05010134CITY OF CUPERTINO
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BUILDING DIVISION - PERMIT
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BUILDING ADDRESS:
2042S qTT.VR.PADQ AV
ROBERTO & CATHY TAM
PERMITN%501013i
W NER'S NAME:
PERMIT LSUE DATE
ROBERTO & CATHY TAM
01/25/2005
HONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
DesCrl hon
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1 hereby of Net I am fie Bu under provisions ofsC dc. 9 (commencing
with Section hem
TOM)fir that I am li thewd uncle apr Prafnssiof hzpwr 9 ( my com came is
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tfaw�(j(tt
I. full force and effect
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BATHRM REMODEL/RE ER, WA L
License Class Lk.g
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Dam Contractor
ARCHITECTS DECLARATION
I understand my plans shall W used as public records
p res
APR 14 2905
Licensed Professional
OWNER -BUILDER DECLARATION
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I thereby user that 11. exempt from the Corns License taw for (W
�rI�J/rp�I Ipps IpI pJ�—s
Co
re mann. (Section 71D1.& Business and Professions Code: Any city 0r runty
whifollch
which requires a permit a ennsuue, altee improve, at structure
Ld NN» 11���9 ss%%" 85000
h Permit t e a sig ed
prior In its issuance, also at 1. the the applicant for such permit m Glc a signed Caterer
of the Conlrumh Lt... Law (Chaptero9
(comm ending wit pursuant 700)of
Sq. Ft. Floor Area
Valuation
(commencing with Section 70n0) Division Cie) of
Division 70f (W Bminexempt Profeon.
An vi
ti
Nat he u exempt therefrom umtl Mme Eau for Mu Alleged exemption. Any vioutlon of
rero
3 e10 0
Occupancy Type
Section 7071.5 by any applicant for a permit subjects the applicant in a civil penalty of
Am more Nen five hundred doll.. ($500).
❑ I. a owner of the property, or my)mployeas with wages As Bier sole compensation,
Required Inspections
will do We work end the structure is not intended oroReud foreale(Sec. 7D44, Business
and Professions Code: The Contractor's License Law dors met apply to a wnu of
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property w ho but Ids or i mprme thereon, m and who does much work himse If or through his
own cmplayus, provided Oilmen improvements vc not amended araneud forsale.If,
however. the building or improvement is sold within au Pest of completion. Ne wmr
builder will have the Widen of proving that he did not Wild or improve for purpose of
Asia.).
0 I, as Owner of the propeny, am exclusively contracting with licensed contras.ai to
construct the project (Sec. 7044, Business and Profusions Col The Contractor's Li.
'
)moue taw Cora not pply man owner of property who Wilds or improve Merton, ad,
who contracts for such projects with a contractor(s) licensed pursuant n the Contactoh
L" rase Law.
lam oder ,B&PC far Nu moon
n Date
R'S C RATION
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thereby affirtundear penalty of perjury au of Me (Allowing dec.lions:
IMveand will mainuina Cenifiena of Continuo ul6imumforWorkertCampen-
...ion. As provitletl for by Section 7700 of the ISWr Code, for Mme performance of the
work for which this permit is issued.
❑ 1 have and will maintain Waiter, Compensation Insurance. As required by Section
1700 of Ne lsWr Code, for the perfmramon of the work for which this pormlt maned.
My Worker's Compensation Insurance carrier and Policy number art:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Clues section reed nal W completed If (he permit is for one hundred dollars ($1010
in le.a)
1 certify than in the Nor .rmAme of The wart far which this Permit ts issued. I shell not
'
employ any person in any menet n In Wcom ubjut7m the Workeri Comperenlon
.
Laws
Lpws ofoifo.,".Dem
j
m hears the Wer Iinfamous previsions of the ISWr Cage, you mum
with such p moans or Ni. permit shall h deemed acmked.
CONSTRUCTION LENDING AGENCY
I hereby affirm than num is a convection lending Agency I'nr the performance of
Ne work for which this permit is issued (Sec. 3097, Civ, C.)
Us&,', Name
Lender's Addma
1sonify Mat Ihaw this application the 10
ad ciunadsearthe sWelInfofmming
agree to comply with all cauoyaNinomn and sue lawsrumen{
with
bunecng
ah ri e
construction, and hereby emhon
rposeunlanhcs of this city m enter upon the
ehove-(We) ageproperty for inspection mephe.
abomnmentio p
(We) agree to ave, indemnify and kith hay a the City Capetian against
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liabilities, judgments. costs and expenses which may in any way seems Bann reed City
In accrue
in can ce of the Sratrng of this
APPL A UN E STAP 5 A s ILL COMPLY WITH A L NONPOINT
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Issued by:9 Date
SO ER. NS `
Re -roofs
Type Of Roof
o rp as omrec or em
AZARDOUS MATERIALS DISCLOS RE
Will Ne appliesm or future Wilding..par t mom or handle havardaus material
As defined by the Cupertino Municipal Cade. Chapter 9.17, and the Health and Safety
a da Section 25532(4)?
C] Y.
All roofs shall be inspected prior to any roofing material being installed.
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If a roof is Installed without first obtaining an inspection, I agree to remove
Will the applic.mLor Tmum building occupant use equipment or devices which
Omit ha'ardous air contaminants As defined by Ne Bay Area Air Quality M.mgcousin
all new materials for inspection.
Uimfict?
❑Yon
'
I have mW Me Intranetwriab requirements undcrchapter 6.95 of the Califor.
nia BOOM & SafciyCode, Sections 25515,75533 ad25534,1 understand Nat line Wilding
does ndy haw e u and th m mi
it isuspohil4' m ratify the occupat of the
m men hie as At or wee or,cudraraar, oceup
Signature of Applicant Date
1
I All roof coverings to be Class "B" Or better
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