01120072 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Be iLDINO ADDRESS: PERMIT NO.
20198 CANIARDA CT PRO ROOFING 01120072
OWNER'S NAME: APPLICATION SUP DATE
•YUM SU I AND YOUNG IT TRUSTEE & 100 BLOSSOM WAY 12/18/2001
:ONE: SANITARY NO. CONTROL NO.
(831) 440-9100
o at0 C ARCHITEC(ENGINEER: BUILDING PERMIT INFO
z u EBLDG ELECT PLUMB MECH
yah u u (_�I
m i LICENSED CONTRACT)R'S DECLARATION Job De$CflpptlOn
{a-p Ihereby affirm that l am licensed under provisions of Chapter 9lvmmencing TEAR OFF APPLY ob DF I'1'
:_t; wish Section7(M)of Di,ismn3°(she Rusinus and Pro(..inns Ccdc.and my license
is in full force and fc
a < U<<n.e)v� `"9 Lie n Go 3 S 3
7 L a v Cantrscmr
O ARCHITECT'S DECLARAT ON ddb
�j 1 understand'
my vlans shall be used as publlo records
iN
Va O O Licensed Pr°feasinnal
X-c. OWNERBUILDERDECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law forte
a a following reason.(Section]0315.Business and Professions Code.Any city or county 2 2 O O
Y which requires a permit m construct.alter,improve,demolish,or repair any structure
i3m pion t I q th ..herm fareuchpernit m fl imed statement - - _..._.. _
We,he is liesins,c][pursturm totbe positions of the Continuities License La (Chapter!)
(commencing withe titi 7000)of Division 3oftheBuamess addNufasa ns Cade) !'f:sisi.Y'1RA_GE1!4U£%! ";ty 1'p-"y�',. . Valuation
ter that he nkeaampt theatfrom and the basis for the alleged exnnptice.Any violation
-of Section]03 f.5 by anyapplicant for a penton subjttn she"pplicam to a civil penalty
I not more than:five hundred dollars asap. 30!NPNf W)WE '..'..I'T•", Occupancy Type
C I,as owner of the progeny,or my employees with wages as their sole compensation,
will do the work,and the suucmrc"-is-not intended a,ofiered'fpr sale(Ser.70,l.. INSTITA
Business and Professions Code:The Contractor's License law does not apply to an 601 — ROOF TEF3d?luQE1rnspections1' `
awne
r ter prnpeny Who builds of improve.Bnaeon,and who a«s such work himself 6 2 — ROOF PLYWOOD NAIL
or through his own employees.provided Nat such improvements menls ore not intender or
comredfon sale.If,however, he l have
n - - ._ tis sba within one year of --'"_"' '" . - --- - -- -- ---- -- - -- - - -- --
g°rimy'°"`""" r 603 - ROOF BATTENS
complaion,the owner-milder will have the burden of proving the,he did nm build or
improve for Purpose of rale.). 604 - ROOF IN-PROGRESS ,
_ r 0n as ownerpr the propene,am exclusively contracting with denuJ contractors m '- - - --- -- -
nswct the erjen(Sec.7011,Business and Professions wo Code)The Contractor's
aLicense. Lo d m apply man owner of progeny who builds p , ..the ...
nd.who re tracts for.such Prot«tui with a comracmr(s).bc ud-p m to the . .. .. . ... .. . ... .. _, _ f. -.
C ntr t License taw.
❑lam toder Scc ,B&PCf this reason
wn
De S Dae
WORKER'S COMPENSATION DECLARATION
1 heathy affirm under pcwhy of pc jury one of the following declarations:
❑ I have and will maintain a Ceni care of Consent to self-insure for Worker's /
Compcnsaima as, provided for by Seen. 37W of the Labor Code, for the
prommtance of the work for which this permit;s issued.
❑1 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,Compet 1 n Is tamer e�nda P(p�lazy "be,,...
�
Ckariie S I``�'1 )sli Policy No / J%''.
CLRTIFICATION OF,EKEMPTION FROM WORKERS
...,•�. ,, t. .. COMPENSATION,INSURANCE`;.
'(This section necdnrn be'completed if the permit is for one Hundred dollars •'' '• Ji s„•-__ _--
(E100)orlusJ
Ic of that the ....v........___ a-._.. .- ...
shift n t employ nY R any m to be sublec(t th Workers'
Campo. t ffalf pate &b
Applicator a"f1!']•I C.-I
NOTICE TO A PLICANI':1111111J.� ager makmq this Cenifcatx of Exemption,you shoulJ -
Z tiecome subjcm m the Woikdr's Can
pcnicamn provisions of the Labor Code,you most ,
C) forthwith comply with sueb provisions or Nis permit shall h deemed revoked.
•
CONSTRUCTION
CONSTRUs LENDING AGENCY
' t
I's1 r by frm the, hen is a consw u n lending for the performance
hewookforwh chthx gems is issued(Sec. ],Cis.C.)Lenders Ndme -a- w -
Lender's Address
t
4+,-iz I ccnlfy that I have read this application and nae that the above information o, -
[,� Loeica'.I agree m comply with all all and countyorho nces and ,are laws relating
0 U to Wilding construction,and hereby aumoBie rePreuntmi.es of this cit,.m eater upon
>:-W the abase mealmired property for inspection purposes.
�r d (We)agree msns,indemnifyandkeephormless the Ciiyof Cupcnmaagainm
L h liabilities,judgments.cars,and apenses which may in any way acerae against said
V z City in cnnquar
scee oflhc gmaling cf this permit. '
APPL A UNDERSTANDS AND WILL COMPLY WITH AL NON POINT'
�SOL B��ULATIONS,: - Issued by: Date
. ih� �.,,c�—� t2�18��
enaneearnpphcanUCraernemr Re-roofs
}; HAZARDOUS MATERIALS DISCLOSURE it"
Y W H the applicant of r°tom lauding burcyc m atom or hoddle-hrilr6ow material .Type of Roof _
as den ed by to Cupertino Municipal Cale.Chapter 9.12,and the Health and safety s __ • ._ _. _- . - ...—.., ..-. c.
Code.Section 25532(7, I f's ' d.I . }p, _^`5 .'• ', , r• ;uJ( ,• ._
'CYes!
_.All roofs shall.be inspected prior to any roofing material being installed. _
W ll me applicant f t bold' goccupant o equipment devices which If a roof is installed without first obtaining an ins ectioti,'I'a ree'to remove
it horrendous contaminants defined by me ByArea Aa,Qalt Mana'emrnt
Quality g g P g
all new materials for inspection Applicant understands and will comply with
Dyesa all non-point source regulations
I his, ad me hozarchrovorchmands rry rem t code,Chaps 1695 of the
C I(om a H' hh&S fdy COJe Sccfons 25505 25533 d 25534 1 nderst bo Nat
f the budding does not comently have a tenant tom it is-my responibitty to notify the - - ”- - --
occupant of Ne rcipiusb oma which must be met prior to issuance of.a Cenincate of
„ Occupan y.. .,,1 ..
� '. -----� i2 Tg 'V- ` Signature of Applicant Date
o ter aulhwizea agent, Dat Al] roof coverings[o be Class "B" or better
OFFICE -