06030145 CITY OF CUPERTINO
BUIL BUILDING DIVISION PERMIT ° CO,l'II,'xRACTaR"T1 .ORMATTr 1V
PERMITN0.06030145
10791 JOHNSON AVE
OWNER'S NAME: PERMrr ISSUE DATE
JOHN PAEK 2006
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oij LICENSED CONTRACTOR'S DECLARATION lob Description
�t 1 hereby afflrm Nn 1 am HarcHarcourtunder proviaiana of Chapter 9(commencing P
with section 7")of Division 3 of dm Business and Professions Code,and my IkenSo is
in fun force and east. HOUSE DEMO
i Iij= License Claes Lie.a
Dau Conleamor
ARCHITECTS DECLARATION
i B I understand my plans Shed W used u public records
isU
TOC Licensed Professional
m3 OWNER-BUILDER DECLARATION
a I hereby.Rete on 1 1. tusin fate the Cssions Co License Low o for de
e O following muga(Section 70]I.S.Business and Pro@Orions h.Or Any airy or county
is which its .permit mcanss the alar.Wprase,h pencitt.repair dna nL 5000
.Z i dols he is l is uancp pursuant
ant he duc the applicant of fmsmh permr's License
a w stsemem
�
dons he islicenscd purwantSo the provisions of the ConmcSoYs UatlSo law lChapur9 Sq.Ft.Floor Area Valuation
(commencing with Section 74100)of Division 3ofdu Busfive and Profusiam Code)or
5— Nat le is cam tit Ihemfoem and the basis fm the alleged mormoan.Any Aosdan of
Section 7031.5 by any applicant for a pemrit Subjects the applicant So a Civil penally of U U Occupancy Type
out more than five hundred dollars({5010.
0 1,u owner of the property,or my employes with wages u deb sole compeasadon,
will do Ne Work.and theanucme is not intended or offered for sale(Sm.7044,Business Required Inspections
and Professions code:TW Commcmes ts Lie som taw donot apply So GS an Motor of q P
property who Wilds or improves therean,and who doessuch work himaelforlluough his
own employees,provided thatauch improvements arc not intended oroffemd fm sale.If,
however.the building or improvement Is Sold within ore year of complation.the owner. _
builder will have the borders of proving pmt he did not Wild Or improve for purpose of
KI.C-I 1,u Owner of the pmpeny,am uelusively contracting with liunaed conlneun b
construct the pmlect(Sec.70/5,Business sad Professions Code:)The Conmcte is U- \
ccne law does not apply 0 an awms of properly who Wilds or impmm tharmn,and \
who comment;for such pmlema with a caavacm(s)licensed pursuant no dm Coodu ctors
License Law.
0 1 am escmpl no Se .B h P C for this mann
under Dae G
LWORKERS4MMPENSATION DECLARATION
1 hereby aairm under Penalty of perjury am of the following declamtiau:
0 I have and will maintain a Cerdficveof Conten m ulf-ilium for WarkoesCompen-
scion,an provided for by Section 3700 of the labor Code.for the performance of the
work for which Nis permit is issued.
❑I have and will maintain Worker's Compensation Insurance,u required by Section
3700ofthc labor Code far the performance orthe work for which this permit Is Wood. '
My Worker's Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This satire need net becompleted if de Permit Is fmomc hundred dollars($100)
or leu.)
1 cerdfy Chat In the performance of the work for which Nis Fermi,is issued•I shall nut
employ any person In my m="to an I to use,Wormsti,compelWtion
Iowa of CAlleraia Data. /
Applicant U9 (r
NOTICE TO APPLICANT.M.after making dds CerdTmeu of Eaemption.you Should
become subject So the Workers Compensation provisions of the labor Code,you must
.JO foMwuh comply with such provision or this permit shall be daemon condom.zt CONSTRUCf10N LENDING AGENCY
y
[-� Ihemhy affirm that dart is a cousumdm lending agency for the Farrormems,of
fx rte+ the work for which tido Permit Is blued(Sec 3097,Civ.C.)
W� A Lendoes Name
:3 z Lender's Address .
U Q I certify that I have mad this application and suis that use above iafmmatiun is
[L Pcorrect.1 agree to comply with all city and county ordinances and stale laws relating to
U building convection,and hereby amhorim representatives o(lhis city to curer upon the
(2I ahovc-mentioned property for im,muon purpoes.
y (We)agree to save,indemnify and keep harrosim Om City of Cupertino against
Fy 4 liabilities.judamcnts,msu and Cape.which may in any way acme gaiml mid City
U in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON-POINT Issued by: Date
SOURCE RECULAT
Re-roofs
Slgnanum of Applian =ter Dau
OUS MATERIALS DISCLOSURE Type of Roof
Will IW applicant or Now Wiling omupan suns m Wille hamrtlom maerm
as defined by the Cupertino Municipal Code.Chapter 9.12.and he Health and Safety
Cook.Scem.25532(a)7yy All roofs shall be inspected prior to any roofing material being installed.
[3y. ell
Wilt the applicant or future Wilding Occupant um equipment or dcviaa which If a roof is installed without first obtaining an inspection,l agree to remove
emit hcudnas air cmumim on a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
CYes ono
I have mad thc havardnus mawdals mquimments under Chaper6.95 ofthc Califor-
nia Health&SafctyCodc,Secdam 25505,25533 ami 1 understood NNifdu building
does nut currently hon a unam Nat It is my ms nsihit ty in nodry the,occupant of tha
requirement,wide tit mel pd an.. afacerdficamof Occupancy. ignature of Applicant Date
Its 5r All roof coverings to be Class"B"or better
Onomr.,aulft,lachipm Date'