08080099 CITY OF CUPERTWOI'c'"E ' -
BUILDING DIVISION PERMIT -CONTRACTOR INka.ORM?i.TIO
xl#.aikA: +1' MI
BUI TNG ADDRESS: PERMIT NO.
�63 E ESTATES DR KEN WONG 08080099
W R'S NAME: PERMIT L59UR DATE
KEN WONG 863 E ESTATES DR 09/24/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
REMODEL—REPLACE ALL BLDG ELECT PLUMB MECH
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uDoWINBeWSH)OORSLICENSED CONTRACTOR'S DECLARATION r
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o ui with Smk0ivisian3of the BusinessaM Profcssious Code,aM mylicense is S+G/C G, v(�wO�/!C/Jct%�_�_?V/,
/rthereby"n"DdouIamlicensed under Provisions ofchapmj9(commencing •^— ^— —^^ Deset Cl2OPn
con force andeffect.
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ARCHITECTS CI'S DECLARATION
U I undcnund my Plans dk uuA as public rtrords
g C H Licensed Profe tat ..I T
5 OWNER-BUIIDER DECLARATION
f I hereby afErm Nal I am exempt from the Contractors License Law for the
Aa i Aa O following mason.(Section](D IS.Business and Profecsiuus Cade:Any City or county
m which require a Permit m cnnwucl,aIle',fmpmw,dcmolLN.or repair any suuctum
a y pnor m its issuance,also requires Dm applicant forauCh permit to file attired summent
< thmhe sfi[easedpumantmN provisioKormecanaa mr,L zea ,w(cnapm 9 Sq.Ft. Floor Area Valuation
Y (commencingwiNS.t..7O )of Div ion3of Ne Businessand Pmfessinns Cnde)or
thal he is exempt therefrom and sex basis for the alleged m e noe .Any violadun of
Section 7031.5 by any applicant for.Must subjects We applicant to a civil penally of APN Number Occupancy Type
.1 mom than raw hundred Colima(35M).
Y YP
❑I.as.of the Property,or my wpleyeea with wage as their sole cnmpeusatioe,
will do the work.and she structure is not intended or offered for sale(Sec.70th.Business
and Professions Cade The Comacmrs License Law dors MI apply to Owner wner of Required Inspections .
Property who Wilda or improves themon,and who does such work himself or through his ���
owu emplaycas,provided that such improvements aro not inNMeel or offered for W.If. 5 7�
bma...the Wilding or improvement I.sold within one year of wrn,letian,the manner
builder will haw the WMe of proving that k did not Wild es improv for Purpose of
sale.). 1 ' /
1,a owner of the property am exclusively contracting with licensed cos—c'm t*77 /,' /A /n� //j �
CoNtrocl the project(Sec.Rasa,Business and Prefessimu Cade:)Tk Contractors Li' ' ' /v ,L C ttt��� V�
«¢se fntw coca nm apply a an with
c of t rapenY who Wilds rs improves thereon.and
who LacLL for such projects with acanuactm(s)Ilcenxd purwamm Ne CanoxtorY / y �/
Licusse Law. II 1 �1/9 D
lam tempt and Sek ,BkPCf this 1.1
c Data
au �
WORK C S ECLIRAData
I hereby aBirm under pe Ya pe0 eeflk falimaing declaratious:
El
1 hew and will mainuin•C.adfeme.f Cousenl m self-insurefor WarkfS Compen-
sasian, provided(Pe by Section 3]00 of the Isbor Code,fm the pertema�a(Ne
wah for
which Was pmnil is issued.
❑I haw and will mainuin Warkers OmMe aeon Insurmce,as required by Sectim
3700 of the Labor Code,for the Performance of the soh Per which this permit is issued.
My Work's Compensation Insurance drier and Policy mother arc:
Cartier. Policy Net:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This accum need not kcomplcted If Ile permit is fortune hundred dollam($100)
or 1.)
I unify Nat in the performance of the work for w ch this mnit' issued,I shall not
employ any Memo in any manner an aslm Wc�e W 'Compenstio
an
Laws of California.cam
Applicant
NOTICE TO APPLICANT:IL after MiOng this Ondfiate of EamnPuon.you should
become Subject he the Workers Compcasaon provisions of tic(ski Code,you most
.J O forthwith comply with such providoru or this permit mW shall be decrtroked.
'Z h CONS RUCf10N LENDING AGENCY
F I hcreby.(firm Nat Nene Taa coasts hs.lendingagency for the performance of
G' Ne work for which this permit is;issued(Sec.3097,Civ.C.)
C 0 fenders Name
Z) z Lenders Address
U Q I certify Net I haw red Nis application and sum that Ne aWw infmmadun is
U. conecL 1-Vm 10 Comply with all city and Co.,,oulinamaut"state tan relating to
0 Wilding construction,and hereby mobodn:mpresenuuws or Nu city to enter upon the
Va above-numforcd properly Per irupeet an purposes
LL (We)agree to saw,indemnify and keep harmless the Coy of Coastline all
fn liabilities.judgmcnW Casts and expenses which may in any way accrue agaleu said City
to comegusnce or the ung car NU Permit,
^ APPLICANT U R NDS AND W L C MPLY WITH ALL NON.POINT Issued by:Do Date
SOURCEREGU 9.
Signature afApplican Re-roofs /
xAzkRD u M Ars lsaosuRE Type of Roof
Writtle spplic-ntc rut Wil " g t Unumhandlc Nm
heaous manal
coed by Ne CuMona Me rtipal ode.Chapter 9.12.arta ft Health and Safety
'c.Section 25532(.)]
pyo aNa All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or comm Wilding amu ant am If a roof is installed without first obtaining an inspection,I agree to remove
IT g P cqulpmem or Devices which g P
emit havNnm air conumin-nLL re UcOncd by Ne Bay An.Air Quality Management all new materials for inspection.
Distric'7 P
0Yca #Nu
1hawradthehvsNousm 3$3mquimm underCLapwr6.95ofNcUifor-
nuHcalN&SectyCWc, cdoe25N15.25533uu12553d.lun&nmdthmifNc Wilding
Jam Trot[urtenDY he usna Dist ri as my sure lit,m notify the amupant of the
requirements which m mein u'aaan of.CartikamarOcamry. Signature Of Applicant Date
0
owneraraathanxedagent D m All roof coverings to be Class'/}.'or better