08050020CITY OF CUPERTINO lya,aT
DIVISION PERMIT
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BUILDING
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SMART WINDOWS & DOORS
PERMIT ND.
08050020 ,
:R'S
PERMITISSUE DATE
YU KOU AND LEE—CHUN
21615 HESPERIAN BLVD
05/01/2008
M:
SANITARY NO. CONTROL NO.
(510) 88.-6010 '
ARCHITECTYENGINEEtt:
BUILDINGPERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
j LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm Nal I un lismed under Provuiou of Chaplor 9 (commcnciny
withsation70(gl)er0ividan3orsiaB aMProfesyg ee.aMmyliccn¢u
in full Tome
RPLC 13WNDWSrRTROFT LIKE4LIKE& RPLC EXTNG PATIO
i ane „-j7 G -y 65
License s
DR
W NEW CONSTRCT
Dole
ARC1mEL75 DECLARATION
I I note ou n l my Planar shall Ito used as public records
Licensed Professional
3 OalNEmBUILDER OEthe
ConTION
Ihemhy .(firm Incl 1 am attempt from the ConurelCodLicense:c Lew o the
county
muoa RD LS, Business,iand Prefectures Code: Any oily or c
followwhich
structure which rtquima • permit re construct, .lar, Impmve, demolish, fi repair try suuetum
Permit t improve. de
Prior bits issuance, sive requires the
C sof for each ContractPermit wfikasigned
Sq. Ft. Floor Area
Valuation
.aw(ChNmenl
that heislicensed puraunlmNcprovisioNoflhcCenuacmr'fllaruclaw(Chapar9
Povisio
3 Business Professions Code
$10000
(commencing with Section 7=)of Division ofsilo and or
that he u muse,, therefrom old the basis for the alleged esempdoa Any violation of
e.At�T Number
32643019 A
Occupancy
Pane Y Type
Session 7031.3 by any applicant for a Permit subjects the applicant to a civil penalty of
not in.. Nal five hundred dessert ISM
17'
� i, u owner of sik proPeny. m my employm with wages u Nov sole campenaasion.
Required Inspections
sure aolnewon BYLnetf
atNQWeilnc s
Lusmsa Lawmen OutA(sec.] sem owns
code The Contlacmff Litmrtm law dues oat apple tf
and Codln
q P
r t is
arty who artawho aassahwort nimaelferthrough nu
pmpenY whobisildomimprovesth
impr
own employees, Provided that Such improvements ere net intendedflo Orn@red roulade. er
however, the improvement u sold
did ora year of wmple for the Ownu-
Ou a
buileu will have, de drNa of pmrinB that h die vel bttild m improve (m pugaaa of
ave, the
uaJ.
❑ I, as Owner of the Property. am exclusively contracting with licensed conuenon b
conmmucl the Miles (Ser. 7044. Business ave Professions Code:) The Contrxmr's Li.
,
cruse Law does not apply m an owner of Property who builds or improves thereon, and
who contracts for such Projects with a contractor(s) licensed Purs unt in do Conuaclo's
License Law.
❑ lanesemptunder See .BkPCforthuwom
n
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pevaltY of Perjury Oa of the following detlaadone
1 nave and will maintain a Certinesm ofConttnt m self -insure for workerscompen-
sulon, u provided for by Section 3700 of the labor Code, for the Perfornnelta of the
wak for which this permit is isru C
❑ I have and will mainWn Workers Compensation Terminate. u nequime by Sceaon
I]1 of roc labor Code. for the performance Of Ute woKfor which this Pemlituiuuee.
'
My WOr CC°�pe�'pdon lnwf^�e curio era Policy num rare:
Cartier✓' r' w"w sal Policy No: ADO DI
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
(fru mire nerd an, be completed if th Permit is franc hundred claims (2100)
or kis)
1 certify that in the performance of Ne work for which this Permit is issued. 1 still not
employ any person in any manner so as in hosanna subject to the Worim' Compenfasioa
U. of Catifcmia Dare
Applicant
4
NOTICE TO APPLICANT: IL afar making this Centftcalo of EaomPrion, you should
become subject in the Worker's CmnPenantion provifioru of the labor Code. you most
r forthwith comply with such provisional or this parmit shall he d timed rewked.
5
CONS ucnON LENDING AGENCY
1 hereby elf. Thu there is a commucdnn lead!, agency for the peffo rumen of
y the wort foe which Inn Permit is issued (Ser. 3097, Civ. C.)
Lenders None
Lendeh Add.
I cadfy that I have mad this application hold sera this the above information is
connect. l .gra in comply with all city and county didinaaes and state laws relating to
Wilding conauunion. and hereby authorise npreannudvu of this city to color upon that
alWve-mmndoad property for inspcnion puryecal.
4 (We) agile to nae, indemnify and kap harmless sive City o(CupeNno
d City
1. enides.ludgmcnu.cvus .z expresso. which cry in any war acus gainasaid City
A consequence of
UNDERTA
� APPLICANT UNDERSTA AND WI L COMPLY WITH ALL NON -POINT
SJ
Issued by: Date V�-
Data
Signature of Applica1102A
Re -roofs ,/„D
DOU
HAZARDOUS AIS DISCLOSURE
Type of Roof //
Will Ne.nt apPlieaforum Wilding asupapt m handle an
r 9 1
9.13. W sise Han"'
Seely refined by sin Cupertino Mu d"Pe Cove. Chapter
Han"' andSafely
. Satiea 35532(.)?
Yea 110
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will da applicant or future Wilding navpann see c4ulpment or devices which
it nuarclnes air contsminanu u donned by the Bay Arta Air Quality Management
all new materials for inspection.
Dim ct]
❑ Yes ,f� �NO
1 have real Use, hxaallous muni.], na,4ameo3undo Chrpar6.95 ofdie Cdif s.
nu HcalthkSeciyCodc, secs' 25333 and 35534.1 understood thelds, building
does; I the oreupenl of th�1ea
have Nath' mYres_Wr.
sw carts u, orY
Y Lf �uCh era CCrllfKla ofoa�p��/,al
�
Signature QfApplicant Date
All roof coverings to be Class '%q" or better
Ownarm.ifirmo dagent mm