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04100051 CITY D—P CUPERTINO 'fit"`"`°`" ��' 4 f BUILDING DIVISION PERM , C®NTRACTQR I FORMA f 6M1,.,.=i� .M .y- w BUILDING ADDRESS: WEI KAI KO PERMIT N'04100051 OWNER'S NAME: PERMIT UZUE DATE WE KAI K8'12 SNE: SANITARY N0. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: PBLDG ELECT PLUMB MECH ]re s" 51". " `a aOp LICENSED CONTRACTOR derpoo ions of hap JobDescrip[ion - �i�w I hereby affirm that 1 am ftle Ba under nal P afro Of Chapter 9(commencing with Smdion7IX1U)o(Division3of dm Business anal Pmfcssiuv Code.atW myliccrse is -eau, in full force and effen. REMODEL (2) BATHRMS tJ p12? License Class Lic.0 n�p Dam C'S DELL /a �� ARCHITECT'S rrr�wwe��� p ppp p 1 \ry\`�_l) 9�1 I understand my plans shall W used as publie«coNa �� '1A 11 ©�� DUI❑1 ILh l u. Licensed Pria.iional S OWNER-BUILDER DECLARATION 1 hereby atllrm that 1 am exempt from the Contractor's Licensee Law for the o o following mason.(Section 71131.5,Business and Professions Cade:Any city or county ie which notifies a permit"I ennsauer, her,improve.dcurchib,or repairany someone prior to its issuance.also mqumer,the applicant for such permit to rile a signed statement t?'< tNt he is licensed pursuant m the previsions Of the Conuamor's Limns faw(Chapter 9 Sq.Ft. Floor Area Valuation (commencing with Section 7")of Division 3 of the Business and Professions Code)or i that he is exempt thcafrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any appimantfor a permitaubjecu the appIhouL10 a civil penalty of 3ALTAIet"cr00 Occupancy Type not more Nan Bve hundred delta.(SSW). ❑1,as owner of the property,or my employees with wages ss their sole compensation, will do the work and the structure is not intended or offend for sate(Sec.7W,Business Required Inspections and Professions Code:The Conuacmts License Law docs not apply to an owner of q P property who builds or improves thereon,and who dao such wink narrator through his _ ownemployees,provided that Curb iapim menu arc not intended oraRentl for.[.If, however,the building or improvement is sold within one year of completion.Ne owner- builder will have the burden of proving that he did not Wild or improve for purpose of sala.l. ❑I,as in,of Be pmpeny,am exclusively Cartoon,wit licensed entrust.m consumer the pmjrct(Sce.7044,Business and Professions Code:)The Conuae re's Li. entre law does not apply m an owner of property who Wilds or improves demon,end who caramels for such projee¢with a cottontails)licensed pursuant re Be Comreetoes License Law. I am exempt ,under Seo. B 6 P C for this reason Own \ d k Date O KER CO PENSJ NDECLARAT I hereby affirm under penalty of perjury tine of the wing declinations:21 ham and will maintain eCcrtifiam of Coosem.self-insure for Workers Compcn- tion,Is pmvided for by Section 3700 of the labor CMe,for the Performance of the work for which tis pc.I,is issued. 0 1 ham and will maintain Worker's Compensation Insurance,az required by Section 37W of the labor Code.for un ado m orce of me work for which this permit u issued. ' My Workers Comp e atinto au nO merand Policynumta,me: Cartier. Policy No.: C EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - - frassonian head not Wcamplomd if the Permit is for one hundred dollars(SIM) it,I..) 1 comity that in the performance of the work for which this parmir is issued,l shall not employanyPe Dain nyman erso asm comeumjcCtu IIWWo,ke Cmwpcm.uo Laws of a' Dt APPIk NOTICE TO APL m :Ibmr aki des Ccnific,m of Exemption,you slarild me subject m the Workers Compensation provisions of the labor Code.you must .J rawith comply with such provisions or tis permit shall W deemed owroad. Z y CONSTRUCTION LENDING AGENCY (. 1 hereby alum tat tem is a construction lending agency for the Performance of X ,1 the work for which this Permit as issued(Sec.3097,Civ.C.) Lenders Name Name ILZ Lenders Address — U Q 1 certify d o 1 ham rend this aproicmirm and setae that me sham iafr m,auun is V. r contact.I agree to comply with all city and county ondininces and sure,laws mlating to pU building construction.and hereby authome«presemadver of thin city to cnmr upon me above-mentioned property for imiccuon purpose:. (We)agree to sam,indemnify and keep harmless the City of Cupertino against F'raq liabiliues.jutlgmcnb.eosu andexpcnsrs which may in anywayamna ageirar said Cit U z in N =UNDERSTANDS ofthe granting of this permit. TWILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA74ONS. �. 4— Re-roofs namrc of Ap icon oR1` Dam HAZARDOUS MATERIALS DSpou or E Type Of Roof Will to applicant me forum building occupant more .handle Health andSafrimperial az dc0ned by the Cupertino Municipal Code.Chapter 9.12,and to Health and Safety 41 Code,section 25532(0+ All roofs shall be inspected prior to any roofing material being installed. 0 Ycs No Will the applicant or furore building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit han otous air rnntaminaau a£dcfined by the Bay Area Air Quality Management all new materials for inspection. DisaicR ❑Ycs Nu 1 have mad the haoaNnusmacrialsmquimments under Chi per 6.95 of me Califon no.Health tit SafnyCala.Sactiaa 25505.25533 dM34.I uodcrear lthat ifmc Wilding does not currently ham a¢rant,tut it is my res msibility m notify tiro a'supant of me req�enta which in bcmipA- iss�c fa cemrr,mnrorrtrPinn'. ' Signature of Applicant Date owner or anmonzc as=n Date All roof coverings to be Class "B"or better F eC� & O 6 s` dtJ,ACUIRVApP'EWdffHlfflEMMOR U cUPERfiNo!c�l�Sr �QUfOROt" •W SCSNED ecifications 'MUST This set plans and -N oe kept on ft lob at all times or,and lterations ►atvfttl to make any n permission fWM on same w D ut written the building Pt•., of Cupertino. ® The Stamping of this plan end speaficetione ;HALL NOT be held to permit or,rovb sl ars approval of the violation of any P. ,t anv City ordinance.01 State taw. pCEr - - . ty^ i -1 . - - �. CT 0 2004 i i CITY OF CUPERTINO ' . � � •' ' ` BUII,DINC DIVISION PERMIT CONTROC� TOR INFORMATION BUILDING ADDRESS: WEI KAI KO PERMITNOO4I000SI OWNER'S NAME: PERMIT ISSUE DATE WEI KAI KO 8,12 IE: SANITARY 0 CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO SLOG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONTRACTORS DECLARATION IOb WALED C 1 hereby off int Nn I am f 0ucd imes provisions or Chapter 9(rommensi is _ b with Scnion]OfXl)of Division3uf NC Businca and Professions Code.end myliccnsc is inmBforceandeffect. REMODEL (2) BATHRMS License Clu, Lic.N Z F w Dau Contractor qq ARCHITECT'S DECLARATION JAN AI ffQop nee I understand my plansd JAN shell te useas public aid. L rV1 7yU G Licensed Professional rrrrrr��� S OWNER-BUILDER DECLARATION lea ft sell rs 0 I hereby.(Bent that 11. exempt from dr COnuamru License Law for cit �np1�\Yf V�Isl\\\\Vlfll) 0 o rallowine moon.(Section](D L5,Business and Hvfessions Crude:Any city Or county Im which requires a permit to consumes,alter,improve,demolish,nr.,it any structure _ rZaprior to its issuance,also requncv the applicant for such Permit o rile a signed antemmn that he is licensed pursuant to the provisions of the Comaictur's License Law(Chaprr 9 Sq.Ft.Floor Area Valuation (commencing with Section 7")of Dividon 3 of the Business and Profeuinns Code)or .- that W is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applowiL 10 a civil penalty of 3 A(P eaflitcr0 0 Occupancy Type not mote Nn live hundred dollar(SSW). ❑I,as owner,and for smty,m is employees with weeds r (Sec. sole compenmlon, will do Ne work and the Tamm is tor's Lic ed or offered s not apply in an.Business and Professions Cam:The Comnaclon,License Law docs not apply lf an owner is Required Inspections Own maplo s,provi improauchicon,andwbo sm not intended ntwork oroffredthrough his owncer.the uiprovimd that such impmmmcntt in not ou ofc orORemd forthe ow.r- huilder citbuildingorimprovementissaid withinone year in improve for the owe of builder will have the burden of proving Nat he did not build m improve for purpose of sale ❑1,as owner o(Ne property,em exclusively contracting with licensed conuecors to comma the project(Sec.]Baa,Business and Profusions Code:)The Cnuacnr's Li- deme law does not apply to an owner of property who Wilds or improver thereon,and who contracts for such projects with a mntracmr(s)licensed pursuant in Ute Connector's License Law. ❑I an exempt under Sec. B&P C for this reason Ow —Tn 1 J n CO \ ON Data —. 0 KER CO PENS ION DECLARAT 1 hereby arrom under penalty of perjury oa of 0th wing declarations: - haw and will maintain aCeniOcmte of Contin to self-insure fon Worker's Comam az provided for by Section 37W of the IaWr Code.for me performance of the work far, which this permit is issued. ❑1 ban and will maintain Workers Compensation Insurance,as litigated by Section 39W of the Labor Code.for the nformanec of Ne work rnr which Nis permit is issued. t My Worker's Compe anon n rocir end Policy nummr tic: Carrier. Policy No.: CER EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thuxction need not lecompleted if the permit is foronchu ichad dollars(110Q, ' 01 lass.) 1 certify Nat in Ne performance of the work for which this permit is issued.I shall not cmpheyanypcp�ni nymn mnasw omit subjmualWWorkers'Campanian Lewa I as D Applic NOTICE TO APIanpans Nrs Genion of of Eacmphi on you sham omit h compo the Worker's Com s Of this n arms hal of Nit tabor Com,you mum ., nhwilM1 comply with such provisions or Nis permiuhallWdeemed invoked. ZN CONSTRUCTION LENDING AGENCY E-w 1 hereby aMO.Nm there its em anximn lending agm ey for the pcifonanx or a thc work for which this permit is issued(Sm.3097,Civ.C.) til Lender's Name y Z 1<nmrs Add. V O I certify Net 1 haus read Nis application and save that Ne above information is ' U. F conch.I agree to comply with all city and county onfinances and state laws relating e pU building construction,and hereby audionoc mp¢tentafivds of this city to enter upon Ne �Ua aWn mentioned property for inspection purposes F4' babilitiet,judgagree nu.costs and exto save. m(ynd keep meay its anyist theway accmc aity Or gainst sair. d Ca this Pew t y gain y t.>Z A APPLICANT of UNDERhe STANDS of this permit. ^ APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCE REGULAqONS. � Q— Re-roofs name of Ap oar o111mebr Dale HAZARDOUS MATERIALS DISCLOS E Type of Roof Will the applicant or room building Occupant sham or handle harafdous mau ial as conned by the Cupertino Municipal Code.Chapter 9.12,and the Hcalth and Safety Cade.Semon 25532(a)? El Yu All roofs shall be inspected prior to any roofing material being installed. ` o Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove L lineations air conummm0ned by Nit Bay Area Air Quality Management all new materials for inspection. ,trio? ❑Ycs Nn I have read the hazardous materials mquircmcnu under Clunc,6.95 order Calif.,. ? nia Health&SdetyCodc.Sadms25N15,25533nd253a.lun&n=dNai(Nc Wilding docs not currently hoax a tenant,than it is my res nsdid m noo ly the ocegpnt of Nc ;;!a!!cMgwhiehm WmatpriY .ccrdBeareorOeegpaay. Signature of Applicant Date Owner ar.mmnria.e ager oars All roof coverings to be Class"B" or better