08040087 CITY OF CUPERTINO m r a,>:, .g..� ^y54• r '*�u ^"°`2.'.,
BUILDING DIVISION PERMIT CONTRAGTQR INFQRMATION
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BUILTILJQ�QR N WOLFE RD #2021 TBD - TO BE DETERMINED 08040087
BR'S NAME: PERMIT ISSUE DATE
'IMMY CHEN 06/11/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHMICT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
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�Op LICENSEDCONTRd underSDECLARATION Job Description
rd F I herby affirm War 1 am of the
under provisions ofChapterCode. 9(commencingsIs p
^z1'u6j inuSection7doifefDividon3a(NCBudrcssaMPrefeuiomCode,aMmylice�tsu TI-CINNABON- NONSTRUCTURAL INCLD (ELEC/MECH/PCMB)
O m i full force and efface
an— License Class (amg
nl-q Da¢ 7SDECr
D-W7 As suall use DECLARATION
U 1 understand my Plans mall be used u public records
6
J,O F Licensed Professional
aN3 OWNER-BUILDER DECLARATION
al 1 herthy eRnn that I em exempt from the Comnaofs License Law for On
COO following moon.(Section 703 1.5.Business and Pmfessints Cad:Any city or county
$fi which require a pmmit to convsucl alter.improvo,demolish,ff repair my swnum "
Z< Prior to i4 its.BRC,a1.RQuims the applicant for such pcmuil to file sei'mcf.oerent
that he is licensed pursuant to the pm.isiom of the Cantrecmfs UCcoe Law(Chapter 9 Sq.Ft.Floor Area Valuation
go (commencing with section 70D0)ofDivision 3ofda,Business and Profession Code)or $120000
e�_ that he is exempt Waefmm and the hues for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects due applicant to a civil Penalty ofumber OQGD
.I mrt adran five boded 500
dcIWx(5 ). 31620096 . E Occupancy Type
❑1.u owns elJm prvpeny,aro mY avplayces with wages u the'v sod campewtian,
will tlo the work and dr atmnur u not Intended a offered for sad(Sec.7014,Busircss
and Professions Code:The Connectors License Law does WE apply to an owner of Required Inspections
Property who builds crice prves thereon,and who does such wart hinwlf orduougb his
owe cmployces,provided that such improvements am not intended oroffertl for sale,if.
however,We building ar imprDWOOM issoid within one year of ccmpleuon,the owner-
builder will love the MmNen of proving Wal K did Ml build a improte for purque or
IVA'as caner of the property,am exclusively contracting with Ramued mnwcfms of
Cawroct the pmjam(Sec 704,Business and Profession Cede:)The Colossuses U-
ccne Law does not apply W an owner of properly who builds or improm thermal.and
who conuacu for sant proXcu with a ca cmr(s)licensed puraxam of the Canossane'a
Licence{ser
1 am oempt under ,B d P C for this mason
Date
MPENSArION DECLARATION
1 he aR under pcndrY of perjury one of drc following Eeclantiona:
❑Ihswa w maintainaceni0oeurc.Wentmsclf-ioureferWortcfsCmnpen-
wion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit u issued.
❑1 have and will maintain Workcls Compensation Insurance,as rcquird by Section
37W of the lana,Code.for the performance of the work for which alis pc.I,is bxx e
My wortefs Compensative lesso.nmer and Policy number arc:
Carrier. Policy NO.:
CERTIFICATE OF EXEMMON FROM WORKERS
COMPENSATION INSURANCE -
('rhu sev.Uve rand rot M completed if We permit is faane hundred&flan($100) .
or leu)
I canufy that in We perfomuran of the work for which this permit' 'sued 1 1 not
employ any person in uym emu o eco es "act eP' n' noon
Laws of California.Data V
Applicant
NOTICE TO APPLICANT:IL after making this Cc o acmptian,you should
become svnjm o the WorkuS Compcwu0.provixionc labor Crain.you mart
.Jz forthwitheOmPIYwildsuchlnvocarsa Wu permit an 1 dxmetl rcwkcd.
.zd O CONsmucr10N LENDING AGENCY
F+? I lterebY spinet Wn chert is a Construction lending agency for We performance of
the work for which this permit is issued(Sec.3047,Civ,C.)
W
l 0 W W3 Name
2.2. ress
Z Lender's Add
lJ Q 1 mnify Wan I have mad Ws applicauon and xule that We above infomod on u
W cornett 1 agme m comply with all City and county ordinances and State laws relating on
-Q building construction.and hereby authorize rtprcxenuum of this city to enter upon the
W ah sve-wnmmed property for impemive purposes.
(~ G (Wc)agree to save,indemnify and kccp harmless lex City of Cupar ino against
r/I Iiabilides,judgmcros.caauu expancs whichmay in anyway..againtuid City
(a
z in eortsrgduxc of the grana of thisrm' v •/ ('^
SOURCE RE APTLICANr UNDERST DS D L COMPLY ALL NON-POINT Issued by: Date
�t,Las.� Zoo Re-roofs
Sigonurc of App
or
an
H RDOUS MATERIALS DISCLOSURE Type of Roof
Will thea li tor(utumbuildCo accupanlsmm or luMlc haurdow mamrial
az deRved by the uperuno Munici Code.Chapter 9.11,and We Health uJ Wely
.s:1Y. 532(a)7 All roofs shall be inspected prior to any roofing material being installed.
[:1 Y. o•
Will One applicant or future Wilding occupant use equipment or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
COm�hCu Towns air Wnuminams u de/fined by thee Bay Arca Air Quality Management all new materials for inspection.
C]Yu rt N
I he-read dme has six materia quimmcw under Chapter 6.95ofthe Califor-
.I.Healthh5afctyCodc, 00255 'Y"
33 tad 25574.1 undcnund thmifths Wilding
don out caremh nv arc tN t y req ='!'i;Y,m usury sic OLLoWnI of the
require. white n u Ca Ccnifcae,or Occupancy,
Signature of Applicant Date
Own.,aro anth antl ant D,te All roof coverings to be Class'W'or better