07030204 7777777777777..
CITY OF CUPERTINO
BUILDING DIVISION PERMIT +C; �1'r'7[ GTQ�ItQRMAT�aN'.
BUILD ESS: PERMIT NO.
��1qp 61Y
RED FIR CT TBD TO BE DETERMINED 07030204
'cR'SNAME: PERMrr ISSUE DATE
`HEUNG SHIRLEY C ET AL 03/22/2007
"PH(ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
0 p LICENSED CONTRACTOR'S DECLARATION
v t= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
:Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WINDOWS WITH DUAL PANE, MODIFY
a ain full force and effect.
i�z License Class Lic.B EXISTING WINDOW OPENINGS
;Fc Date Contractor
a ARCHITECTS DECLARATION
i d< I understand my plans shall be used as public records
�0.
O y Licensed Professional
v OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
-e O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
V� which requires a permit to constntct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
-_ that he is licensed pursuant to the provisions of the Contractor's LicenseLaw(Chapter 9 Sq.Ft.Floor Area 7 4 6 4
Q Valuation
t–$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of e�pJ Number Occupancy Type
not more than five hundred dollars(5500). 3 5 9 0 5 0 4 E :'f7 CJ
❑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
and Professions Code:The Contractor's License Law docs not apply to an owner of 'Required Inspections
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
;met the project(Sec.7044,Business and Professions Code:)The Contractor's u-
cense Law docsnot appl to an owner of property who builds or improves thereon,and,
who contracts for such p ,cut w' a contractor(s)licensed pursuant to the Contractor's
License Law. V
C]I am exempt under B&P C for this re on
lerDate
3ZZc
WOR ER' OMPENSATION DECLARATION
I hereby affirm under nalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑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 Worker's Compensation Insurance carrier and Policy number are:
Carrier. 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 perfo a e f th ork for which this permit is issued,I shall not
employ any person in any as w become subject to the rs'Com sati
Laws of Califnmia Da
Applicant
NOTICE TO APPLICA :If, r making this Certificate or91
mption,bm sha Id
become subject to the Worker's ompcnsation provisions of the Labor Code,you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z' " CONSTRUCTION LENDING AGENCY
H 1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
ALender's Name
a Lender's Address
U C I certify that I have read this application and state that the above information is
Iy �. correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspecuon purposes.
Cc
a (We)agree to save,indemlify and keep harmless the City of Cupertino against
,.,C/1 liabilities,judgments,costs an xpenscs which may in any way accrue against said City
U Z in consequence of the grantin f Otis pc t.
APPLICANT UNDERSTA ILL COMPLY WITH ALL ON-POINT Issued by: Date �—
SOURCE REGULATIONS. 3/
2_ `
Re-roofs
Signature of Applicant/Contractor Da
HAZARDOU MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
'ode,Section 25532(a)? All roofs stall be inspected prior to any roofing material being installed.
❑Yes KN.
If a roof is:
Will the applicant or future building occupant use equipment or devices which
nstalled without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes .Wo
I have read the hazardous tcrjals requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Senion9 2553 d 25534.1 understand that iCUtc building
does not currently have a tenant,4afi y responsibility to notify the occupant of the
requirements which must be met 'I rt issuance of a Cenifrcatc of Occu an Signature o.Applicant Date
Owner or authorized agent ,re All roof coverings to be Class"B"or better