06110037 CITY OF CUPERTINO
BUILDING DIVISION PERMITC: t�R I�QRMATI€�N: `
PERMIT NO.
BUIL 1 G ADDRESS:
6600 JOHANSEN DR TU NGUYEN 061100,37
PERMIT ISSUE DATE
OWNER'S NAME:
,IN RESIDENCE 5309 A-SILOMAR CT 02/27/2007
SANITARY NO. CONTROL NO.
r..SNE:
(510) 4E7-6170
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
i p C LICENSED CONTRACTOR'S DECLARATION Job Description
VF1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z,Uy with Section 7000)of Division 3 of the Business and Professions Code,and my license's NEW S FL WL—19 9 3 ' ,COVERED PORCH 28 ' , GARAGE 437 ,
e in full force and effect.
)nZ License Class Lic.R SANITARY IS SUNNYVALE' S JURISDICTION
F p Date Contractor —
ARCHITECTS DECLARATION PORCH 28 ' X 38 . 51 1078 .28 --SEE BELOW
i a a I understand my plans shall be used as public records
)yU
O y Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that T am exempt from the Contractors License Law for the
00 following mason.(Section 7031.5,Business and Professions Code:Any city or county
umwhich requires a permit to construct,alter,improve,demolish,or repair any structure
--y prior to its issuance,also mquires the applicant for such permit to file a signed statement Valuation
=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $452956
t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
a that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of [� Number Occupancy Type
not more than five hundred dollars($500). 3 7 5 3 6 0 C'7 . V U
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt der Sec. B&P C for this mason
rlwnerDale
WORK MPENSATTO RATIO
I he y affirm un penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as w,:� orkcrs'Compensation
Laws oC California.D
Applicant
NOTICE TO APPLI :If,afte ing this Ccrtificam of Exemption,you should
become subject to orker's C nation provisions of the Labor Code,you must
Oforthwith comply such prns ns or this permit shall be deemed revoked.
Z" CON UCTION LENDING AGENCY
(~-t I hereby affirm that there is a construction lending agency for the performance of
(Y > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0 z Lender's Address
U C) I certify that 1 have read this application and state that the above information is
U. `" correcL 1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
W ahovc-mentioned property for inspection purposes.
t.1. (We)agree to save,indemnify and keep harmless the City of Cupertino against
►F-t C/] liabilities,judgments,costs and expenses which may in any way accrue against said City �7
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued ty:
SOURCE REGU TI S.
v�-L Re-roof;
Signaturcof licant/Commic T Of Roof
HAZAR US MATERIALS DISCLOSURE Type
Will applicant or um building occupant store or handle hazardous material
as defined by the Cupertin unicipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roots shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a Too;,'is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that ifft building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requiremcnhie must be m prior to issuance of a Certificate of Occupancy. S ignatu'e of Applicant Date
All roof coverings to be Class "B"or better
Owner of thorized agent
/'Date"