07110037�f�1"T'��i�� a
akC 1 R,A.G"CORII�I'E4T.tN.iATI , L\
BUILDING DIVISION PERMIT
F
amLpl�(r�r�pga ERMIT
STEVENSTEVENS CREEK BLVD
/NA/MLE;
KEEN ON CONSTRUCTION CO
NO.
07110037
N1ER''S
PERMIT ISSUE DATE
FRED CHAN
1426 DE LA CRUZ WAY
02/08/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHIIER GINEER:
BUILDING PERMIT INFO
COMM'L TI, INSTL 2 WALL
O O D O
LICENSED CONTRACIOR'S DECLARATION
- lob Description
I hereby sabre dust 1 w na licensed under provWoof Chapter 9 (mmmmcing
Mth Section 7") of DiWsion 3.f& Business and Profeatione Cade, and my license u
in full to= and effect
Limn Claus Ir'. R
Dau Contracur,
ARCHITECTS DECLARATION
I understand my plans shall be nd As public me obi
-
Licensed Professional
OW NER.BUILOSR DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
follomag moon. (Section 7031.5, Busba a and Prolamines; Cade: Any city or =my
which acquires a permit in comaruct altar. imp rrc, demulbih. or repair my stmctum
prim m its issuance, also requires the applicant forsuch permit to rile a signed statement
that he is licensed numerical to the pmviaians of me Conhmur'aLmn LAw(Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Sudan 100(1) of Division S of the Business and Professions Code) Or
that he bi amp, them(ram and the Ambi for W alleged emmption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any Bpplleant for a permit subjects the applicant to a civil penally of
.1 mom than five hundred dollars (5500).
❑ 1, As owmr of the property, or my employees with wages u their sole compensation,
Required Inspections
e ns
will the the wark. and theswcture u OutmuMed or ofrmcd L., W. 1141, goal=,
And ProfeaLicenseCade: The Contractor's LiceLaw does sat apply m an owner of
q P
Property who build, orimgow them nt.and who doessuch work himmlforthrough his
own employ.. provided mat such improwm rds arc not intended oroEeled for sale. If,
however, the building ser Improvement I. sold within arm year of completion, the owner.
builder will haw the burden of pmv(nS that he did not build or improve for P.M. of
rule.).
I, u ow e, of the property, am eaclad,tly... meting with licensedmnvacmn m
ca t the project (Sec. 70144, Business and Professions Code:) The Comeseter's U.
cense law does not apply u an owner of property who build, or tmprowts Merton. and,
who contracts for such projecu with a contramu r(s) licensed pursuant to the Contracter's
License Law.
❑ 1 sac exempt an�tler/Sec B dI P C f r thl mpann
Dau i s0
WORKERS COMPENSATION DECLARATION
I hereby strum under Penalty of perjury am of the following declarations:
0l ba amd will mainWna Ce ammof ConntWmif-imum fw Worker`s Compem
smon, As pmvided for by Section 3700 of the Lsbm Code, fm the performance of the
work fm which this Permit is issued.
❑ I haw and will maintain Worker's Compensation Insurance, u required by Section
3100 a the lAbm Code. for the performance of the wank for which this permits unreal.
'
My Wrok . Compemation inrmce carrier and Policy number am:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusecdm reed not be completad If the pemtt Is foram hundred dodans ($100)
or lest.)
1 certify that in the performance of the rank (or whicA mise Permit bi Acted, l shall not
employ my .a in my mammc�olloh��onu .-j to tie Warlecd Campenmtan
Laws of Califamia Dau //KK ��DD((11,,
Applicant
NOTICE TO APPLICANT: If, after making this Cenifiam of Exemption. you should
became subject in the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shut M deemed mvokcd.
CONSTRUCTION LENDING A0ENCY
I hereby hthi that them is a commumdran lending agency for the Performance of
the work for which this permit Is sced (Sec.3051, Civ. C.)
'
Isnder's Nurse
,
Lender's Address
j 1 certify that 1 haw, reed this Appliwion and sou Nat the above infosmatiun Is
correct. 1 agree to comply with all city and county ordinances and sum laws mladng to
building construction, and hereby autharies mprammatiws of this city to enter upon to
i abow.mendoned Property far inspection Pughmea
(We) agree to mw, indemnify ad Peep hsrmlem the City of Cupertino against
j Iiebilides,judgmena,cmu and expenses which may In any way accrue against said City
in eoascquemm of the {renting of this permit.
' APPLICANT NDERSfANDS AND WILL COMPLY WITH ALL NON -POINT
p��
Issued by: Date _ a Z7
SOURCE RE
MATIONS.
yg'la 9
Re -roofs
Type of Roof
si nataace _
Signals. plieanOC�on HAZARDOUS MATERIALS DISCLOSURE Dam
Will dm applicant Or form building ocivpmt store or handle has door material
termed by the Cupertino Municipal Code. Chapter 9. 12, and the Health and Safety
. Secure 25532(a)1
El Y. �Na
All roofs shall be inspected nor to an roofing material beim Installed.
P prior Y g $
If a roof is installed without first obtaining an inspection, I agree to remove
Will ft applicant or future building amvpant use equlpmem or deWm which
emit haardom air contaminants m tclined by the Bay Ana, Air Quality Management
all new materials for inspection.
Disomy
�No
❑Yrs
I hew mad, hviNous mamriau mquirtmenu unde,Chaptard.95 fthe Califor.
nu Hmal" Safety Cade Sections 25505, 25533 aW 25534.1 undnmsrm thstif tlm Wilding
dos ret curmntiY a ten et. tis it as my responsilrility m notify tiro oecuPanl or the
rtgaiacmcats sunk mlxp�t pdo, to commutators c«dham ser
m
Signature of Applicant Date
et
All roof coverings to be Class "B" or better
Owner Or authavmd agent Dam