00070003 (2)CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
FRAN LEE CONSTRUCTIO
_STNI"00070003
813 LONNA LA
OWNER'S NAME:
2091.7 FRRGO DR
APPLICNI'l,0 /1/ t[.L-1 /2000
VJ/ [11/ ¢r
TSAO AUSTIN D AND VIVIAN
PHONE:
SANITARYNO. COMIRO.No
_(408)996-2527'
ARCHRECI'IENGINE IE
BUILDING PERA11'1'INl'O
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❑LW ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby unirm'11:11 1 an, Iicenwd under proIiziona of Chapmr 9lcotmnencing
will Sec ion mahq nnui)i,' nn3 nllhe Buoinc%v LaidProossini„de. Colend Illy lien
.
TEMP POWERrce
is io full film. and uOeel.
Lieen,e Cla% Lice
DagoCoatraswr
ARcUrrhm sUECLARATION
1 undcestaud my plans shall he toed as public record,
Licensed Prafevaional
OWNER-BUILDER DECLARATION
1 hereby a0inr that 1 :in, emoopl (cont .he Contractor'.,' License Law for the
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following reason. (Section 7031.5. Bminen, and Prol'ussirna Core: Any city or county
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which requires a permit in construct, alter, improve, demoli.h. or repair any ,truclure
prior to its issuance. also requires the applicam for such permit In file a signed amemen,
Sy. Ft. Floor Area
valued i
mal he is licensed pannanuo the prookions of Controetore I.men,e Law(Chapter 9
Iconunencing with Scclion 7000) of Divhioa 3 of the Btvua, r and Prol'es,io is Com)
or that he i, cacn,pt thereltmn and the basis lire the alic,cd exemption. Any violation
of Section 7131.5 by any applicam for a permit objects the appticaut 1. a civil penalty
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APN Number
Occupancy Type
of not more man five hundred dollar, ($500).
35919022.00
nycc, wisages a, nor vile coulpemaila.
l,usnvae,ofthe c,I, or y cerylh wI
Gprm
Required IDSpeCt1O0S
will do the work, and the atucture is not intended or ollemd! for elle (Sec. 7(94,
politics, amt Profession,Cade: The Contra.....v Llceaw Law does nal apply 10 an
or of pol Who bund, of improves thereon, and who doe, such %ark himsaf
103 — UFE R
orv1lmnour Ill, own cn,plo ,r,. pmvidcd that ,rich improvetnems are not imcmWl or
however. budding,, itopmec is within one o1
304 — ROUGH ELECTRICAL
ouared lia Ae. If, the cor sold year
plehon. the nenbu0der will have the burden ofptnving thea he did nn, build or
w
iom
mprove for purpose of,ale.).
t of bar ryo,ro, um esdmivnly eontron a, w,,It licensed contractor, to
1,n
tract the Pmjnn (Sce. 7044, Bndnc„ and prn@a,io is GMe:) Due Conlmnor,
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License Law does not apply to an owner of property who huild, or impnne, thereon.
and who contract, Iia such projecu with a contracmrls) licensed pursuant to the
Connector', Uccme Law.
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01nm`n,/crena ler Syee�� ,nHI refor ntL, rennr
ow'r j�_ eILCit�ale
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WORKER'S COMPIiN5AT1ON DECLARATION
I hetchy aflina anderpenalty of perjury one of the tol low l ng declaratinrs.
tab
0 1 have and rill mainmin a Certificate of Crowd, m self-inwre for Worker',
Cotnpemation, as provided for by Section 37(3 of the Labor Code, for the
perfnnmt or of lhn work li,r which Otis pcoull is is,ned,
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01 love and will mainmin Worker'v Cnmpenvalion Insurance, a, required Ii
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37W of the Luxor Code, fill the perfumunce of the work for which this permit m
slued. My Worker's Compensation Insurance carrier and Policy another are:
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Currier: Policy No.:
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CERTIFICAI [ON Of: EXEMPI [ON FROM WORKERS'
COMPENSATION INSURANCE
I this senlon aced nm he completed it the Penni. iv lin one hundred dollar,
(510) or less.)
I rend, that in .he perornarrice of he work for which this permit i, issued, 1
6,11 not emnloy any Pcr,oa in trey manner so it, u, hecomu stbjea to the Work','
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Co..i'aseliv Lown of Califurnlu. Dat,
Applicant
NOTICE TO APPLICANT: If. ufie, anaking this Certificate of Exemption. youshould
become suhjcct to the Worker's Compensation provision, ill the L Ire r Code, you matt
fonhw lth nnnply with >ach Pro ...inns or, a, panni, ,hall be'deemcd revoked.
CONSTRUCHON LENDING AGENCY
1 hereby alum, that them is a construction lending agency for IIIc perfunearce
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,it'.he work or which this corail I, Issued (Sc,. 307. Civ. C.)
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Isnder's Nerne
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Lender's Address -
1 certify that 1 have mad this application and state that the drove information is
nen. I agree u, ann,ply with all city and country ord nanaa, and ,rue h ws relating
or building umgmerinn. and hereby uoholile rcprescnrnrve, of his city to enter upon
the aMventealioned propcny for inspection purntncs.
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(Wc) agree in.%al e. indemnify and keep harmless the City of CupeNr r against
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liabilities, judgments, costs and expemm which may in any way accrue against said
Cly in „m..... we of he 8on0ug of this pencil.
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APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Dald
SOURCE REGULATIONS.
Re-roofs -
Signature of Apphcam(Counanor Dale
HAZARDOUS MATERIALS DISCLOSURE
Will the appheam or future Wilding mnapanl slow of handle hamWous material
Type of Roof
as defined by the Cupertino Municipal Code. Chapter 9.12 and die Ilcalth and Safety
Code. Section 2553200?
O Yes GNo
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building overpaid use egaipnan, or devices which
If a roof is installed without first Obtaining an inspection, I agree to remove
emit hvarJum air containments as defined by the Ray Area Air Quality Management
District?
all new materials for inspection. Applicant understands and will comply with
C Ye, 0N
all non-point source regulations.
I have read .he Wcanh uv tnumrials requiretnenu under Chapter 4.95 of Ibe
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Califamia Health & Safety Code. Section, 25505.25533 and 25534. 1 undemnnd that
ifthe building does nut currently have a tenant, that it is try responsibility a, notify the
,vpanl ,I 'he requimntenl, wldch nntst be met prior lu'os of it CcnitSOW of
("cu'all '
Signature of Applicant Date
All roof coverings to be Class "I3" or better
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owner ited Date
or athho ager(
vrrta.c