06070184 CITY OF CUPERTINO 6
BUILDING DIVISION PERNIIT CONTrReiCTOR.NORMA ION"
w t,hae.;+f.'�uf3h .`«°"w,;r» a: .ce• av°n,
BUILDING ADDRESS: SEAN YANG Ps'gMITND'06070184
1189 CRESTLINE DR
ffR'S NAME: PHtMRISEUEDATB
SEAN YANG 09/08/2006
F,svNE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
t� t�
�ap LICENSED CONTRACTOR'S DECLARATION lob Description
I 1 hreby affirm that I am licensed under pmvisiau of Chapter 9(Commencing
with Secdon7000)of Division 3 offt Business and Professions CadC.and my license 13
InflfifaRCIUMICUCCL ADDITION 491 ' FAMILY ROOM/BATHROOM
gz oemfeGl`" Contractor REMODEL EXISTING BATHROOM
4 ARCHITECTS DECLARATION
i a 1 undersand my plans sha0 be used as,public words
iy
ep Licemed Profmitnel
sy OWNER-BUILDER DECLARATION
1 hereby affirm that I am cscmpt from the Connamm's License Law for the
00 following reason.(Section 7031.5,Business and Profnasions Cale:Any city or county
i$ which requites a permit to Construct.slot.Improve,demnlsh,or minor any structure
•iy
poor wits issuance.also requimthe applicant rarsuchpcmaiitofile s.ignedsharememVal1106255
G dtu he is licensed pursoant to de provisions of the Conuxwfs Liccum Law(Chapter9 Sq.Ft.Floor Area Y'
<�$ (commencing with Secdon7000)of Division 3afthe Busimemand Prolerdom2S
cedc)or 105 r
`;.. that he is Numpt ihrefrom and the basis for the alleged cumptim.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ppN Number Occupancy Type
not more than Eve hundred dollars(5500). 3 6 225006 . 00
Q 1,u owner of the pmpesty.w my employm with wage u their sole eompemdon,
will do Newark and emsuunom hoot samad oraffrard forsalc(Sec.7014.Budnm Required Inspections
and Pmf unums Cade The Contractor's License Taw dm oro apply w an owner or q P
property who bu PIDr ter impmvea thereon.and wM dm suers wile,MmvSf or through his
".employ.,provided dist such improverems me tmti eanded ortffcted for aide.If.
however,the building or Improvement is sold within one yes,of completion.the owner.
builder will have the burden of proving,Nat h did not build or Improve for purpose of
am).
®®1,u owner of the property,am eaelu ively contracting with licensed mntnems he
fonutmm the prejm(Sec.7044.Business and Professional Cade)Th CmUa 5 U- .
Cense Law dos ria apply he..owner of Property veno Wilds or Impmvea threw.and.
we,contracts for ouch projects with a conoactor(s)licensed pursuing to the Contractile,
License Law.
Q I am exempt under Se B&P C forthis Mason
r Date a— "D
WOR 0.'5 OMPENSATION DECLARATIO
I hueby affirm under peulty of perjury oro of the fallowing daclara omo:
Q I have and will maintain ACenifteaa of Common It selfduure for Wortme,Compeer
cation,as provided for by Section 3740 of the labor Code,for the perfomaac of the
work for which this permit is issued. -.
Q 1 haw ad will maintain WmkN/a Compensation Insurance,as required by Schon
3700 of the labor Cask,for she performance of due wosk for which this Permit is issued.
My Work s Compensation Insurance Carier and Policy number art:
Carder. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need Out In completed lithe permit Is Bottom hundred dollar(SIM)
.,less.)
1 Mnify dent in the performance of the work for which this Permit is sued,I shall not
cmployanypersoninmymumcreounbccamesubjen}olh Wo Campewtlen
laws of Califamia.Dai�_�7p�4 �- Q
NOTICE comesubject
ct LICANE Com king the,Cisions or n Exemption,you a must
become subject m the Wohcfovisons or ns previsions of the labor Cade,you mull
,JO forthwith comply with such provisions or Ne,permiuhell be deemed revoked,
r r~�.. CONSTRUCTION LENDING AGENCY
[•+ Ihereby alfimtOw them Is a Comunicdnn ending agency for the p ficomarwe of
0.'> he work for which this Permit h issued(Sec.3097,Civ.C.)
W�Q Isndmfs Name:
] Lenders Addreas
C_3 0 1 certify that 1 ban mad this application ame soon that to above lot ..ten h
Lg t" Corea.I agree in comply with all city and county ordinances and sum laws relating to
0 U building convection.and hereby authorial reprosenairea or this city to emir upon the
k1 atuve-mentioned property for immcdon pugmsea
P. (We)agree to sew,indemnify and keep harmPCs the City of Cupertino against
r•t 1.'n liabilities.judgments,casts and expenses which may in any way aecae against said City
U In consequence of the granting of this permit
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �-
SOURCE REGULATIONS. , �j/tA
)2 " // Re-roofs
Signmureof AppImandConuMChZ�/ V V Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllcantor future building oneop oLRCre or handle haallous material
as de0ned by the Cupertino Municipal Cade,Chapter 9.13,and the Health and Safety
IF.Section 355324)7 All roofs shall be inspected prior to any roofing material being installed.
C]yes R NO
Will the applicant or forum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardou air contaminants as defined by NC Bay Area Air Quality Management all new materials for inspection.
D s tint[
❑Yen )0o
1 haw mad the hauerdnusmaarials requirements under Chapmr6.95 of the Califon
ria Heat"SafetyCock,ScuMM25505.35533 and 25534.1 understand Load!Ne building
dm not currently haw a ananL that it is my responsibility a notify du Occupant of Ne
requirements which m met p,�I '`a enar.cerureakoroccupancy. Signature of Applicant Date
g�� '0 6 All roof coverings to be Class"B"or better
Ownerorauth rbeda rat Das'