05060030 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT �;�CONTRACTORINFORMATION��;r
�'I V,W37; f,'
BUILDING ADDRESS: DWK CONSTRUCTION , PERMITNG05060030
10420 CALVERT DR
I` IN 'S NAME: PERMIT ISSUE DATE
ROGER WANG 1646 S DE ANZA BLVD 06/24 /2005
NE: SANITARY NO. CONTROL N0.
(408) 615-1508
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION
MI Mosby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section70f10ymr Division 3oflhe Buri.ark Professions Code.and my tireve is
e�y imfull form and erwi. REVISION--TRUSS CIA..
I Liz License ClassLica
a Dam Convenor NO NEW PERMIT ISSUED/ORIG. $¢04110067
F tJ' ARCHITECTS DECLARATION
s5 m I understand my plans shall M used as public recordsCy
U
3 o G Licensed Professional
S OWNER-BUILDER DECLARATION
<F I berehy,affirm that I am exempt from Yes Conuacmrs License Law rot the
o O following mean.(Section 7031.5,Business and Pmrcasions Code:Any city nr county
K$ which requires a permit to construct.aiteo improve,demolish,or repair any atrwtum
y2<
prior it)its Lttuance.alW occulter the applicant for such Permit to file a signed aldlLmcnt
that he is licensed pursuanuo Ne provisions of de,Contractor's Limnse Law(Chapter 9 Sq. Ft. Floor Area Valuatio$115
QFC (commencing with Section 7(Off of Division 3 of the Business and Professions Cow)or
y that he is exempt therefrom and the basis for that alleged exemption.Any violation of
Section 7031.5 by airy applicam fora permit subjects the applicann0 a civil penalty of APN Number Occupancy Type
not mom than BK hundred dollars(s50% 37518004 . 00 p y YP
I,as owner ofthe property,or my employees with wages as their sole compensation,
will do Outwork.and Iheswcturru notimmnded m offerrk rorsalc(Sec.7041,Business
and Pm(essiom Code:The CanOactoYa Limme,Law does not apply m an owner of Required Inspections,.,
property who builds orimproves thermn,and who doessuch work himself or through his
own employees.provided that such improvements are notinanded or offered for sale.It,
however.the building or improvement is sold within one year of compledon,the owner.
builder,will have tM thmm of proving that M did No Wild ar improve for purpose of S`
sale.).
❑I.as owner of the property,am exclusively contracting with licensed mnraemra 10 \\
construct the projha Sm.7(f14,Business and Professions Cada:)The Contractors Li. J
cense law does not apply to an owner of property who Wilds or improves thereon,and
who concocts rot such projects with a conmacut licensed pursuant to Re Convactor`3
Limae Law.
❑1 ant exempt under Sec. .B h P C for Nis19, moan
Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ow,of the fallowing declarations: -
❑1 hive and will maintain aCertifieam or cement to self-inure for worlmescompcn-
reach,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Competwtion Warrart¢,as required by Section
3700 of the Labor Code,for Ne pedmmance of the work for which this pennit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not Mcmnpleted Rule,permit is for one hundred dollars($101)
or less.)
I Unity Out in the performance of the work for which this permit is issued.I shall not
employ any womn in any mm�eJm^�c7e41
cnlr Woren'Compemadmi
LawamCalifmD
Applicros
NOTICE T)AP I ICANT:If,afterting this Certificate of Exemption,you should
become subject m the Worker's Com p_mmsion previsions of the labor Chao,you must
.J O foMwith comply with such provisions ter Nis pc.I,shall W deemed re
mkcd.
Z� CONSTRUCTION LENDING AGENCY
[-. 1 hereby affirm that there is a com mIcton lending agency for the performance of
<Y the work for which this pernit is issued(See.3097.Civ.C.)
0.Q Leaches Namc
r7 z Unders Address
U I mniry that 1 have sad this application and sate that tM shout Information is '
F' corrha.1 agree to comply with all city and county ordinal and sum laws relating to
0U building constroction.and hereby authome mpresematives of this city to enter upon the /-
.r W above-mentioned property for inspection purposes. C
f, C (we)agree tp save,indemnify and keep harmlesspethe City of Cupertino against /)
N liabilities,pdgmena.costs and exnses which may in any way re.against said City
U Z to consequence of the grants ng of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE E ULATIONS.
Re-roofs
Signawmof Applicant/ tractor Date
HAARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(optic Wilding oaupant store or handle hvamous material
as dcfmcd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
r.0Yee 25572(,)? 91 No All roofs shall be inspected prior to any roofing material being installed.
�e
Will the applicant or future building occupant u¢equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.nth haumom air mnmminants as dcrincd by the Bay Ama Air Quality Management all new materials for inspection.
Dist irt7
❑Yes 9rI No
1 have mal the hvamtms materials requirements undechapter 6.950!Oc Califon
nice Health 6 Sarny Cole,Sccuom25505,25533 and 25534.I undersand Nat i(the Wilding
dors not concmly haw a¢tent that it is my responsibility to notify Oc aeupans of the
reggirements which mint M met poor to iasuamc or.Cerideate orampanen Signature of Applicant Date
r�r 2;;Lc All roof coverings to be Class "B"or better
Owner terauthorised,gem Da¢