupertino against T
ti � liabilitiesjudnsi,case,indemnify
es andwhich keep hayinany Way accrueupertiagainst oagCity rj FNW
U Z ren consequence of me granting of this permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by51RKS Date
SOURCE RECULATIO �a( O -(.':�;7 A/
f Re-roofs
Si modest, pphcm� nuacmr
an,
MATERIALS DISCLOSURE Type of Roof r
Will dr appliYYan,or future(wilding occupant store or handle haeandous material
.defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Seelig.2553](.)�ja
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will IM applicaI Ica building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvaNnm air Co., ane,.asflefrned by the Bay Arca Air Quality Management all new materials for inspection.
Disvicf7 �/�l"_\
❑Yes ❑
1 have mail the haarmw.s materials rcyuirements under Chapter6.95 of meCalifor-
ro.Himldt A Safety Code,Scomps 0%5.25533 aid 2534.I understand dot if me building
does net currently have a rnmt,mat is is my responsibility to notify the occupant of me
ryuir nts nim mu mel pd miaam car. 'neararga o Signature of Applicant Date
ere a,amnariase agent All roof coverings to be Class"B" or better
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family(parent,spouse or child) will perform:
A. �x All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 o;-3 be
2. A state licensed contractor will be hired to do: +17 2003
A. _ All of the work B Y
B. _ A portion of the work(complete sectio elow)
Contractor Address/City Phone# State License# Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office..
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side). p ` i7
Property Owner's Signature? C ` 44e:
Job Addregq:i /! S 5 ltd . PeF�it# �3 `
• Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
CITY OF City of Cupertino Building DepartmCO
10300 Torre Avon
CUPS DT Phone: (408)777-32212
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. if your work is being performed by someone other than yourself,you
may protect yoiirself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
if you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
if you are an employer,you must register with the state and federal goverment as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensa do
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the hiternal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of htdustrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a Bcensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours, •
Building Department,
City of Cupertino
Printed on Recycled Paper