07050233 CITE'OF CUPERTINO n��TTORI�Y�QRIY�'�I4�1�*
BUILDING DIVISION PrL'.1�MI _ PERMIT NO.
BUILD2 1�DpgEs MONROVIA ST TBD — TC BE DETERMINED 0 7 0 50233
1111 b PERMIT ISSUE DATE
OWNER'S NAME: 06/Q-7 /?n07
CHONG PANG & MEI LENG NG SANITARY NO. CONTROL NO.
INE:
BUILDING PERMIT INFO
rARCHrrECT1EN;G1NEER: BLDG ELECT PLUMB MECH
(�reoQ SED CONTRACTOR'S DECLARATIONJOb DCSCnptlOn
uI hereby t I am licensed under provisions of Chapter 9(commencingADD FROrIT ENri'RY COVER, CHANGE SLIDING DOOR TO BAY
Uwection 7000)of Division 3 of the Business and ProfessionsCode,and my license isa a force and effect. WINDOW.
j z License Class ---Lic•g
p
Date Contractor
w ARCHITECTS DECLARATION
j aJ
a I understand my plans shall he used as public records
>aU
u.H Licensed Professional
O a OWNER-BUILDER DECLARATION
ayt I hereby affirm that I am exempt from the Contractor's License Law for the
<,I y following reason.(Section 7031.5,Business and professions Code:Any city or county
Ii which requires a permit to construct,alter,impmvc,demolish,or repair any structure ]~t.Floor Area Valuation
u H prior m its issuance,also requires the applicant for such permit to file a signed statement c' $9432
?a that he is licensed pursuant to the provisions of the Contractors License law(Chapter 9 q
Y k$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
a that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p Number Occupancy Type
applicant for permit subjects the applicant to a civil penalty of 3562302 : 7
Section 7031.5 rive
arty app
not more than five hundred dollars(5500).
0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
will do the work,and the structure is not intended or offered for sale(Sec.7044.Business
and Professions Code:The Contractor's License Law does not apply to 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.).
as owner of the property,am exclusively contracting with licensed contractors to
wet the project(Sec.7044,Business and Professions
Wilds or'm roves thereone:)The Contract ,
cc Li
a Law does not apply to an owner of property P
who contracts for such projects with a conimclor(s)licensed pursuant to the Contractor s
License Law. B&P C for this reason
0 1 am exempt under Sec.
Owner
I Date 1
WORK MPENSAT70N DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insum for Workces Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section creed not be completed if the permit is forone 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 m e ome subject to Ute Workers'Compensation
Laws o(==1
Date
Applicant
NOTICE TO APPLIC making this Ccnificats of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
F~..c I hereby affirm that there is a construction lending agency for the performance of
7 the work for which this permit is issued(See.3097,Civ.C.)
(Sa QLender's Name
0, Lender's Address
U 0 1 certify that I have read this application and state that the above information is
V. E~" correct.I agree to comply with all city and county ordinances and state laws relating to
CU building construction.and hereby authorize representatives of this city to enter upon the
above-mentionedproperty for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City Date /
U z in consequence of the granting of this permit. V
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULAT19ps-
��tJ L L1107rRe-roofsSignalurcofAppli n r ale Roof
HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Munici a1 Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? Alroos shall be inspected prior to any roofing material being installed.
0Yes "° If a roo','is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which all new materials for inspection.
emit hazardous air contaminants as defined by the Bay Area Air QualityManagement
District?
0 Yes NO
I have read the hazardous materials requirements under Chapter 6.95 of the Cal i for-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the Wilding
docs not currently have a tenant,that it is my responsibility to notify the occupant of the Signature of Applicant Date
requirements whjcj mu met prior to issuance of a Certificate of p'`�`Y•
'11 1�� All roof coverings to be Class"B" or better
Owner or authorized agent Da _