05070164 CITY OF CUPERTINO
BUILDING DIVISION . PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: SCL CONSTRUCTION CO. PERMIT NO.05070164
7592 �4nm.ANT)RRRY PT
OWNER'S NAME: PERMIT ISSUE DATE
KEVIN KUO 1664 SAMEDRA ST ---O-7Z27/200c;
NE: . SANITARY NO. CONTROL NO.
650) 678-8311
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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_Oo LICENSED CONTRACTOR'S DECLARATION
(m1 hereby affirm that 1 em licensed under provisions of Chapter 9(commencing Job Description
tZ wI'
Seed..7(XXf.f Division Sof the Busing and Profession Code.md my license u I
in ran force and erceL rj-/ REVISION-FROM HIP ROOF TO GABLE ROOF
j Liow Clus ' Lic.p "
=a,o oak. u Contractor NO NEW PERMIT-IN HOUSE ORIG $#05020073
tJ` AR HITECTS DECLARATION
c$et< 1 understand my plans shall W used a public records
Om '
Licensed Professional
g OWNER-BUILDER DECLARATION
I r I hemhy affirm that I ma exempt firm due Cmartmo roc License Law for the I
_p 0 following moon.(Section 703 L5,Business and Professions Code:Any city or county
<m 9! which requires a Permit to construct,alter.improve,demolish,or repair any structure
°¢y prior to its issuance,also requires tW applicant for such Permit o file a signed statement
< that he isliicensedpursnattoaw oreiumaoftheCaaua=our,uecm.Law(Chapter 9 Sq.Ft. Floor Area Valuation ' $0
y-a (commeu ncing with section 7")of Division 3 of the Business and Rotations Coot at
that y $ at htl' exempt therefrom and tae bats for the alleged exemption.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
.at mm6 man five Waidrea dollars(5500),:. 36229010 . 00
❑1,as owner of the property,or my employees with wages a their sole compcnadon,
will do red work,end red swcmrt is not intended or offered for safe(SIL.]014,Business
and Profession Code:The Conmcmrs Liccne law does not apply m an owner or Required Inspections
property who buildsor improves thereon,and whodoessuch work himself or through his
own employees.Provided mat such improvements we not imnWed moffered fmaak.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have res burden of proving mat be did not Wild or improve for purpose of \
safe1.
❑1,as owner of that,See 7W.
,am exclusively contractingofess ,with licensed cu.ex m
contract the es not (Sec.o in Business and property
who Wilds
Code:)The Canoac on, rod
whoclawdocsnotap ply to owner ofpcopeny who Wildsorimprove Ciarm and
whocontactsLaces for such projects with a contncnor(s)liuned pursuant to the Conuactoh
License Law.
" ❑ lam exempt under See. ,Bh PCfar this moon ........
... iter Date _.
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury on of me fallowing declarations
1 ham and will maintain a Cenifieate o(Conent to sec f-intim for WorketrSCompen-
com.as provided far by Section 3700 of me Labor Code,far the perfaimanc,of me
work for which mit permit is issued.
I have and will maintain Worker's Compensation Insurance,as acquired by section
3700 of the Labor Code,for Be performance of Be work for which iris permit is issued.
My Workers Comp sa'in lnumnae canis,and Policy atimarart:
Carrier. : Policy No.: ZZ 3x
CERTIFICATE OFEXEMPTION FROM WORKER '
COMPENSATION INSURANCE
(Thu sicrim need not a cemplewd if the permit is for one hundred dallars(SI W)
nr esu)
1 certify that in me performance of me work for which this permit is ismad.l shall nm
employ any person in any manner m as to become subject to 1W Workeri Compersimm
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making mu Certificate or Exemption,you should
become subject to die Workers Compeneloon provisions of and Labor Cade,you muff
.JZ forthwith comply with such provican or oris Permit hall W deemed mated.
z O CONSTRUCTION LENDING AGENCY
I wreb affirm mat there iso mntrietinn leadin forme
F Y Sage^cY Perfurmarwe of
a
to work fur which iris permit is issued(sec.1097,Ci,C.)
W Q Lender'sName
C 1<ndcr's Addw Address '
U
V Q 1 certify that 1 have rod this application and stair mar red save m minting u
U.0 f building 1 agree ct remand with all city and county oNinanmt and stare laws relating e
�(, ithowngeonwctiagand hereby
ectionpt rcpmunutivcs a(bis city to enter upon me
G ]hove-(We)i new I.soy for inspection ace,ha.
(We)agree to ave,indemnify and kith hay in an the yac o against against
U h in
ides.judgmcntgrosuand or this
nit. they in any way accrue against said City
U z A APPLICANT
of Be NXRSTAagaf iris permit.
APPLICANT UNp�RSi SAND WILL COMPLY WITH ALL NON-POINT Issued by: Date _ 2,7—o Jr
SOURCEREG C TON
Re-roofs
Signature of KriplicamiCouractor Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future building occupant tore or handle Nominates material
as defined by to Cupertino Municipal Code.Chapter 9.12,and tW Hcaitb and Safety
Code,Scmom 25532(a)] All roofs shall be inspected prior to an roofing material being installed.❑Yea Grg.
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Omit harardoue air contaminants a dcfned by the Bay Arca Air Quality Management all new materials for inspection.
Diaries]
Q Ycs
I have mad the to owdous materials requirements under Chapter 6.95 of Be Califor-
nia Heath fc Safmy Codd,Section 25W5,25533 and 25534.1 unicarmad mat if to Wilding
does not currently have a tenant,mat it is my maponsibility m noury one occupant of the
requirements which sW Ortoiauance or.ccrifibamarQbanan=r' Signature of Applicant Date
-�� �.'3-
Owner ar aureoriaeJ agcm Dam All roof coverings to be Class "B"or better