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CITY OF CUPERTINO
DIVISION PERMIT
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M�CONTRACTORINFORMATION '
BUILDING
BUIL DING ADDRESS:
PERFECT TOUCH CONSTRUCTION
PERMITND04030211
1083
OWNER'S NAME:
PERMIT ISSUE DATE
TENNYSON HEN CHERYL CHING
E:
SANITARY NO. CONTROL NO.
(408)258-4928
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(�
LICENSED CONTRACTOR'S DECLARATION
Jo
Nil I am under provisions of Chapter 9 (commencing
I Wmby affirm m lice
with Soman ]000) of Division 3 of Nc Business and Pmfesslnns Code, end my license is
imfull fo=and effect.
DEMO (E) HOUSE
License Class Loc.9
Dam Contractor
NOV 09 2004
ARCHITECT'S DECLARATION
1 understand my plans shall M used m public records
01" ///.
U I
Licensed mid
OWNER -BUILDER DECLARATION
L ®� G
herebPnoficy
I Mmhy a(nrm that 11. exempt from the Contras License Law for IM
affirm
tl
G V
Coo
followingrtseon. IDnextr Business and Pc fide oli Code:Any city or county
permit re eminmeL alma, Improve, demolish. or repair any suuctum
which requires seroma
i,
s its n
to the rMapions; or forsuch Contommit micensle ae ned Law (charier
thiarmiu iepead pursuant Nc Co
porstion7
Sq. Ft. Floor Area
Valuation
) or Diviomaf
usines'and Professions Code) or
morrim noing it Business Cnda)of
(w encixemit Section]BBB)th
basisofrofrbe
Any
Nat he b therefrom and the bas. far the alleged exemption. Any violation of
32A�@,➢JsDIItI(�be100
Occupancy Type
Section ]thend by my fonprmiuubjecu the applinntmacivil penalty of
31.5 b
replan
not mart Nan five hundred dollars (SSW).
❑ I,us neroftheprdpenyormyemployccswiNwagesu Neirsdlccompnmtion,
Required Inspections
will do the work. and Neswaure is automated ororfxed forsal= (See 7044, Business
e t apply to ner an ow. of
and Promommts Code: The Committees License law dosno
property who Wild, or ire paves tMrton. and who does such it himself or through his
ownemployees,pmvidedthatsuchimpmvemenuartnotinundMoroffr fma cTf.
however, Ne building or improvement is sold within one year of completion. the owner -
builder will has IM burden of proving Nn M did not Mild or improve for puryote of
sale.).
t1. as owner or the property. am exclusively contracting with licensed contractors to
C Imcr NC project (Sec. 7p4:. Business Bad Professions Code:) The, Cimomuor'x Li-
cense Law doer not apply to an owner of property who Wilds or improves; NCRAn, and,
who concis for such projects with ieomranor(s) licensed Farman w the CW=toh
License law.
❑ 1 ora� a%%.'Srapt under Sec. B h C for this moon
/PP
OwneF/ LL� �f
TION
W KER'S OMP SATIONDECLARATION
1 Mmby affirm under penalty of perjury one of the followigrjeclnatimvc
have and will maintain a Certificat, of Consent in self-insum for Workeh Compen.
on, as provided for by Section 37W of the Labor Code, for the prfonnertce of the
work for which Nis permit is issued.
0 1 have and will maintain Workef s Compensation Insurance, ax required by Section
37W of Ne Labor Code. for Oc performance of the work for which this permit is issued
My Worker's Compensation Insurance canner and Policy, number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M cam pined i f tM permit is for oro hundred dollars ($10(l)
in Was.)
1 unify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner an a In become subject o lM Workers Compcmadon
laws of California. Data
Applicant
NOTICE TO APPLICANT: IL after making Nis C=nifcam of Exemption, you should
become suhjacr to the Worker's Compensation provisions of We Labor Code, you most
Forthwith comply with such provisions or this permit shall W council revoked.
CONSm ON LENDING AGENCY
I hereby is a construction
Nat Nen is agency for the Performance of
!
whaffirm
sed(Selending
theLe work fur which Nis permit is issued (Sm. J09y. Civ. CJ
Nam=
Lender's
� Icnderi Address
I unify that I have mad this application and stem Nat the above information is
correct.) agtce to comply with all city and county doubleness and sure laws misting to
auNonu mprtsenuti rs of Nis city m enter upon Nc
building construction. and for
abevetmenudne4 property for i purposes.
(We) igme to uve, indemnify and keep harmless the City of Cupertino agamsr
/
expenses may in any way seems against City
34ta�
of thepanting
incoises,judgmen¢coatsandofpesPermit.
permit.
A
/
Sthis
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON -POINT
I REGULATIONS. �/a
Issued by: Date
Re -roofs
(SO�RCE
ry� ,
0 L/1,
en�vcJd
sem"
yp�a tet ' v Dat/
I HNARDOUS MATERIALS DISCLOSURE
Type of Roof
tha applicant or forum building occupantstom or handle hazardous ram=rial
defined by the CupninoMunicipal Code. Chapter 9.12, and dm Health and Safety
e, Section 25532(¢)9 .1
❑Ye, lSINa
inictWill
All roofs shall be ins ected nor to an roofin material bein Installed.
P P� Y g gWill
the applicant or'(umm building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
haaris air contaminants u defined by the Bay Arta Air Quality Maag=mem
all new materials for inspection.
?
❑Yes (tNu
1 haveread dmhaaardsmsmal=dalsrequirementsander Chatand
Cod e, Seismts thn
thrif cWilding
Milting
does.na11hd:amlyy
dps nor cun=ndy have a unana Net it is my responsibility b nouly the mcupant of the
n,itismyrsnd25534.1 in .p
m immen tswhlahmuube21 mmprimwaanmofaceNfcamd(Gccuplacy,
Signature of Applicant Date
��
All roof coverings to be Class "B" or better
owner dr auth .<d agent pare