The URL can be used to link to this page

05070171CITY OF CUPERTINO BUILDING DIVISION FERMI BUILDING ADDRESS: 21885 WOOI OWNER'S NAME: KWONG-I PHONE: ARCHITECT/ENGINEER F-19 n O p LICENSED CONTRACTOR'S DECLARATION U)= I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and Oeffect. '7 Z License Class g1- U'iW. "C6G[..ic. Datca IA^/z(a Contractor a —/ - r ARCHITECTS DECLARATION aa I understand my plans shall he used as public records �qU iy Licensed Professional n y OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement ~ z a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 ce ti (commencing with Section 7000) of Division 3 of the Business and Professions Code) or i $ 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 not more than rive hundred dollars ($500). ❑ 1, 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 and Professions Code: The Contractors License Law docs 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.). ❑ 1, 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- ccnsc Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contmctor(s) licensed pursuant to the Contractors License Law. C3I am exempt under See , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under 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 Secdon 3700 or the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: .�'iir=-t•r�eir�. et> Policy No.: // L:_'- : CERTIFICATE OF OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cl7tls section need not be completed if the permit is for one hundred dollars (5100) 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 to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you mat `Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY (--� I hereby affirm that there is a cwnstructinn lending agency for the performance of the work for which this permit is issued (Sec. 30997, Civ. C.) fz7 ~n Lender's Name Cl. Lender's Address �DZ U Q 1 certify that I have read this application and state that the above information is Il. F-' correct. I agree to comply with all city and county ordinances and state laws relating to Q U bui)ding construction. and hereby authorize represematives of this city to enter upon the a above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against Hv) liabilities, judgments, costs and expenses which may in anyway accrue against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REG} ATIONS. Signature of ApplicanUContractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupenino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ,,,,,,lll))),,,,,,��...��'''��.'''''' [:] Yes I, . Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? [3 Yes I_9 [have mad the hazardouTTss materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code. Sections 25505, 25533 and 25534.1 understand thatif the building docs not currently have a tenant that it is my responsibility to notify the occupant of the om;nts which ,must be met prior to issuance of a Certificate of Occupancy. Owner or authorized atcnt - / I Date Z M GENERAL CONTRACTOR INC I PERMIT NOO 5 0 7 0171 65 VICTORIA S (415) 585-1823 PERMIT ISSUE DATE 07/2005 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB MECH Job Description SFDWL-2 STORY (3962' -LIVING) GARAGE 494' Sq. Ft. Floor Area Valuation $877185 APN Number Required Inspections Issued by: Re -roofs Type of Roof Uccupancy "Type Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better F CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 218' ' -/);- PERMIT # 6 S0 ('u /� � OWNER'S NAME: 6j o kl ' PHONE # C1 � •- .3 s' �-5 GENERAL CONTRACTOR:j ! s� FAX # 40, !�- G%22- - IC 2. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 1�A `. Owner/(;Z"6ntractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 1�A `. Owner/(;Z"6ntractor Signature Date TO: Kwong-Tak Chui & Susan Louie FROM: City of Cupertino DATE: September 06, 2006 RE: Address: 21885 Woodbury Permit #05070171 City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: (408) 777-3228 FAX: (408) 777-3333 BUILDING DEPARTMENT With the length of time it takes for PG & E to provide gas and electric to a project we are allowing both utilities to be released prior to finals. This is allowed only if the inspector agrees and feels it is safe to do so. The owner and contractor need to sign this form stating that they understand they can- not move into the residence until they have received all of the required finals and the City has given a certificate of occupancy. If both do not sign this form, the inspections will be incomplete and the utilities not �elqdsed until we have a signed form. Owner(s' y/ Builder - Kwong=Tak Chui Contractor - Z M General Contractor -Mike Liu Z.M. General Contractor, Inc. „ 765 Victoria Street Tei: (415) 585-1823 San Francisco, Ca 94127 Fax: (415) 587-0983 E -Mail: zmacinc@sbcglobal.net CA. Lic. # 809662 To: City of Cupertino ... Sub Contractor List Name Addresses License # Business # -Air Systems 80 Gilman Ave. Suite I CA 740667 21614 Campbell, CA 95008 Tel: (408) 376-0406 Ct,C-( - /�4iz�� _ %is - S Ss