04100179CITY OF CUPERTINO
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CONTRACTORANFORMATION
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BUILDING DIVISION PERMIT -
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BUILDING ADDRESS:
CAL CONSTRUCTION
PERMITNO04100179
1181 CRESTLINE'DR
ER'S NAME: -
PERMITISSUE DATE -
KANG SEOK SEO
3148 EL CAMINO REAL if"104
12/20/2004
ONE:
SANITARY NO. CONTROL NO.
(408)241-7799
ARCHI'fECTIENCINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DEC RATION
Job Description "
hay, ffirm Net 1 am licensed under rov' ons of Clupmr Y (commencing
iOScctia )of Division Sof the Businrss f Ines C.I.AnemyliceOrria
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ADD 485 SQ. FT. /RELOCATE KIT. /MS BEDRM
License a L1C.p L.,
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I un mTdmy A.C.ldyll be user az puMi)iiecordsllN\
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OWNER-BUILDETDECLARATION '
I hereby dTi. Thu 1 Am oxempt from the Cmunswo Ys Limit. Law for the
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following reason. (Section 7031.5, Business and Prorecdum Cale: Any city nr county
which requires A permit m construct, Aller, improve, demolish, or repair unY nsumum
pnor m its issuance.=,,qones the applicant ror such permit to file a signed Cu mmcnl
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Ft. Floor Area
- Valuation
thetheislicensed paoramatnmeprovisions of the Contmntor'sueenxLw(chapmr9
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(commencing with Section 7")of Division 3 of the Business and Profusions Cale)or
that he u exempt therefrom and the bard for the Alleged eumption. Any violation of
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QCCUpaDCy Type'
Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of
not mom Nan fiw hundred dollars (MO(l).
D I, u owner of lid property. or my employees with wages as chair xlc cmnpensadon,
Required Inspections --.
will do the work and the ..Co.. is not intended Or offered for sale (Sec. 7014, Business
and Professions Code: The Contractor's Limve Law Odea not apply m An owner or
property, who Wilds or improves derucon,And whodOcSAuch work himself., through his
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Own employees, provided Nat such improvements arc nolitundcd oroRered for safe. If.
however, the budding m impmvemem is said wide... year, of Completion. Ne ow be,-
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builder will have the burden of proving Nn he did not Wild or improve for purpose of
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sale).
D 1, as owner of the progeny, am exclusively contracting with licensed contractors to
Cafe:) The Co dancons n
]Obs, furowner
ceutmct the project apply of and property
ownerofprogeny who Wilds Orimproves
not whoWilds
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eta
COn=ane
whoClawdoes
who Contracts for such pmXCu with aconlncmrts)Iiunxdpursmm reek Conuaccas
r each
License taw. • .
❑IBempt under Sec. - ,BkPCfar Nis xazon
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WORKER'SCOMPENSATIONDECLARATION
I hemby aRlrm under penally of perjury, one of do, following declumions:
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D I have and will maintain a Ccnifcau of Couxcn to Aelf-insum for Workcts Compen-,
cation, az provided for by Section 3700 of the labor Code, for she performance of the
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work for which this permit is issued.
D I have and will maintain Wake,', Compensation I... u required by Section
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37Mofdo,Ube,Code, for that perfmmma of on work for which Nis permit is issued.
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My Wo aces Compensation Insurance Cartier and Policy number an,
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Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
' COMPENSATION INSURANCE
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(This section need not Wcompkred ifec permit is for a.. hanNeddmlars($IW)
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11If35.)
1 cenifv Our in the perforn.ntt of in. work for which this permit is issued. I shall at
..Ploy any person in any mentor w a m become subjeet to lha Worked Compensation_-
Laws of California. Dau
Applicant
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NOTICE TO APPLICANT: If. after making Nis CenifCau of Facmption. you chuuW
become Subject to the Worker's Compensation previsions of the Labor Code, you must
forthwith comply with such provision or this Permit hall be dcemcel reveled.
i CONSTRUCTION LENDING AGENCY
1 hembyich0 Nat ass len ding agency for du Porfdrmance of
nai issued
' the work (m which Nu permit is issued (Sec. Jtri], Civ. C.)
Leachm sNamC
Lcruenaer5 aaemlr
I ttary Net I have read this appliesuon and aux Nu the above infomation is
COMCL I agree to Comply with all city and county ordinances and sure laws relating to
building Conwuction. and hereby amhOnm mpoucnle ives of this city In cnmr upon do
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgmcuts,costs and expenses which may in any way same against road City
in consequence of the granting of this Permit.157
' APPLICANT UNDERSfAN AND WILL COMPLY WITH ALL N N-POINT
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Issued by: Date
SOURCER GUL TIONS ` Z
�' e
e-roofs
Si au c tr AP icanl/Cunuactm Data
HAZARDOUS RIALS DISCLOSURE
Type of Roof
Will Ne applicant or future Wilding Occupant store Or handle haardous mammal
a denned by the Calendar, Municipal Code. chapter 9.12, and the Health And Sefcty
ode. Section 2s532(e)]Nd
All roofs shall be inspected prior to any roofing material being installed.'
DDyes..
If a roof is installed without first obtaining an inspection, I agree to remove` -
Wilt the applicant or for building Occupant use cyuipment Or devices which
Coth havardous air Contaminant p defned by the Bay Area Air Quality Management
Diene,]
all new materials for inspection.
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DY.A
Itemmad the haranbaA materialsrequirementsunder Chapter695orthe Califor-
nia Health&Sufmy Coec. Sections 255(15,25533 and 25534, 1 understand thuilNe Wilding
does not Care t have • an L Ont it d my mApdo'"Olily m notify the occupant of the
myvi ams bi must be c ormissumccofaCc emeorCecupancy
Signature of Applicant Date
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All roof coverings to be Class "B" or better
Ow draurh i[cd agent m