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07020062Op W F :UU :Z raa f LL raa .Q� � V1� �pC < m to V L CITY OF CUPERTINO PERMIT BUILDING DIVISION BUILINQADDRESS: x317 METEOR DR SHIAN SAW FU PERMIT NO. 07020062 'SR'S NAME: PERMIT ISSUE DATE 3HIAN—YAW FU 7 SANITARY NO. CONTROL NO. PHONE: ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) ofDivisiort 3 of the Business and Professions Code, and my license is REMODEIr 3 BATHROOMS. NO STRUCTURAL CHANGES. ADD in full force and effect. License Class Lic. a ELECTRICAL. NEW SHOWER - PAN. Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Cale: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's (Chapter Professions Code) $12000 (commencing with Section 7000) of Division 3 of the Business and or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type `` not more than rive hundred dollars (s500). 3 2 6 4 3 0 (i 3 . ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law docs not apply m an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). 1, u owner of the property, am exclusively contracting with licensed contractors ct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- qs.m cense Law does not apply m an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 1 am exempt under Sec. B & P C for this mas !` y�[J ter Date ORKE O DECLARATION I ereby affirm un pe ty of perjury one of the following declarations: 1 have and will main ' a Certificate of Conscnt to self -insure for Worker's Compen- sation, as provided for b Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Workces Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workees Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manno so as m be o e subject t >c orkers' Compensation Laws of Calif - Dfft NOTICE T6 LIC , after mala ngrs crttfrcate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 7 forthwith comply with such provisions or this permit shall be deemed revoked. 01) CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) ~ Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. y (We) agree to save, indemnify and keep harmless the City of Cupertino against n liabilities, judgments, costs and expenses which may in any way accrue against said City /17 © '"� '-ZW in consequence of the granting of this permit. / Date / -+ APPLICANT U DERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued t y: SOURCE G LATIONS. Re -roof; Signalu of pplicandContrac?Uriiup� HAZAR MATERIALS DISCLOSUREWill Type OfRoof dto applicant of tlding occupant store or handle hazardous material az defined by the Cupertin Mal Code. Chapter 9.12, and the Health and Safety ode, Section 25532(a)? jam/) All roofs shall be inspected prior to any roofing material being installed. ❑Ycs k] No / If a root' is installed without first obtaining an inspection, I agree to remove , Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants asdefined by the Bay Area Air Quality Management all new materials for inspection. District? O Yes � lu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if thebuilding docs not currently have a ten t, that it is my responsibility to notify the occupant c ' Date rcquirc n which mus{ be et r to issuance of a Certificate of occupancy. �`~ J Signatu 'e of Applicant "B" All roof coverings to be Class or better Ow or authorized agfit Date