06010143 CITY OF CUPERTINO '• ,�' ' '-+ ' ' 'a
BUILDING DIVISION PERMIT -�k,CONT'RACTORTN ORMATION,$
BUILOING ADDRESS: PERMIT NO0 6 01014 3
19147 TWIG LN
OWNER'S NAME: PERMIT ISSUE DATE
CHAU TRAN & LIEN TRAN ---L-612.1/2006
NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
trap LICENSED CONTRACTOR'S DECLARATION
. I thereby affirm Nat 1 an licensed under provisions OfC'hapur 9(commencing Job Description
ZE with Section 701O)of Division J Ofthe Business und Professions Code.and my lkense is
±� in full force andeffett DEMO (E) HOUSE Yg
!}lqa,
yya= License Class LW.N (��J Lqg.,,.,
F O Dau Contractor
ARCHITECT'S DECLARATION
wU I understandmy plans shLl w truth u public rtcoNr ,
g LL k' Licenced Professional
x05 OWNER-BUILDER DECLARATION J*f-Zd 2006
iI I hcrehy aIT".dot I am exempt from the Contractor's License Law for the
CC following mean.(Section 7031.5,Business and professions Code:My city or county
�i which¢quires a permit to cnnsWct,alum,improve,demolish,nr repair any structure gagirrhia, _ $9000
Zy prioroits i.or¢c.alw requires Nc aPPliont forsuch permit to rileasigned suumcm fY0
< that w is licensed pursuant the provisions Of the Conuacmri License Law(Chapter9 Sq.F[. Floor Area p — Valuation
x�$ (commencing with Sation 7000)of DivuienJaf the Business and Profrssioas Cork)or
�vY�.,�/
_ Nat he u exempt Ocufrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mots Nan Eve hundred dollars(9500). r Occupancy Type
❑L as owner of de property.or my cmplay us with wages.de'v sole compmeadon,
will do the work,and the structure o not intended or offered fersale(Sec.7044,Business
and Pmfessiens ac
Cade:The Centrorom
r's License Law does t apply are owner of Required Inspections
Property who builds m improves thereon,and who does such work himself or through his
awn employees,provided Nat such improvements am net intended oroRened fmsals IL
however.the building or WPMWOOOL is sold within rn your of cwnpkuon.the owncr-
builder will have the burden of proving that he did Out build or improve for purpose of
ask I.
h as awrur of thin property,am uelusively contracting with licensed eonbuaors OnnstNat the project(Sec 7044.Business and Preform.Code:)The COOuaeors U.
cove Law does not apply to an owner of property who builds or improves themon,and,
who contracts for such projects with a convuorts)licensed parson,On rhe Canwcoe,
License Law.
❑Iamucmptunfdu/�S'c5e, er, � � ,BAPCfm Or n
Owner C—RP9aVpt"�f�VK Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under parody of Perjury ore of the fallowing declaradou:
1 have and will maintain a Cer ifiwu of Consent to ulf-insure for Worser'sCompen-
sation.as provided for by Section 3700 of the labor Code,for do,performance of the
work for which this permit is issued.
❑1 have and will maintain WorkeYs Compensation Insurance.as required by Suction
3700 of dic Labor Cod,for the performance ofthe work for which this permit u issued. '
My Warke's Compensation Insurance carrier sob Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mous inion need not w completed if the Permit is foranc hundred dnllaeb($100)
m loss.)
I certify that in to pie fon oro"of thc work for which dr Perini,u issued.l shall nor
cmployanypersoninanymaoeratiss. b tl6 /arkut Comperearrom v
Laws of California.Dam L L
Applicant I
NOTICE TO APPLICANT:IL aMi making this Cenificare of Exemption,you aboard
become subject to the Worked Compensation provisions of Ne Labor Cads you most
.,Z, foMwith comply with such Provisions or this permit shall be deemed revoked.
zO CONSTRUCTION LENDING AGENCY
(-' Iwuhy aRthi des,deuua (Seclending agenry for the Performance of
!Y the wart for which this pemiuurA(Setit u c.30 JOY/,Civ.C)
Qnds Name
Z:) U
z Undoes Address
t.J Q 1 cunlfy that 1 have read this applicarimi and sum that the above infineroOm u
f^ correct.)ague in comply with all city and county on inan¢s and sets,laws relating to
QU building construction,and hereby authorise represemuives of this city to enter upon the
ahovc-memim¢d Property for inspection rourewhich ex
H a (We)19.1 to save,indemnify and Imp h.mless the City of Cupcnino against
Z liamoseq,judgmcnclosts ang Of thissIsult. may in anY wyacrnWagainsuaiO City
O,'Z in conaequcnec of thin grating of Ibis Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITHµµµ.L NQQN.POINT Issued by: Date Z.
SOURCE GUULAS * —
AL-4
T4IIO,,N��S. ////�f'�� / / al y
Stg.turt pplja-ntracmr� G xDau Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future building occupant nose or handle h.ardous material
u deft ed by the Cupmue.Municipal Cade.Chapter 9.11.and Be Health and Safety
Cork,Schon 25531(1)? ��aa..Na All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or mom wilding occupant au equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
mit hxaardn.ori,contamiunta as dc0ncd by the Bay Asea Aj,Quality Management all new materials for inspection.
District?
❑Yes No
1 have mad Ne h.a,dtws nuouns lste,hicmow under Chrq ur6,95.f the Cslifor.
nice HUI"SalmYCade,Savona 25505,25537 an!15534.1 understand lhatifde building
does not currently have a Worn,Nal it is my responsibility m notify the occupant of Ne
regaim,og„ ;much 1priarm asce,tiBe.Waraaypw1y-rle6 Signature of Applicant Date
Owner or autwrivzd,gem 6�D �
am All roof coverings to be Class"B"or better