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05110051 CITY OF CUPERTINO /v ra �' t "y�a{+� '`'' . r:, BUILDING DIVISION P�Iv R(�T wV©4\`J„ Q .L11R�, AT1\ "• BUILDING ADDRESS: - 111,1110S110051 10540 CUL5RRTqQN DR S NAME: PERMITISSUE DATE NER' DONG NGUYEN E SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INTO Ill . /r BLDGO ELECT O PLUMB MFCH O O 1op LICENSEDC ACTOR' DECLARATION lob Description 1 hereby ar om Net 1 am licensed under provialons of Chapter 9(Commencing fwith Semon 70)0)of Division 3 of Me Business and Profcarum Code,and my Heaven u ±; inrullfaee"a Oct. ADD 2322 ' (1287 t LIVING/1035 ' BASEMENT). ;tpDa¢ Les Can ' � GARAGE-418 ' /REMODEL-1035 ' -SANITARY BY SUNNYVALE 7W ARCHITECTS DECLARATION U I understand my plans shall he used as public record+ tO r^ Licensed Prommional g 3 OWNER-BUILDER DECLARATION 2I hemhy aRrm that I am exempt from the Contractors Uccnw Law for the Doing moan.(Sago.7031.5,Business and Prefrsdam Code:Any city or County 5$ff which squirm a Permit to comtruct.alar,boom",demolish.or repair MY atmctute -il�m prior in its Interco.also mquirm the applicant lersuch permit to Sld a signed smtemat E neat he is licensed puraant to the pmvisiotu of the Canvecwei Lomas Lou(Chapter 9 Sq.Ft.Floor Area Val✓ 4i6(L 8 0 0 s� (commencing with Section 7000)afDivlsian 3afnec Business and Profeaiom Code)Or y $ neat he is exempt Lh=fmm and the basis for the alleged a.rrefolon.Any viohgon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type oat mom than live hundred d.Ib m(M). 37533039 . 00 O 1.an owner of Ne property ar my employees wine wages an them note compewdon, will the the work,and Mesuraum Is Feat inandad or offered for sale(Sm.7044,Besimaa Required Inspections and professions Cade:The Conu ares License Law doer not apply w an owner of q P papery who buildsorimprov thereon,and who doessuch work himself or through his ..employ=.provided that Inch improvements are notlnanded oroQemd fmula.IL however,the building or Improvement is sold within one year of cmopledon.the owner- builder will haw tie burden of proving that M did net build or Impm"for purpose of ' sale.). O 1,as owner or the properly am caelusively convecting with licensed Conveetoa le Construct the project(Sec.7044.Businev and Prighadam Code:)The Conoa7ars U. came Law does not apply to an owner of property who builds or improv t emon.ad. w m enn.cts for such projeela with a.nusior(s)licensed pursuant w the Convenor. Lleense Law. ❑I am exempt under See .B&PC for this muon nee Date WORKER'S COMPENSATION DECLARATION 1 bemby arf-m under MWty of perjuryore of the fallowing declamdom: 0. I haw and will mainuin a CerGw Ocaof Conant"self-lnsum fm Wark resCompce- sad.,u provided for by Section 3700 of the Labor Code,for the peremance of Me work for which gds permit u issued. ❑1 ha"and will maintain Workers Compe union Insurance,u natural by Section 3700 of dm Labor Code,for the performance of the wart fm which this permit IS Issued. My Waiters CompenwimCChwranca"rim and Polity nuae� Gorier.CCG CAITs FlCvr[ti i/ TkNyFA WORK6ER S COMPENSATIONINSURANCE ' I (Ihls ani.had.thecompldted Inge permit Is imam hundcd dollen({1001 or less.) I certify that in the prformence of the wad for which this pewit is Wood.I.hail not employ anyperson In any mamtera as a became subject to Me Waders'Cmnpemetion Laws of Califamia.Date Applicant NOTICE TO APPLICANT:If.aper making this Ccnincaw of Exemption,you should became subject in the Worker's Compensation previsions of the labor Coda you most vJ O forthwith comply with such pmvialam or this pewit shall W dcemed revoked. z CONSTRUCTION LENDING AGENCY (r 1 hereby anlrm that neem is a constroemnn lending agency for nee performance of the work for which this Permit Is waned(Sec.3097,0%C.) W Q Lenders Name Z LeMers Addma U Q 1 certify that I ha"mad this applleatian and mw that nee above information Is W F correct.I agree ro comply with all city and County ordinuem and saw laws telling 10 pU building connotation,and hereby authorize mpmsenwrime of thiscitytoenteruponthe W above-mentioned Property for Inspection purpose. (We)agree to on.indemnify and keep hmmlea the City of Cupertino against „y rrAA liabilities.judgments.costs and expenses which may in any my accrue lgalml said City U,^Z in consequence of the granting of thin permlt. S� ', Q a. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 60 Date 61 sOUEftEGULA71(1ffs. Gln REG C7' Fi/V(/ferrL/ Re-roofs Signature of Applican tractor Data H of US MATERIALS DISCLOSURE Type of Roof Will nee applicant or future building occupant Clem or handle hazardous material as dCEmd by the Cupertino Municipal Code.Chapter 9.17-Ind the Health and Safety Season 75537(.)? All roofs shall be inspected prior to any roofing material being installed. Oyu CiNa Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit horrendous air co amimna IF de0ned by the Say Arta Air Q aby Management all new materials for inspection. District? OYU Nu I have teed the hsaNau materials requirements under Chapter 495 of the Calif n- niaHealth&SafetyCode.Secdw 75505.75533 sed 25534.1 understand gut ifge Wilding dors not currently haw a anal gut It u my responsibility to notify the—put ar nee requirements which most be met prior he bmamm of a cnninc.a of OCCCPmey. Signature of Applicant Date Owner"Mthadadagent Date All roof coverings to be Class"B"or better