03070130 CITY OF CUPEWIINO
BUILDING DIVISION PERMIT CONTRAC ruff INTORMATION
BUILDING ADDRESS: PAUL POON PERMITNO03070130
23074 LAW Nil. C:T
t ER'S NAME: PERMIT ESUE DATE
Pr UNG: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i o o LICENSED CONTRACTOR'S DECLARATION
u, 1bonnyarumdratIamftheBusiness
uunder ndPrfessmfsCode,.vmylicenseis Job Description
�iE with wean, md.fec,. .mn3nrme nasm vs and Professions GUJC.and myliccnsc is
in imnlnmaanderreet' ADD 543 . 5 SQ. FT.
;�? License Class Lic.s '
H p Dam T'SDE L
As shall pause DECLARATION
4I, I Professiononfirrstand my plans shall M recd as public records
I,t, Littnud Professional
S OWNER-BUILDER DECLARATION J
aS 1 hereby affirm that 1 am exempt from the Contractors License Law for the f./�
O O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m r which requires a permit In construct,altar,improve,demolish,or repair any svuelum
uzr
prior o its issuance.also requires the applicant for such permit to file aspried smmment
-c that bee is lice ntedpursuumnu
anotheprovisionsOftheContractor'aLiLaw(Chapter 9 Sq. Ft. Floor Area Valuation
eF0 (comm`ncing with Section 7001 of Division Sof the B usiness and Professions Coerc)lir
Nat he
exempt therefrom and the basis for rbc alleged exemption.Any violation of 32608027 . 00
Section 7131.5 by any applicant for a lac.(,subject,the applicant to a civil penalty of APN Number -- Occupancy Type--
Dns more than eve hundred dollars H6500).
-- - — -- Pane Y ---'
❑I.as owner of the properly.or my employees with wages an their sole compensation.
will do the work.and thcauurium is not intended or offered for sale(Sec.7044,Busiwx 101 _
and Professions Code:The Contractors License Law ones not apply to an owner or d Inspections
property who builds or improves thereon,and who does such work himself or through his 102 - PIERS
own employee,provided that such improvements are not immndea or offered for sale.It, 103 - UFER
however,the building or imp ovemem is sold within one year of completion.the owner-
builder will have Bre burden of Pfnving that he aid not wild or improve for Intonate of 104 — REBAR
'al`')' 105 - ANCHOR BOLTS
construct1,as owed of property,em exclusively contemning with licensed contractors i-
consme project
n(Sec.706x,Business and Pmcss
terts coda:)Tbe Contractors
's u- 106 — SEWER & WATER
censer law does nor apply to an owner or progeny who wilds or improsrs thc¢on.and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contractors)licensed pursuant to tw Contractors
Law. u 203 - UNDERFLOOR MECHANICAL
�`I<r10(y�/) ay se`. )Dow PCB'jl �o`f1, 204 - UNDERFLOOR FRAME
WORKERS TION DG RATION -f v) - 205 - UNDERFLOOR INSULATION
I hereby affirm under pe..try or pc.jury one of following deel..atons: 301 - ROUGH PLUMBING
❑Iban and will maintain aCertificate of Consent nm selGinsum for m 302 - TUB & OR SHOWER Worker's Compc -
saenn.ins p.nvidnd for by Section 37W of the Labor Caere.(so the performance of the 3 03 — ROUGH MECHANICAL
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
7700 of the Labor-Code.for the performance of the work for which this pnmir is issued. 305 — FRAME
My Worker's Compensation Insurance carrier and Policy nuntwr am: 306 — HOLDOWN.S,
Camco Policy Nit
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.)(ITissecumn need nut w completed if the permit is formic hundred dollars($10D) 309 - EXTERIOR LATH
1 certify that in It petforpor.of the work roe which this permit u issued,I shall nm 310 - INTERIOR LATH
employ any person in any manner u as to become subject to the Workers'Compensation 311 — SCRATCH COAT
Laws of California.Dela
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If.after making this Ccrificam or Exemption,you should 501 - FINAL ELECTRICAL ENERGY
became wilhcompyect the Workers Comsor thinermitionshal of tdemedrvoked.you mon 502 - FINAL PLUMBING ENERGY
�z forthwithcomply with such Ira ionnsorthis permitshallwacemcdt Conde,
zo CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that there is accustruction lending agency lot the performance of 504 - FINAL BUILDING ENERGY
Y the work for which this permit is issued(Sec.7197,Civ.C.)
1.1 p Lender'allot 505 - FINAL ELECTRICAL
j Z naersAaa s 506 - GAS TEST
J p 1 early mat 1 have read lois application and state mar the.bove inmmrabnn in 507 — FINAL PLUMBING
]., correct.1 agree m comply wilt all city and county ordinances and state laws rotating to
D U buildingconswction.andherebyauthorisemprexamosivesofthiscitytoenteruponthe FIN MEC CAL
abovcmentiuned properly for inspection purposes.
Y 4 (We)agree to save.indemnify and keep harmless the City of Cupertino egains'
0 9 FI
jto ino.ities,juagntcnts.costs and capcnscernit. may in any way accrue egainsr said City
Z lie ties,puce oTthe seaming of thinks which
5 AP LICANT UNDERS DS AND WILL COMPLY W T LL NON-POINT Issued by:5 MWNGO
WRKS Date
5,,(yG`p'J-°��a�%!ryIG/UJLA�T,`�,T}T�Y�)�
Si gnawrco�plicanUC t�v ->�Sy �/ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant lir future building occupant store or handle hwardous material
as defined by the Cupertino Municipal Cruise.Chapter 9.12,and the Hcabb and Safety
Oftchar,godour
,OVon25332(a)? aes No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant da,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
air conuminanu as dcfned by the Bay Arca Air Quality Management
District, all new materials for inspection.
0Yes ';{A7Nu
I have mad the hanardins\mawrials requircmcnu undcrCwpkr6.95 mf the Califor.
Dia Healon 81 Sscty Cale,Sections;35505,25533 and]5531.1 understand thutf dr wising
vireo nor cyseqttry haw a¢ k that it is my t¢pa6ibilily ton dfy wxupant of tw �
fie uimmE lib ohm t t dmrmissaaneemraceniceam ana.y l Signature of Applicant Date
fir me anmmei.ea resent ;lp All roof coverings to be Class "B" or better