08080076 CITY OF CUPERTINO > «&Y fea��'/.K d(�%p1 `I" ('
BUILDING DIVISION PERMIT 4 CONPTRiACTOR IANFQRM T-ION.
BUILDING ADDRESS: PERMIT N0.
21.836 GARDENVIEW LN TBD - TO BE DETERMINED 08080076
`YNER'S NAME: - PERMrr WOE DATE
K IANG CI'IIH—HEN AND SHIOW—LING 08/11/2008
I NONE: SANITARY NO. CONTROL NO.
ARCHITECTiENGINEER: BUILDING PERMIT INFO
BLDG EIFR PLUMB - MECH
0 0 0 0
sOp LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby sfntre dual I am licensed under provision ODSCTI^f Chapter 9(commencing P
R viNSnethm,f)(ID)ofDivision3oflhrBusinevvdtiuW
itfinouCode, re,he is R&R WINDOWS & PATIO SLIDERS; NON STRUCTURL
^�F in full foroeende —C17 X
j^�g Licome Cl 1.11.11.11.1r
SGK CONSTRUCTION PD FOR BUS LIC 8/11/8
nt, Dau P Contractorn.1-s
e ARCHnECTS DECLARATION
e U I undersund my plans shut W used as public mcoNs
k wG Licensed Professional
i10 1 OWNER-BUILDER DECLARATION
i E 1 Wreby efr.that 1 em exempt from the Comrmmrs License Law for me
O O following mason.(Section 101.5,Businesr and Pmlebons
ssCat:Any city of county
IRE! which requites a permit to cmnvua,alar.W,move,demolem.or repair my structure
i< prior to its issuance,also requites the Applicant farsuch permit to file a signed statement
that he is licensed pursuant to me Provismsmf the Connector's Lee.faw(Chapmf 9 Sq.Ft. Floor Area f- Valuation
� (commencing with Section 1000)of Division 3 ofdte Busitrssand Profession $
Code)or 17000
try g$_ met W u exempt therefrom and the basis for the alleged eaemption Any violation of
Section 1031.5 by wry applicant for a permit subjects the applicant u a civil penalty of Number Occupancy Type
Out more dun rive hundred!dollars ISM3 2 619 0 9 6 ,Off P Y YP
1,as owrcr of the prop.M.Or my eroployest with wage as their sok compewdon,
will do de,work and the mm.m.is not intended or offered for We(Sm.](M.Businss
and Professors Cal-The Comractors Ll.law does oro apply to an ow.of Required Inspections
property who Wild,a i mpm Ws durtron.and wW does such wort himmif m mmugh his
own employers,provided the such improvements ere out inuMed areffered forsale,ff,
however,me Wilding or improvement usold within mon year of completion.me owner-
Wilda will have the burden of proving that he did Out Wild or improve fee purpose of
alk.).
0 1,as owner of the property am conclusively convecting with licensed contractors he
can ect the projen(Sec.load.Business and Profecsans Code:)TW Connamurs U.
cense law don Out apply to an inner of property who Wilds or impmvrs meRon.and
who contracts for such projects with a convactor(s)licensed pursuant to the Convenors
License Law.
lam nem pt under See ,B&P C for this won
iva Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following derlantions:
❑1 have and will mountain a Ccnifimu of Cement to self-iuum for Workers Compere
satiun,as providd for by Section 3700 of the ISWr Cak,for the performan¢of the
wort fee which this permit is issued.
C I have and will maintain Workers Compensaddn Insurance,n requited by Seerin
3100 M don labor Cook,fee the pesformsocaofthe wart for which this permit is iuum. .
My Workers Compensation I..nein and Pini.,number art:
Cartier FAAtA2LC Policy Not.:C��s–qtr�rL,_�1L0'yy
CERTIFICATE OF EXEMPTION FROM WORKERS' —
COMPENSATION INSURANCE
(this sedan need mtbccompleu l lithe permit is feeon hunddeddo0sr(1100)
or tau)
1 crosfy that in me performance of the work for which this rancid is bound.I shall not
employ any person in any manner as to bnomc subject to the Woken'Canpensadso
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eremphon,you should
become subjm to me Workn's Compensation provision of the labor Conic,yon most
O foMwim sh
comply with such Provisions or this permit all W dnmrevolted.
olted.
ZnCONMUCTION LENDING AGENCY
7. the work furwhosby i�ms��rt u a cmwrucsn lending agency for Ne perfomence of
Permit fi bound(Sec.wiry,Civ.C.)
ALender's Nahm
z fendw
fenders Add
U Q I comfy that I have read this application and auto that the abuw InfomuWn Is
gy^ cormcA 1 agree m comply with all city alb county oNbmm�cu ander sulaws tclating he
C)LS.^J building construction,end Wreby announce representatives of this city to enter upon me
[17 show-mentioned property for ospencon whichpurposes
n, (We)ague to taw,huh mnify and keep harmless me City of Cupertino against
Z IlabnWenjudg Of the
and espeuerwhtch may in any way said City
UZ in conscgvenAn a[IW granting of this permit
^' APPLIA D�ANDS AND WILL COMPLY WITH ALL N N POINT Issued by: Date
SOURC A /
/1 b/ Re-roofs /
Si u fApplican onu¢tor I 0m,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future Wilding e.Chapi rtom a hutok havNoua material
u dc0rted by the Cupertino�Mu.�n!ici�pal Code.Chapter 9.11,and IW Health and Suety
. cy.25531(a)1 t4 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs
Will the A lieanl of mare Wilding cast If a roof is installed without first obtainingan inspection,I agree to remove
pp l Wnt use equipment devices which P
� cod hourdnua obs contaminants u dcmted by Ote Bay Area Air Qualitty Managcmcm all new materials for inspection.
Dievt<tl
❑Yrs
I have read dte bacau materials nquiremetu under Chapies6.95oftheCalifer-
niaHnith&SuclyCde.S=6=25505,25533"B5M.iudcrrundmsbftite building _
dna not carers re ant that it u MY
tmpons-oil'ty u notify aecupant of dm
rcquento a et our to issuawc oft Ccnificato cu Si at fAppli nt Date
Own to, morncd agem Dau' '
All roof coverings to be Class')}"or better