05020073 CITY OF CUPERTINOnngxa^K'�xa»:=a+
BUILDING DIVISION PERMIT ,dC0.NTRACTOR IINFQRMATION
BUI LDINGADDRESS: SCL CONSTRUCTION CO. n PEaMITN005020073
s
OWNER'S NAME: PERMIT IS5UEDATE
KEVIN KUO
E: SANITARY NO. CONTROL NO.
(650) 678-8311
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_00 LICENSED CONTRACTOR'S DECLARATION
a do F I lnm Li
icby Ofirm that l acnv.d under Provisions of Chapwr 9(commencing Job Description
$ with Section 7")of Division 3 of the Busircn and Profession Code,and my imirece is
p a inhdlform and effen. ADD 975 ' (MS BED/FM .RM)
j y�? License Class Lic.R
F Date Comncmr
tl ARCHFTECPS DECLARATION
< I command my plans shall W need u Public milord
isyU
30 Licensed Professional
3 OWNER-BUILDER DECLARATION 11 I� (I {�
i I hereby alTirm that I R cxcmpt R D ibo DECLARATION
License law far the Illlh� FU'\\I�(/y/fes\\\U IL77�i Il{`Lf�-�-,
00 fallowing rtuon.(Section 71n 1.5.Business and Profs ions Code:Any city of countyLn
I
m ff which requires a permit to construct.alter.improve,demolish,or repair any structure
yai prior to its issuance.also myuirn the applicant for such permit to file a signed sotemcnt g fl
i< that he isliesedpursuantrothepowisio.ofthe Contractor's Liccvclaw(Chapter 9 Sq. Ft. Floor Area Bio�ofls Valuation
(commencingwild Section 7")of Division 3 of the Business and Professions Code)or
y $ thin he is emmpt therefrom and the them for Ute alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a a civil penalty of 3 G1M2 Anber0 0n Occu ane T
not more than five hundred dollars($500). 11 tl P Y�Type
i,uowar a(Ue Propeny,amY employes with wguatMir sole compensation, R ' n(I hit. fl C=;/
will do the work.and the swctum 0 not intended or offered for sale(See.7044.Busiest.. Re aired Ills eCL10DiV �-i
and Poofessions Code:The Contractor's Liana Law does not apply to an owner of q p
Property who builds or improves thereon,and who does such work himself or through his
mvn employccs.provided that such improvements are not intended or offered for sale.If.
however,the Wilding or Wpmvemenl is sold within one year of completion.Ne owner.
builder will have the Wrden of proving that In,did not Wild in improve fm purpose of
alt.).
1,as owner of the property,am exclusively convecting with licensed contractors to
construct the project(Sec.70s4.Business and Profession Code:)The Conuactar's U
cone law docs not apply to an owner of properly who Wilds or improves themun,and
who contracts for such projects with a conwIDlor(s)licensed pursuantto the Contractor's
License law.
❑ tom cx/cmy��n�d reset. / ,B&PCfor this....
Owner b Date _ -
WO0.I. 'S COMPEN ATIO LARATION
1 hereby affirm under penalty of perjury an of IW following declnotionic
have and will maintain a Cmifote of Consent to self-insure for Wortds Compcm
=hail,n provided for by Section 37M of the Labor Cade,for the performance of the,
work for which this permit is issued.
❑1 have and will maintain Wufkeh Compensation Insurance,as myui ed by Section
37M of Ne Labor Code,for do performance of the work for which this permit is issued.
My Workces Comperwadon Insurance carrier and Policy number art:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need not W eumplewd if the peomit is Forane hundred dollars(5100)
nr teas.
1 mod iv then in the porfunnaneo of to work for which this renmil 0 issued.I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Lava of Calif D'ytp /
Applicant U
NOTICETOAPPLIeA�: iter making this Cemficnc of Exemption you
become sobjat to the Wohef a Compertsnion provisions of the Labor Code,you must
.,z faMwith cnmPly with such provision of Nis permit shall bo deemed rewkcd.
zO CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that there is a construction lending agency for the performance of
C! the work for which this permit is issued(Sec.3097.CO.C.)
W 0 L endcr's Name
r7 z Lender:Address
U Q 1 certify that I have read this application and sure that the about information is '
W r correct.I agree to comply with all city and county ordinances and sow laws miming to
0U building Conswnion.and hereby euthono,repraenoti.ea of this city to enter upon the .
r W aMvo-mcndaned property for intramural pulp..&
(~ C. (We)agree m save,indemnify and keep harmless Ne City of Cupertino against
N liabi India,judgments,costs and expenses which may in any way soma,against said City
U in consequence of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
SO IRE REGULATIO S.
7 „,2-,,. 411'13Z� Re-roofs
�hgmhdrc of Applicanti ontra<mr Date�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fuwrt Wilding cm.prantamm of handle hevallon maerial
as topped by the Cupertino Mumci at Cade.Chapel 9.12,and the Health and Safety
Code,Schon 25533(4)?
Yes All roofs shall be inspected prior to any roofing material being installed.
11
Will the militant or tonne Wilding occupant ueecquipment ofdevim which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants as defntd by the Bay Arca Ain Quality Management all new materials for Inspection.
District? \.
❑Yes /d-'Lw,
I have road the bsNons mnerials requiremcros under Chapter 6.95 of Ne C ldrrr-
niaHealth&Safety Code.Section,25505,25533 and 25534.1 undersand pan if len Wilding
does not eunenty have a worm that it is my responsibility to nod I the Occupant of Oc
requircoems which must W met pool to issasne of d Cmificale or gecuparey. Signature of Applicant Date
All roof coverings to be Class"B”or better
.04&r read agent Wo