04060224 CITY OF CUPERTINO
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BUILDING DIVISION PERMIT CCINTRACTQI TNI`ORMATION:x
BUILDING ADDRESS: KUEI CHIN LEE PERMIT NG 04060224
OWNER'S NAME: PERMIT ISSUE DATE
SNE:
SANITARY 0. ii�ROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
D O
LOo LICENSED CONTRACfOR'SDECLARATION IobDescrip[ion
1 hereby affirm Net I am licensed under provisions of Chapter 9(commencing
with Section]akn of Division 3 of the Business and Professions Code.and my license is
aa'n infuliforceandn
erfe .
5'q_ License Lie.g REVISION--DEFERRED TRUSS GALES .
Dam contraeum NO NEW PERMIT ISSUED/ORIG. #03110149
aq ARCHITECTS DECLARATION
Y e I understand my plans shell he used u public rccends
JyU
;LLT' LIeCnECd Professional /
CS OWNER-BUILDER DECLARATION
I hereby olrirm Net I am exempt from the Contractors License Law for the
a o following mason.(Section 7031.5,Business and Professions Code:Any City or county
K m which requires a permit Rs consumer,alter,improve.demolish,or repair any structure
ewe+
prior it)its issuance.also requires the applicant for such Permit to rile a signed statement
�E that he is liecreed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq.FL Floor Area ^ Valua[iM107
(commencing with Section 7000)of Division 3 of 0e Business and Professima Code)or v 4
y 3
at M is exempt Nemfmm and be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars($500). - t,
❑I.0 owner of she propcny,or my cmploYtoe with wagesaz Neirsole compenution, 37526005 . 00
will do On work.and Ne awcem a
is net innded or offered for nate(Sec,7044,Business
and Profcssiuna Code:The Contractors License Law dors or apply a an mvnar of Required Inspections
property who builds or improves Hereon,and who does such work himself or through his
own employees,Provided Nat such improvements ase not intended oraReed forsate.If.
however,Ne building or improvement is sold within one year of completion.the owner.
builder will have dee burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the properly,am exclusively contracting with licensed contractors to ,
consumer the project(Sec.7W,Business and Professions Code:)The Contractors Li.
cense law does not apply to an owner of property who Wilds or improve Neaten,sod
who contracts for such projects with a contractor(s)licensed pursuant to the Convectors
License Taw.
0
Issue p under Sec. `,(�., n`-'L^gyp B&PCfor this recon ,
7 ^
WORKER'S COMPENSATION DECLARATTON�
L hereby elfimt under penalty of perjury onepf`NC following dwarations:
and will maina Ctortificam ofConsent msilt-i10ure for Workers Compton-
-
tain u provided for by Section 3700 of the labor Code,for Ne performance of the
ark far which Dia permit is isswd.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Coda.for the perfmmanec of the work for which this Permit is issued.
My Workers Compensation Insumnea carrier and Polity number M: .
Carier, Policy No.: _
CERTIFICATE OF MEM"ION FROM WORKERS'
COMPENSATION INSURANCE
(This section reed nor W Completed if the Parmit is furore hundred dollars($1010)
or less.)
1 certify that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner so as a Wcomc subject to the Workers Compensarimi
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making Nis Comficate of Exemption,you should
become subject to the Worker's CamPenaation provisions of IW Labor Code,you must
.7. 0 forthwith comply wide such provisions or this Permit shell Iso worried revoked.
z CONSTRUCTION LENDING AGENCY
[-r aril-r I hereby affirm that there is a construction lending agency for NC Performance of
lx s1 Ne work for which Oia permit is issued(Sec.3097.Civ.C.)
W�Q Lender's Name
z Lender's Address
U O 1 certify Net I have read this application and suite that the above information is
"F correct I agree to comply with all city and county ordinances and sate laws relating to
0U Wilding construction,and hereby authmim represenatiun of Nis city to enter upon Or,
above-mentioned pmperty for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
iF•t l Imbiliries,judgments,costs and expenses which may in any way seems,against said City
U in consequence of the granting of this Permit.
t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E ATIO 5.
SignaW�APPBC�tra�r \,J Dames Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant or future building occupant smrgyeWnJlc hatwous material
u defined by the Catalonia Municipal Code,Chapter 9.12,and the Health and Safety
Code, yea2ss3z(en
E3 yea yNo All roofs shall be inspected prior to any roofing material being
Will the applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
havardnus air concomitance as Jefncd by dee Bay Area Air Quality Management all new materials for inspection.
ic"
❑Yes �No
1 have mad the havardeas materials requirements under Chapter 6.95 of thc Califon
.is Hcalde&Safely Code,Secumu 25505,25533 and 25534.1 u muscand Not if the building
docs not currently aw a tenanr,Nat it is my msponsihility m notify the mcupwi of thc
require h must W t tle(m eseme of s CCNfic.m of C e11C.
1l must
&TV& Signature of Applicant Date
ow uraudeorizedagent Dme All roof coverings to be Class "B" or better