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00070015 CITY OF CUPERTINO BUILDING DIVISION PERMIT • CONTRACTOR INFORMATION: f \ BUILDING ADDRESS - PERMIT NO, .� 'ON'UGN'S,NAh1FG0,.3 tt-i Fll_t+HLLE - KIM',S CUSTOM BUILDIfAPruCA11ON x8@@7.0015 `1/ Y HONE, RI9HWHIV, 0262 BLACKFORD AVE SANITARY N007/051/'L'19M azo ARCHITECT/ENGINEER: ♦ (.4081999-0333 BUILDING PF.RMITINFO PP ❑❑ III.DG, ELECT' PLUAIR MUCH iU LICENSED CONTRAGI1O11'S DECLARATION 0-4E I hereby minx that 1 am licensed and.,Pnwt,xm,m Chap,er h mommo.c ns Job Description F=t ..nth Sectiort70sR)nf Dmtsmn 3 ofthe Businessland Profe%sainm Cinie,and my license a S is In full have and effect. + - m r+c Class eO U i to Conamn ac ARCHI'rECT'SDECLAR ATION TEMP POWER I tmdc,k d my plan,titan M meal tic public roof,as oO Licensed Professional - ' S o OWNER-BUILDER DECLARATION tai 1 herehy allirm Off 1 am mentpl In the Comnutnl',Lucnse Law I... the t Y 6 Iollowing resort.(Section 70315,Utilities and Proo....as Code Any cny or cant ' s,?O which ref,mes a permit to construct,alter,improve,demolish,or repair any structure - 3°�-° nrmnu its Iauaacc.el,o rcfnue,,beapPhe.Iut forsu ch PCrmu b.fie anagned adtenaenf ___- - tbut hc,,1¢cmcdPontammthepowi,ion,aline Cnitaracmr',1-tcenie Law(Charter 9 S Ft. Floor Area I Valuation (commcnang with Section)IXIB)of Dmvlan Sol the business and om od Prolesst Ce) 9' or that he is exempt therefrom and the basis fur the alleged exemption Any sedation , of Srchfn 70315 by tin)apphcam is a"aff'chiods the n""froat to u coil penalty . of far if re lban five mmderd dallal,(St,N), APN Number Occupancy Ttge ❑I,as never of the property,or my employee,with xagee as thcnole uimpen,ntton, will do'hr"lit,and the stm um n not imend^J of ,decd for sale(Set,?O44, - business and Professions Cet File Comractar s Iaccrok Law does not apply to an 34216042.Rh uired Inspections owner of propmy Who builds colmprovrs thereon,and who ulnas such,.n k himself - - o through his awn employees pooled that such unproucnan,me nut Immid'd or ollemd for sate If,however,the building or Imprmcnaent is sold within one year of ' completion.the mrser-bailde.will have the burden ffpm.ang that hedd not lmudor 103 — UFER ' improve for mq'awemf,ale'1' 304 — ROUGH ELECTRICAL ❑1,m owner of the property,am exel mwcly confiding whit lit erred contractors to s construct the project(Sec 70VL1,business and Pm1r,,tun,Code'I The Contractor's L cca,e Law does not apply to an owner ut property who hit Jds ur topones thereon, ' urd who contracts for such proleaP will,a carinatons)fcenwd I nistmnt m the Comracmex Lmvn,e Lax' ❑lamexempt under So, •.B&PC fir this reason' re ` Owner Date / - WORKER'S CO\/PENSKI'ION DECLARATION _ � '\ I herehy avian uadrr pen.Jty tit perjury into ul the tollfwmg JMarmlons ] 1 have and will maintain a Celnficam of Consent to wH-Insure (or Worker's Cnmpemxunr, d, provWcd Les by Sell 391nf tit Thu Labor C'u lo,dur the - .. \ perfnnnance of the work for which hit,pemm is i,aied a , ❑I have and will maintain W'orker's Compensation Insurance,as n tcd by Section 30011 ill the Labor Code,for the pclfmr a,c of be xmk Inr which this nalit 1, 1 issued,l•ly Worker's Compensation Insurance carrier and Policy number are Comic, Pobry N'.: CERTIFICATION OP EYEMI'i'ION FROM WORKERS' COMPENSATION INSURANCE fl lit,111lan need non be cort,leled II'the penml is Inr line hundred dollars r (Sr'Wlnr less) 4 I candy that In the performance of the work,for whuh Il a,per nut n......J,1 ,hall sal employ any pi:nun if any m as ai become subject,,life Wnikefs" Compensation lax,of California Date nne 1 Applicant , Nf FRA7'IOAPPLICAN r If,mtm molar,th;,Cond arm of Exemptiola,Yim should ' Q Qhecome,ub)ect to he Worker's Compensation p,it el,Ifns of w.Labor Code,you forth,nh comply with such prom,Inns or this pi,hall be deemed invoked w .^� CDN3TRUC I ION LENDINn AGGNCY e e ' a , I hereby abima thin these is a.mod(Seen lending agency for the performance - W of the work for.inch this pennn n Issued(Sec 30O"!.Civ C,1 ' Q odcf', re Lo .�. Z Lender',Add Addrc... V Q I certify that l hose read this application and vdre that the above mtfrm.umnn , ti. Fy correct I a,mo to comply with all city and r....nty nidmancea and same lax,claim, , Q C.7 ao building cotna motion.and hereby aalhnrne representatives of this city to enter upon ^ ©/. } G>a the atone-mentioned property for aspec,ion purpwe,, ,D (We)agree msavcl iademndyad keep banal..,the City of Cupertino a,mmf LI Vi liabilities,judgments.costs and expense,.blob may In any way actitm against said r U City in consequence of like granting of this plemilt. APPLICANT TANDS AND WILL COMPLY WITH ALL NON POINT �`.e ' SOURCE REGULATIONS ISSlled by: Dat Signamrc of Applicant/Contractor Date Re-roofs - HAZARDOUS MATERIALS DISCLOSURE Will the applicant It future huildmg occupant store m handle E,Aml mmrnal Type of Roof` as defined by the C. ratio Municipal Code.Chapter9 12,and the Health and Safety ' Code,Section 25532(a)a t t� ID Ill 13 No • All roofs shall be inspected prior to any roofing material being installed. Wait the applicant of future building occupant use equipment or device,which l If a roof is installed without first,obtailiin an ins action, I a ree to remove suit h;vaMOU,ter cnntnn.nent,;n JellneJ by the Hay Area ism Qualip'Manu,ement g, p �', D1°rI°' _ - all new materials for iiispection. Applicant understands and will coin I with ❑Yea ❑No' comply all non-point source regulations: I hme lead @c humrdfa,Ilat ends Itammunniwadcr ChaPtc.695 at the California Health&Salrly Code,Sceuon,25505,25533and 25534.1 undenmndthat - a' t If the lnuldmg,kfea not currently base a mmur,,than n ,i,my rerywsb m duy notify the - ....plan of the rcgmn.emtn which must be met prior to issuance of x Certificate of o rc ccuparcy. - 1: -Signature of Applicant ' Date owmar in aanaod.ed as.Iif Dan. All roof coverings to lie Class "B'•or better