06070144 CITY OF CUPERTINO az'cy+Tu+ b'"' 1�" � ' {� • (, * '
BUILDING DIVISION PERNUT CON70-UViTQyRINE';O"""—'Aa a
BUILDING ADDRESS: - P__rNo.p6070144
21915 LOMITA AVE
OWNER'S NAME: PERMIT ISSUE DATE
LUMIN CHANG
SANTIARY NO, CONTROL NO.
x
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT O O PLUMB MECH
O O
0G LICENSED CONTRACTORS DECLARATION Job Description
itI hereby afRrm that I am licensed under proviaons of Cluper 9(nom lime=s P
hit Salon70tg0 of Dividon Sof les Buatnesa and Profession Coda.and my license is
infullrare 11MeffmL REVISION TO ORIGINAL PERMIT ## 05120136
Data melon cno tactor REVISED DETAIL 1 SHEET A-7 PER SITE CONDITION
ARCHITECTS DECLARATION THE REAR LEFT IS ABOUT 2" LOWER THAN THE FRONT.
i I an&stand my puns mmR be and as public l=oath
' Licensed Professional
c
to OWNER-BUILDER DECLARATION
SS I hereby affirm that I am a crop,from the ConumcbYa License Law for the
O O fallowing Basan.(Sccdun 703 1.5,Business and Profeuiam Calc:Any city or=only
j$ which m lulres a permit is mo==ot almr.Improve,demolish,Our mour my someone
•z Sat prior bits issuance,also requires the applicant forsuch permit b file a signed msmmem
<
Insults,hij..and purposes to Its,provisions of the ComuterLk..Law(Chapter 9 Sq. Ft. Floor Area Valuation
B (commencing wish Secdon7000)ofDivision 3ofshe Businessand Profesions Cents)ser $365470
.• thus he is exempt thereucen and the basis for the alkged asemp0on.My violation of
Section 7031.5 by any applicant for a pe=w saltiness one applicant to a mB penalty of APN Number Occupancy Type
not mart Nen 0w hundred dollen(5500).
1,u mmr of Ria psopeny,m my employco wlu wgu n their mle campemdon,
will dodmworkand destruction,lsmtimendedmoffemA for We(Sce.7044;Budeeu Required Inspections
and Prefpdou Cade:The CoawMfa Lkcme Law dao set apply ban ow.of q P
property who bullds m improves thvean,and who doeseach work hi nad f ser through his
awn empinyees,provided that such impmwmenu am net handed ma@sed finale R.
however,the building or Impmwmant Issold wubin arc year of=mpkdon.the amen,
builder will haw the modern of proving Net he did not build Or Improve for purpose of
ate.).
1.u own=of of than immeny,sin exclusively comer Bing with licensed=ntracbn b
o tinct the pmjcd(See.7044.Buainea and Profession Cade:)The Comracmr's Li.
cons:law does not apply an an own=of property who bail&or impmrr4 thereon,and
who comment for such projects will amstraetor(s)IlCenfed plaivant b the COnanoh
1.1ace.Law.
❑ tom eters Sunda Sea ,BAPC for this recon
Ow )am
—r
WORKER'S CO P TION DECLARATION \
J
I thereby aflim under Paul one of the fallowing dechumm ria
P,saw
will mainWna Cedfiouaf Cenumbsslf-inwre fm WorkGa Compen- '
wort,eadear,f r provided far by Section 3700 of the Labm Code,for Um penomarsco of the
woh for which Nis permit is issued.
0 I haw and will maintain Worker's Compensation Wurana,u required by Seaian
3700 ofthe labor Code,for the performance of the work for which this permit is issued. '
My Warker'a Compematfrm Insurance carrier and Policy number am:
Caller. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThisseWan need not becempleed if the permit Is foram hundred dollar($100)
or las)
I certify that in the performance of he wart for which this permit is issued,I shall not
e"Ploya non in any manmrso uubmomc tithe worken'Compenathan
laws afu
NOTICE TO )the WOO
IL afar mato Ce =of Estortration.morCod youshould
become subject b IM Waiter's Campetwl fpr cions of the lahm Coda you moa
.J O faMWlth comply with such provisions or Nu plr t hail bat deemed nwked.
'Z^'n CONMUCTION LENDING AGENCY
F l hemby alarm thw there u a construction lending agency far the performance of
IY0.> use work for which rob permit ts issued(Sec.309'7,Cl..C.)
94 G Len&r'a Name
=z Lender'sAedev
U O i emify that 1 haw mad thus application and sum shat the above informNun is
IL.F comes.1 mince Out comply with all city and county edin ores and sum laws¢lasing to
OU building construction,and hereby authmim mpmsenutives of this city m crier upon the
move-mentioned prepcny for impecthen purposes.
P. (We)agree to low,indemnify and kuP hamleu than City or Cupertino against
rat Imbilitimjudgments,toms most expense,which may In my way aCene against said City
U In=nmponce of she grand"{of this P=IL �i--•2�''//
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date V�
so CUTATIONS. -
'2 Re-roofs
I4AZARDOUs EtDISCLOSURE Dae Type of Roof _
Will the appliant m fatbe building occupant more m handle huudou material
u&fined by the Cupenlno Municipal Code.Chapter 9.13.and the Health and Safety
Code,Section 25l33(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Wil
the appfiaant ser=tam mandmg occupant sac egaipmmt ser Jeviees which
If a roof is installed without first obtaining an inspection,I agree to remove
It missions air contaminants as dented by the Bay Area Air Quality Management all new materials for inspection.
District? kk��''
❑Yes kprvo
I haw mad fthaardmu matcriab requiremrnu apte
underChr 6.95 or the Glifor-
nu HcalN a Safciy Code.Smthem 25505.25533 and25l34.l undemanst thmifthe hitting
ng
does o=nly haw a war,that it m my responsibility u,notify Ifo=upset or the
requ ichmntea pd orloIssuance ofaCedRcaeefOccupancy. Signature of Applicant Date
`�( 2a seg
Owner orauNeriand a em Dae All roof coverings to be Class"B"or better