05070015 CITY OF CUPERTINO zf A�• +' m cs„p *. "^ IM#:
BUILDING DIVISION PERMIT �NyTRi"TUR I1VF'(�R1VIATIO '
T, L ...c1. 0 MA
BUILDING ADDRESS: NARC.'O PLASTERING "r'IMITNcb5070015
:R'S NAME: FERMR ISSUBDATE
ROBERT LEUNG 1075 E WILLIAMS ST 2005
PHONE: SANITARY NO, CONTROL NO.
408) 293-2060
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO ELO
PLUMB MECH
O
LICENSED CONTRACT'OR'S DECLARATION Job Des , w` ® �®
I Mrtby affirm wt 1 atn licensedONTRA ummr S DECLARATION
of Chapter 9(rommendng 'Vv/+aL
with Sttdon]01110 of Oivinon Saf,W Bunnell um fcuiun Col::dusylicewete
"�z Lkeew a deffem 8 , 3 Y STUCCO ABOVE GARAGE &
Dam - —��canDECL REFRAME GARAGE ROOF ZOOS
ARCHf1EC1'SDECLARATI N
I underuand my plan"I W used an public records
3�
`cad
Licensed hereby anal �. OI�®I
OWNER-BUILDER DECLARATION U ® t]�Si
I WrtM1y affirm Net 1 em mumps from the ConuamH License law for de 1\Y,ttV—_
pO following muon.(Section RD1.5,Businea and Fn(essiow Code:My city or county
IgE which requires a permit to construct,anter,borrow,demolish.or repair any centrum
prier to Its lstuana,also requires theapplicant for such permit to rile.signed summent
< that he Is licensed pursuant to the provision of theConwctor's Licence Law(Chapter 9 Sq. Ft. Floor Area -Valu$dt00 0 0
mmemlt,
(c the
with Section 7000)of of the Buslnand Prefesdnn Cook)or
$ that he 4 exempt Nem(rom and the basis rive the a11c{ctl exemption.Any Notation of
Section 7051.5 by any applicant fm a permit subjects the applicant to a civil penalty of APN Number Occupancy oat tome Nan five hundred dollars(5500). p y 71�ype
❑Lummerofthe progeny,army employm with wgesuthebule companutra, 36204025 . 00
will do the ve&and the Nuclues bnoHnwftdora@red ferrak(S.C.7014,Bus acres Required Inspections
and Profession Cade:The Conwcmh Liberate 4w does re
dot apply M an owner of q p
property who builds or Im prows decnon.end who deo awh work bimul(ar through his
av employees,provided that such improwmcnusam, .ended oraffereE forWe U,
however,the W Ildln{or improvemw Is said within one your of completion.the owner- _
Wilds will have the When of proving that he did.,Nod er improve far purpose of
.to).
❑1,As awner of the property,am exclusively contracting with licensed commatom to
convect the project(See.70",Business am Profession Cade:)TN Contractors U.
came Lew does not apply to an owner of propeny.who builds or Improv merman,and
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractors
License Lew.
❑Ism exemp,underSee. ,B&PC(mthismasom
r Dam
WORKER'S COMPENSATION DECLARATION
I hereby a0lrm under penalty of perjury an of the following Mclatadonr:
❑INw and will maintain a Cutifiwmafconento sel6lnum fw Worttrr Compen.
urian.as provided for by Secdon 7700 of the LAW Code.for the performance of the
work for which this permit is ismad
❑1 have And will msinWn Workers Compensation Insurance.As required by Scedw
5700 of the Leber Code,for the performance of Ne wort for which this permit is issued
My Workers Compensation Insurance anis and Policy number am:
Caller. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aerie need amiscompleed Inas pemru latero.hundred dollen(SIM)
or less)
I certify the,In the performance or the work fm which this permit Is load,I Ntl1 net
employ any person in anym –i Jhccoma subject to the Workers:Compensation
Lewsof Califom .Dam
Appnwnt PITC na
NOTICE TO�n Me Workr'afterboostingrob Certificate of of Exemption,you Nauta
became abject to it Worker's r'oCompcar this provisions of We Obs Code,you mull
�O forthwith comply with such proviri.n m Nb permit shall W dcemed revoked.
z CONSTRUCTION LENDING AGENCY
aN.. INreb affirm that then is a combucuan lending agency
f' Y { .) for the perfwma.c of
ILI 7 the work(m which rob paresis 4 isa.tl(See 5097.Civ.C.)
QLenders Name
a z finders Addrnm
U O 1 ceNfy that I haw read Wa application and rum that the a Ww Information is
U.^ coma.T agrte to comply with all city and county aNlnancesand sue lawn m W ng to
p Vr building construction,and hereby wmmlu repreaenutim of this city to enter upon IN
Lid aWw-(We)ai progeny for
emnify an keep ho / �O
gyr eera)egme to caw,indemnify and kap homeless;m the City of Cupertino s al City L ry
L4 Iiabllidu,judgments,cwu and expenses which may In any way acme agalnstuiO City
U 4 in consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued,by:9 Date —
SOU CE REGULATICINS.
�^)Cjj A./ l^�L �A/\. � l'I '9"? Re-roofs
Signatuw o(ApplicsaKonnata Dam
HAZARD SM IAISDISCLOSURE Type of Roof
Will the applicant or rum Wilding oaupm,pwe er handle lamoderts material
rM ❑ined by the Cupertino Municipal Code,CMpmr 9.11.and the Health and Safety
e
sdan W32(.)?7 All roofs shall be inspected prior to any roofing material being installed.
Yue Na
Will the applicant or futore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmh heard..air caauminanu dcfncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I hew mad the hertrd.us materials requirements under Chapter 6.95 of the Califon
nab Health B SaretyCade,Sections 25505,15555 rod 25551.1 understand that if the Wilding
does not currently haw a tenant,that It is my responsibility to and ry are scup ret of the
onto moms hI Wmetpdartoisauantc_aryceruntamo(Ocapancy. Signature of Applicant Date
OwncrW authoriad Age.,
Y� t Date All roof coverings to be Class"B"or better