06060261 CITY or cuPt RTI o
BUILDING DIVISION PERMIT ,w3xrNRMATION�
waF
BUILDING ADDRESS: PERMIT N0.
OWNER'S NAME: PERMIT ISSUE DATE
TIU TSUNG-TIEN ET AL 01/02/2007
E:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION C� O O O
m I kmby affirm that I am liansed under provisions of Chapter 9(commencing Job Description
<, withSection7M))ofDivision3ofineBusinessandProfessionsCoda,andmylicenseis 550 ' ADDITION TO: GUEST BEDROOM SUITE, KITCHEN,
in full force and effect.
in? License Class Lic.4 NOOK & SKYLIGHT
IFO Dam Contractor
'pp ty ARCHITECTS DECLARATION
i k I understand my plans shall W used u plant,recoNS
:.0
Q� Licensed Professional
g OWNER-BUILDER DECLARATION
<y I hereby affirm that 1 am exempt from Lie Contractor's License Law for the
c D O following match.(Section 7031.5,Business and Professions Code:Any city at county -
e
.9 which requires a permit to construct,alter,improve,demolish,or repair any structure '' r
,¢i prior m its issuance,also mquorm the applicant(Of such permit o Glc a signed statement -
a< met he is licensed formula to the previsions of Lie Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
eFG (commencing with Section TAXI)of Division 3 of lW Business and Profeuinns CtMc)tar $11-7903
45?
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicam for a permitmbjecu Linc applicant o a civil penalty ofNumber Occupancy
mm more man five hundred dollars WWI. 31633081 M4 Pane Y Type
❑1,as owner of the property,or my employees with wages as roulade cnmpenadmi
wilt do the work.and the swaum is not intended or offered for is].(See.7144,Business --
(-
it Pmfessiam Code:The ContracwYs-License Law does nor apply'0 an owner of; _. _. ____.__._._-Required-Inspections 1 ._..._._— _.._._._._._ ..........
Property who buildsbr iimprovet meiion,and who demsuch work himselforthrough hill ro _own emPlpyees;proWded lhusueh improvements are not ireiidWmoRved for sale.If,i tis�1' ��y,{,{. �l,y hC ffC.'t,v;�j�:`+% _7'�i:
I, however,the building or improvement is.]it within one year of completion.me owner-,
builder will Have the bane of Pro g Lbat he did not baud or int' for....•5 of
salt) i I ,
1,as uwnor of dw rt 1
❑ sec.property, exclusively WLNI)CCnoCennV Li.
' Conswdnhe.projcn(Sec.700,1,Business and professions;Code:)no Conmazmr's Li. 'rE `„",i_Il•,_`
! cense law don not apply to an owner of property who builds or improves shereon,and I
I who Contracts for such projects wish a contractoas)licensed pursuant m the Commences
LiceveLaw: _. . . —__—...._. __.__._—_ ____ ____________ ___ ___.—____ __—._ ._.—_. .__ _—.__._II._..__.__...-
11.N! AFY NO
❑I am exempt under Sec. B A P C for this moon! L
... Owner. _ . � _ ._. .!!�'•'” _Due. 12 .0_ _._.._._.__—_-_.___....—____.___.
fl::'"- W KER'S COMPENSATION DECLARATION -
1 can I. adcr penahy of perjury one of the following declarations:
❑Ih:ve and will maintainCenificom of Consenllo mlf-insure for Worker's Compen- �------------ - - ---- -- --� "----""--" ----_._'_.._.
- I session;es provided Tot by Section 3]oO OLdLe Labor Code,'fm'.the pcRmons dus nof me ,•!mdU T)C jPri:-;,til
,.I work for which this permit is Issued.F!o: v.,.,n. ..,iciro,o am,. ...ca
.,. ,:.-i �.., u;
❑I have uLd ell maintain Workces Compensation Imunnce,n mquimd by Section
-:1 370D of die labor Cotle,for thepeRarmenec of Ne doikforwhich this permit is iuueel!
�s ic41 My Workers Compemadon lasescc carrier end Policy numberart:"'--"'-
CERTIFICATE OF EXEMPTION.MOM WORKERS'-_._._....__.. t
"I a_m;:J irinrs`n'°t COMPENSATION INSURANCE
(Thumetian need not Wcomplemd if the permitisfmpnchundrctl dollar(EIW)
or Ina) t - ,11 is c tt
1 c n'fv that line perB a c of me ark far h ch tins pc mit s CE 1 shall not
mploya )personmany ma rte mow bciL sit cn to the Wo kersC pcnsafon _b;l "C. I' UGI -d ._..__..I --_. pint
La safe if ma Da
APplicai .:, I
NOTICE TO If.after making thisC wlG of Excmpl on you ih old
Wcbmcih i the okras Compcmauon pro Dons of the lahh Codc yo ung ,J.js4 ,. 11L�•t::. _..l __ ._.__.._ _ /)'r.'•1`tf, ti !` )c'_... _._..-.._.
z Tache tin M ly Ih cM1 pre s n n tints perm t shall be deem d ked I c
O .•. 1 151,1
u
Z� 'I L •CONSfRUR10N,LENDING AGENCY lJ'•T �'ll>: L --._....—_..___ _..... __ _ .. ._. _ .. .._ ..___.._.
herchyafrum thou the sea nsuuetinn lending agency,torlhe performnce of
_ __. —.—_ .._.. .rt1:.I'•,.1�;. -1 E+1(.-rc _
Z � d¢w�rk(tar inch Nis ppnnl is isined(SCc.309]C C)
Name
O is dcis ,r� - - l ";•y -J.�t s h - lit I. ii'S .
3 z 3. Linde?s Address, - .-- - _. _
J O' " '•I certe o co have mad ll s opald too a d sum Thai Inc pave formation it I '1;o.'s'
1. H cdmcm.I agree to comply whin all city and county nta nancn and seam laws totaling upt"e
�U Auimingcot.lood ionand hcmhosacion. representatives a(this city mLu ;,,,,U.1j --/ _ 1 -
W ahovcm nuuncd property for Lm lsenam which m f *'1! r",,m,l.o•i t o-1; re m j ,
CL I_(WC)agree 16 ave,indemnify and keep harmless d1C City of Cupertino+ganit
req I hditicif dgmcnts,case ticxpcnscswhreh ymanyway eccmcgainstsoldQty I
J z inconsequence ofthe granting ofthis permit ._ - _—. ._ _ __ __ ._ _ _ .. _ . ,,T .. _ ..
APPLICA NTS UNDERSTANDS AND,W L CO PLY WITH ALL ON POINT Issued by: 7 Date
/^ ` ��
I SOURCE R U ONS.
- Re-roofs----- -
P Sgnamreaf IcahV .Mono, -- - - - Date !•f't .n IL_.a
•f V. AZARDOUS'MATERIAIS DISCLOSURE I n:.o.u. Type of Roof i •` '
-- thea limn'or future Wilting complain,store nth dl h amous material[ .........
..
az defined by line Cuperimo M n!pal CCd?'Chapmr 9 li 1 A the HCaIN anJ Safclyt i.L'1 L11 ', t
Crust,S-tied 25532(a) •? a' .I° t h. r.,
-c,.x❑y i shall be inspected prior to any roofing material being installed.
„ g If a roof is installed without first obtaining an inspection,I agree to remove
`,Wil]the applicant i future building an pant use equipment o d cn which
1 i it he it a co uminanu as d f ed by the Bay Area Air Quality Managememl all new materials for mSpCCIIOn.
Dst mss r. �
!❑YCS 1a WAIL _ _._._�,
Ilhavc'ma
"td&SxddthCdCp 16.t het 5,2553ire ecu ndcrChapter69lifthe Calm,
a Hculthk5af ty Cede Sects m255U525533 and 255341 denuntl mal fm b (Jing
i doe at c rte Ily h vattem.1,11hal d u mspmrh111y in hour,the ace par of the
p it mgmrt m etch "it be mel nu sugocc a niGcalcofOccup Signature 0_fApplicant Date
r w s t rti aC m
r-
ow + morlae seal_ 1 t i =- - / Flo
'All roof coverings to be Class or better,'
g,.