12080083CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10392 SCENICCIR
OWNER'S NAME: CHENG CHARLES K AND JOYCE K
OWNER'S PHONE.: 4085643886
❑ LICENSED Cf)NIRA(_fOR'S 1)ECLARATION
License Class Lie. b
Contractor Date
hereby affirm Ihat I an licensed under the provisions of Chapter'9
(commencing with Section 7000) of Division 3 of the Business S Professions
Code and that nn' license is in full force unit effect.
I hereby affirm under penalty of perjury one of the following Elio declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the perfomnance of die work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and side that the above information is
correct. I agree to comply with all city and county ordinances :rad state laws relating
to building construction, and hereby authorize representatives alibis city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liahilities,judgnicnis,
costs, and expenses which may acerae against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulatirns per the Cupertino Municipal Code, Section
9.18.
CON'IRACI'OR: CIIENG CHARLES K AND PERMIT NO: 12080083
JOYCE K
10392 SCENIC CIR DATE, ISSUED: 08/08/2012
CUPERTINO. CA 95014 PHONENO:
BUILDING PERMIT INFO: BLDC r ELECT 1- PLWAIB r
NIECFI r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REMOVING EXSISTING ROOF AND INSTALLING
PLYWOOD AND
PRESIDENTIAL SHAKE .27 SOFT
Sq. Ft Floor Area: 0 1 Valuation: $11000
APN Number: 35707023.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAPS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Date I Issued by:
❑ OWNER-BIIILDF.R DECLARATION
hereby affirm that I am exempt from the Contractor's License Law fur one of
the following Elio reasons:
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 R Professions Code)
I, as owner of property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business d Professions Code).
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 Connpensation Insurance, as provided Ivor by
Section 3700 of the Labor Code, for the performance of the stork for which this
permit is issued.
I cenify that in the performance of die work for which this permit is issued. I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califamia. If, alter making this certificate of exemption, I
become subject to the Worker's Conipensaion provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANTCERTI FIC TION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances land state Imus relating
to building construction, and hereby authorize representatives of this city 10 enter
upon die above mentioned property for inspection purposes. (We) agree to save
indemnify and keep hamdess the City of Cupertino against liabilities, judgments,
costs, and expenses which may acerae against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date.
ALL ROOF COVERINGS TO BE, CLASS "A" OR BF*lTER
HAZARDOUS MATERIAIS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health S Safely Code. Sections 25505, 25533. and 25534. 1 will maintain
compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health S
Safely Code. Section 25532(a) should I store or handle hazardous material.
Addilionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Qualily Managemem District 1 will
maintain compliance wilh (lie Cupertino Municipal Code. Chapter 9.12 and the
Health & Safety Code. Sections 25505. 25533, and 25534.
0%% rice or authorized agent:
Date:
CONSTRIICI'ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ CJ
Lender's Name
Lender's
ARCHITECT" S DECLARATION
I understand my plans shall be used as public records.
Licensed