08070022 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
B..
BUI
MING ADDRESS: PERMIT NO.
%.0`-571 & 20573 SCOFIELD DR TBD TO BE DETERMINED 08070022
R'S NAME: PERMIT ISSUE DATE
S
,�,!,'I-
Sh]'E LUONG THANG DO 08/26/2008
,
'F: SANITARY NO. CONTROL NO.
ARCHITECTfENGINITER: BUILDING PERMIT TWO
2 STORY SFDWL W/PORCH BLDG MECH
a as LICENSED CONTRACTOR'S DECLARATION 3 , 6 19-
4dF Ll_' ription
I hereby affirm Thai I am licensed under provisions of Chapter 9(commencing Q�DWc'
with Section 7000)orDivsIon 3 ofthe Business and Protessium Code.and my license is
mfull force and effect.
Z Lima.Class-Lic.0
Dan-Co.ammor
ARCHITECTS DECLARATION
I understand my plans MIT On used as public records
JyU
Licensed P-de"d...I
OWNER-exempt DECLARATION
I I hereby affiran That I am exempt from the Contractors License Law for the
�02 following reason,(Sommi 703 t.5,Best..and Professions Cods:Any city or county
which.,.I.. .it re mmoren. Ilm.improve.cimnafth.ore any met..
prior in its issuance.else requires the applicant for such Permit in rile a signed statement
a U==Law(Chapter 9 Valuation
that the is licensed pursuant to The provisions of ft Contractor Sq.Ft. Floor Area
(commencing with Section TWIT)of Division 3 of the Business and Professions Com)or
,at M ta exempt therefrom and the Wig for the dlcgcd assumption.Any violation of
Section 7031.5 by any applicant for a permit subjects The applicant to a civil penalty of APN Number Occupancy Type
act..m data five hundred dollars(S500).
0 Lasouncerrortimpropeety.army employees with well theirsoiccompirmadon,
will do the.&-and the a=.m isnot intended or.ffersed permit,(Sac.71144,Business;
and Profession.Cade The Commecon`3 License Law does not apply to an Owner of Required Inspections
property who bolds or Improves thencon,and who does such wort honatelfor Through his
am employees,provided that such improncracens use not mardicul watered!formic.IT.
however,the building or Improvement issold within*an you of completion.the owner-
builder will have the laudien of p000inj;that so did.1 build or improve for purpose of
sai.j.
a2r1..mrner or the pro;.ny,am exclusively contracting with licensed contremars to
coustract the project(Sec.7044.Business and PoolOuldons Cade)The Contractor's Lt.
cause Law does not apply te an owner of property who builds or lorprovas domer.W,
who contracts for such projects with a commends)Hermancd pursuant in The Contractors
Lie.Lau,.
exempt empt under See B&
I mason
lu� " thin UO
WORKER'S COMPENSATION •CLARATION
I hemb,union under pe.try of perjury one of ths following declarations:
I ham and MIT main ud.a COrtifficam Of Cementto self-Insure roc worance.Com,cm,
I I
.[I...as provided for by Section 3700 of The Lalso,C.M.for the ponforeem.of the
wasit for which This Permit is Indeed.
We
oil Ave and will maintain Worker's Compensation Induchance,a required by Section
3"of the Labor Code,for the Performance of the ones,for which This Parrott is Turned,
M"misce.Compensation Inscrace.,carrier and policy number sm;
Carrier. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection need out mcompleted Ifflut permit is forme hundraddellars(SIM)
Tom.)
I cmdry that in the performance of The work for which this Permit is Issued,I half not
employ any person In any moon!gMsubj;�1todhcWkcxs'Compcnxad.n
LamOfC.IIr ppaate
Applicant
NOTICE TIT AP I IrANT:If.after making this Cerd!I#of exemption.you should
become subject To the Worker's Compensation provisions of f the Labor Code,you a=
Z forthwith comply with such provisions or This Permit shall be decreed resonant.
z 0
CONSTRUCTION LENDING AGENCY
I hereby&ffirce that them is a construction lending agency,for the performance of
the work for which this Permit is ismand[Sm.3097,Ch,C)
Lms Nunn.
M z Undoes Addecas
U 0 1 cemity,that I have read this appli.stimn and man,tha the above i.ficurratim I.
L,E cornet.I agree to comply with.11 city and county ardinaread,ared sue laws misting to
O building construction.ad hereby authonse rePrescroUthmal Of thin City in crucrupon We
show-mentioned property for inspection purposes.
(%)agree to save,indemnify and IMF homeless;the City of Cupertino against
w liabilities,judgments.costs and expenses which may in any my amore against mid City
U Z in consequence of the fignotfing Of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
. , 0)ii qkACQ,, Zb(d(A Re-roofs
Signalcon,aTAWlicarloZonnuclor U Dart
HAZARDOUS MATERIA DISCLOSURE Type of Roof
Will the APPHCxmE or future building occupant sama or handle mandous material
e0ned by Thh5e5C I
3�1)nbm Municipal Code.Chapter 9.12.and the Hcaim and Safety
.Section
❑Yen ? �Vbl. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It lm,.Ardous air contaremarns as dollood by the Bay Area Air QURHLY Management all new materials for inspection.
District?
r3yes V.
I hew oudl the harsol.. mriab remmoncrustusicur Chapter 495 ofthe Califor.
ni.ifluds&S.I.LYC(dc.SmIleads 25505.25533 seat 15511.1 undameeml that if ft building
dean have out mu ha .mume,me It 0 my nexperousibilily 10 unity the occupant Of the,
Z_
reaq.i umm,,�ehdch mu(v be Signature of Applicant Date
Mas gtor in essuarce,of.Cendicana o
41t. UZ U41- All roof coverings to be Class'}W`or better
OmO or authorbed agent U Dow