08060071 CITY OF CUPERTINO 'X �'S+=' e Rv a:`a f EI TWEE p
BUILDING DIVISION PERMIT .c 0N1IUCT0R�II�TN'ORMA'.�j0N'
PERMIT,_ .m.Fe.mo. . . .. .. :. .9.��...n
BUILJINSGSApQR HANNA DR SERENA CHOU 8060071
l-R'S NAME: PERMIT 2 02 DATE
SER1ENA CHOU 18800 HANNA DR 07/17/2008
PHONE: SANITARY NO. CONTROL NO.
ARCH=IENGINEER: BUILDING PERMIT INFO
ELDGO ELECTO PLUMBO MECH
O
u 0 G LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm Nat I an Ikeved under provisions of Chapter 9(commencing Job Description
Z with S«uon 7IXMI)orDivWanSaf the Budarev aM Pmraaimu Code,W mylkeramu HOUSE DEMO
in fall forte andeffx.
Z Limm.Class Lic.0
ol-•q Da¢ Cmuesmor
RW7 ARCHITECTS DECLARATION
U 1 command my plans shed he used u public mmnla
ya.
LLa Liceued Professional
5 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am camp,fatten the Contractors License taw for then
i
00 fallowing mason.(Section 70513.Business and Profesgam Code:My city m county
S$ which enquires a peamit or c^nstrucaL alter.improve,demolish.or repair any structure
_iy PH.m its isswnce,alw mem.the applicant for such permit m fikaaigtma aamnmm
E CNet he is licensed puma.w errp
, rovision,of the coarmumrs uauc Law(Chapter 9 Sq.Ft. Floor Area $20000 Valuation
1. (commencing with Section 7000)of Division 5 of am 0usineas and Professions Cade)or
RE E ata he is ssrmpt therefrom and the buss far the alleged uem0 .My violation of
Section 7011.5 by any applicant for a permit subjau ted applicant o a civil penalty of
rot mart Nen fsw hundred dollars(M). 35729044 Number Occupancy�Pe
❑Lao ofdmpropeny,.myemployeawdhwagau0 4mic rope Um.
will ao thewoaL and the he Com as roakmadegs,Law do(.sale(Sec.-(1111,Buirw
and my who W Cade:The Conmrmrs uvl"d law dao tet apply if rd awnv of Required Inspections
Own a aY lobo bulla viopmves h im e,and who acessuch w.khimwred Nroogh his
awnemployee,prodded improvement is
not intended!or offered for oak. r.
however,the have
thWilding or improvement u mid within ons adl of mprove 1 ,the owner- -
W it .wiB have ere Warden of gvvkg this bo aid not dub.improve(.puryase of
u
L as owner of the Propen,w eclutivel,connaming with Hamed mmnctms to
ammact the project(Ser.70th,Business and Profusions Code:)Ths Cmtrwdors U.
const Law does not apply to an owner of property who Wilds or improves themon.and.
.1W mnuaeu for ouch project with a mntrmina(s)licensed Panama,to the Convauars
Lice.Law.
Or
acmes u B k far faun^
Dau
WORK 5 COt/��P N N DECIA ATION I
at%
I hereby oleo under peull/af perjury arc of ted following treWau
❑1 ham and will maintain a CaNfrate of Coment to ulf.mmm for WoHou sCompen-
ssdon,u provided fm by Section 5700 of the tabor Code,fm the performance of the
work far which this Pumice u iauea.
❑1 hove and will maintain Worker's Compensation I..,u required by Sutton
5700 of are later Cade,for ted ciao(mmunce of du work for which Nu paiaia Is Issue
My WaryiYs Compensation lance n¢camer and Policy number are:
CmHm, Poll,No,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(TMs smite surd fiatbocarepkoA Int permit is foronchunmed do0au($1011)
or leu)
1 mdfv shot in the performance of the work fu which this rental) u Loused,I shall nm -
employ mypeam^many meuermu I me cath Na 'eampenssdm
Laws of califomi -
Applicana
NOTICE TO C s after m ti ra
u nifiam of Exemption,you could
eubje m' Wo Com'rimfon,rovisioes of the lour Cade,you moa
.,O roMwids comply with each provide.u this permit shall W dcemed makcd.
Zu) CONSTRUCTION LENDING AGENCY
(—r Ibomby.M.that Nero us mmsncHm kMint agency far the perfame.of
6i
the work fm which gm permit is issued(See.5197,Civ.Q
WQ Lenders Name
z tenders Adamss
V Q 1 merry Nu I have mad this applicso m and sou ata the move information d
Vr t— conte 1 agme te comply with all city and county Ordinances and some laws mining in
O Wilding corwsrtetian.most thereby anthodm rtpauenudws of Nu city to new upon am
W above-mentioned property for Inspections purpae.
CL (We)agree to save,indemnity,and lace,harndeu We City of Cupm uam silliest
Vl IiaCommen edgmennd,Standing upuuu which may In anyway acuu agaiutuid city
t.)z A camequnce of am granting of Nis permit
APPLICANT DE ANDS N ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR ULA NS.�'�
—f� 'I�, �/C Re-roofs
S gsuyNe f ,pile D e
US MATERIALS DISCLOSURE Type of Roof
Will the appil.1.future Wilding amupmt a.e err hmdhe hanrdou material
ld=
Rood by 0m CuPenino Municipal Code.Chapter 9.12,and she Health and Safety
p.u552(')± It All roofs shall be inspected prior to any roofing material being installed.
Wier ted, licant.muue Wilding torn If a roof is installed without first obtaining an inspection,I agree to remove
pp g wan use cquipmQu m&vim which g Pe
c7�na carr cmuminanu tau defined by Ne Bay Arta Air Quality Management all new materials for inspection.
❑� b4
I he.mad the huardous...data scqulrcmenu under Chupkra.95 of ted Califar-
ealth g:Safety Caae,Smnmm1550S,25551 255X.1 urrdvaand thnifgm Wilding
roes c Y L the it' my mihi'I sea ratify the.euVmt ar Ne
n,quimmc av tptiar ' tt fir CenifimamarOc Signature of Applicant Date
Owner.aatharlmd agcm Dem
All roof coverings to be Class'%¢"or better