08030179 CITY OF CUPERTINOP ^ >t"•v
BUILDING DIVISION PERMIT r:CONfRACTCTR,TA1k'ORMt�.TFON
PERMIT NO.
Bu ap�1�GST"TNTERSTON PL RICHARD KIM CONSTRUCTION 08030179
ER'S NAME: PERMIT ISSUE DAIS
ZALUSKY ROBERT L AND 2340 MONACO DR 05/12/2008
"O L's T^Ir SANITARY NO. CONTROL NO.
(408) 206-8369
ARCHITEC fENGINEE R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u O O LICENSED CONTRACTOR'S DECLARATION
m I horoby affirm than 1 am licenxd under provisions of Chapmr 9(commencing Job Description
�,� wiNSWson]IXIU)ofDiWsion3ofthmBusinessandPWfcssiamCodedMmyliasWin MBR BATHRM, BATHRM #2 , BEDRM #3 , LIVING ROOM
in full farce and eBett
30Z Lento Ciro Lk.N
f Dam Contractor
ARCHITECT'S DECLARATION
e 1 understand my Pesno shall tee used As public records
s
l' Licensed Professional
5 OWNER-BUILDER DECLARATION
r�i 1 hereby affirm that I em exempt from the CanlrxtNs License law(Or the
D O following reason.(Section 1851.5.Business AM Professions Cade:My city or county
R m which esquires a permit W consusml.ahce,hnp reA.doomlub,m repair any souctum
yzi prim b its isstyrax,also requires Ne,pplionl for such pneritlo file aligned sammem
< NU W ss Rcomcd pursuam to she pmv ms of dm Contractors L'xrnx Law(Cbapmr 9 Sq,Ft.Floor Area Valuation
(cammeming with Section 700M ed Division l of she Bust.and PmRuions Code) $70000
y $
than be is exempt Nuefrom and Om bases for the alleged excerption.My violation of
Section 7031.5 by any appliant fm a permit subjects she applkam W,civil penalty ofNumber Occupancy
Act mom Nan fiw humbod dollars(IM 36222027�� Parc Y Type
I,uowmi of clic propvly,mmY cevploynes w'nh waguuthm'v sok canpewthon,
will Pr thewon,and she he Com u nmkmnded m aft do(male(Sec.Ran,Business
and property
oro Cade:The camncmra Mwho law dons Wt apply lf an awe m Required Inspections
man enYwho WLINorlonprowsch imporoMwho dosstiltwmk himsrlfed Vwugh hes
awn employers,provided Nes such improwmrnls tae not iemrWM araQuM(,scale If.
however.the aebWilding ea Impmwmrnt is hold within oe Learor 4opmsm fu,the ower-
Wilder MR luso be Wren of proving Nu he did rot build a improve for purpose of
tale.)
G3,T/u owner of the Property.son exclusively connecting wish licensed ronuenon as
construct rhe project(Sec.7014,Business and Pmrmsiom Code:)The Contrectoas LL
came law does net apply W on weer of property who WIIN or impmwa shemon,and,
who contracts for such projects with a conlnctm(s)licensed pursuant m the Comructots
Lkcasc law.
❑I em exempt under See ,B A PC far N4 mason
p� Dam
WORKERSC 1P ! TIO ECIARATION
I hereby affirm under Penalty of ties �one Ne following deluasions
❑1MftandwillmaintainaCeniOamof Coventwo f-inmmfmwo SCMPM
satlon,
wr pmridhi fpe by Beeson 5]00 a(rh labor Code.fm the pufaman¢of Ne
wool,far which this permit is issued.
0 1 haw and will mairmin Workers Compenuson Wareham.as expend by Section
3700 ofshe Labor Code.far the peRarmaee or Ne Anna,fee which this Forest,is lssuM '
MY WorkeYh Compemason htmrarc aniu and Pulley number Are:
CArao, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThesoemlW need Wt be compkmd itshe Permit k foroW hundmddoltus($100)
turf e.)
1 certify that in the performance of the work fm whichNis Permit u intend.l shall at
maployanyperaminanymanncr oat Who esuIt. W the Warless'Cmnpcmahon '
LAof c.hfamle.�D/a'm"
Applicant ,fur'ay
NOTICE TO APPLICANT:IL after making tiCoeirsm o Exemption,you should
been.subject ha Ne WurIme.Compewson providam a labor Code.Yen met
.JO foMthNo
wico.Ply with each visiom N
or u m
permit 041 W duced rewked.
,E.i `; CONSTRUC ION LENDING AGENCY
[� .y. I hereby affirm that dem u a construction lending agency for the performance m
I5: the work far which his Permit U issued(Sec.3D9],Civ.C.)
ELender's Name
=Z Under.Address -
V 0 1 eerily that 1 haw mss this application AM sum Nat the abaft itdormason is
C) r'� cemmL I a{RC c io and
wrN all rdb Nd GIp ns need,,,,of NO lade lawn mWing W
C) building abow-gcomwniroperty farebYwNori,ereprrxnusws of Nu ci,yWrnmrupnn Ne
,how-mendomnl property fm C pees ns purpowhich ms
F y (We)agree W aft,indemnify and keep homeless she City of Copenino gaunt
Z in
of thecmtsendofpcmarnit, may in anY way,mrcagalm,said City
V z A PLIC ranee of the UNDERSTANDS
of this permit
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Sig _ _"r Re-roofs
nature of Appli HAZARDOMA DISCLOSURE Dam Type of Roof
Will Neapplkammfumre buildi. Forms'..., 1.hauard as material
defied by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safely
.section zss3za)y
Y. 0 All roofs shall be inspected prior to any roofing material being installed.
Willshe a cart or tam Wilding lav If a roof is installed without first obtainingan inspection,I agree to remove
pP { Pae taxi equipment Qu or Manna which Pe gre
..it ha'ramnua air conumimnu u deRmM by the Bay Ara Air Quality Management all new materials for inspection.
P
pYrs
I have read the hazvdas materials mquimme,,ande ch.,n6.95 of dm Califon.
nu HWW&S,fuyCod0.Smtimu15505,15533a 25534.Iwdnaatid Nusfde Wilding
does rot currently haw,a mnanr,that it is my rrsyoesiNlity W Waft,the m.'Wsm or dm
myuitemC;les which mut W mel prior W Women of a CeniRam of OmapunY.
� Signature of Applicant Date
'—I,- ,
Ower m,tmmi rd agcnt ,m All roof coverings to be Class';W'or better