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04110172 CITY OF CUPERTINO - rs ' 'tea ;cue -a� -" ' '�� BUILDING DIVISION PERMITOql Ct1NTRACT�OR INFORMATION BUILDING ADDRESS: R PERMIT qc0 4 110 172 811 KIM T V OWNER'SNAME: PERMIT ISSUE DATE GRANERA DARLENE A AND ANTH Y 2004 E: SANITARY NO. CONTROL NO. ARCHITEMENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 .0, LICENSED CONTRACTOR'S DECLARATION JbDescri [ion i u� I hereby afpun that I am licensed under prooP visions of Chapter 9(commencing ^� with Section 70Ygphl Division 3 of the Busimosand Professions Cndc.and my license is "=us nnmmeandereet. RELACE 2 WINDOWS (KITCHEN ) n g z Licensc Class Uc:x Z;:a Dam Contractor ARCHITECTS DECLARATION 1 understand my phos shall he used as public records JyU 30a. Licensed Professional S OWNER-BUILDER DECLARATION 1 Wrchy affirm that 1 am exempt from the Contractor's License Law I'or the —0 0 following mason,(Section 7031.5.Business and Professions Cole:Any city or county al m which mqns ui.a pcsmit to construct,alter,improve,demolish,or repair any structure 0 0 _„ priorm its issuance.also requiresthe applicant forsuch permit to rile asigncdssacmem < thin W isliecnscd punuamc4oum provisionsofthe Comu rturi n haptm9 Leetaw(CSq.Ft. Floor Area Valuation ,ts-0 (commencing with Section 7BOB)of Division 3 of the Businessand PrarealMOSCOde)or i $ that he is exempt therefrom and the baso for On alleged exemption.Any violation of JJ�� Section 7031.5 by arty applicant for a permit subjects Ne applicant lin a civil penalty of BIS Occupancy Type not mom man five hundred dollar.(5506). P Y YP ❑1,as owrcr of the progeny,or my cmploym with wages u thev sole compensstian. will do tine work and dmawcturt is not imm�dcd urottcrtd fonalelSec.7oEa,Busircss and Professions Code:The Chanteuses License law data nm apply In an owner of Required Inspections property who builds or improves demon,and who docs such work himself or through his Win employees,provided that such improwmanta art not intended clattered forsals.If. builder.,the avec ingthe or Wohm o ement porvinissold a within of year of completion.me owner- builder will have Ote Wrtlen of proving that be did not Wild or improve for purpose of ' talc.). 1 �f I.as owner of the propcny,am exclusively contracting with licensed contractors to caustmct line pmjem(Sec.]OEs.Business and Professions Code:)The Contractor's Li. cense Law docs not apply to an owner or property who Wilds or improves demon,and / who contracts for such projech with a contractor(s)licensed pursuant to the Contractor's License Law. ❑lam axe In on Sec. B&PCfordisrtavon 7 ',�'^ ,A nee Dam�X W `K COM �TTONbECLARATION Ihereby affino�er penalty or perjury one of the following declarations: ism and will maintain aCendicate of Content to self-insum for Worker's Compen- _ provided for by Section 37M of the Labor Code,for the perfomram of the work az for which it.permit is issued. ❑1 have and will maintain Workers Compensation Insurance,az required by Section 3766 of the labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carver. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W chmplesed irtM permit is fnrhnc hundieddollar.($1110) or less) I certify that in de perfmmanco.I de work for which this permit is issued.I shall out employ any person in any manner sh w in become subject o the Werkeri Compensation Laws of California.Data _ Applicant NOTICE TO APPLICANT:If.after making this Cenificam of Exemption.you should become subject to de Worker's Compensation provisions of the Labor Cook,you must .,z forthwith comply with such provisions or this permit shall he deemed revoked. z O CONSTRUCTION LENDING AGENCY 'c. I hereby affirm that dem is a construction lending agency for de performance of CCime walk fur which this permit is issued(Sec.3097,Civ.C.) yA Lender's Name z Lender's Address U 0 1 cmud y Oat I have mad this application and sum duet the above information is t" cond e1 agree In comply with all city and county onlinances and state laws relating to 0U Wilding constmtion.and hereby audOdWOcpre.enmives or this city to enter upon the r fill shove-mentioned property far inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertinoagainst rliabilities,judgments,costs and expenses which may in any wry acerae against said City U in consequence of the granting of this permit, APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date 5 URC GULA ON$. r/ urtJc.e �-- Re-roofs tgnamm oflivinuc.onexter Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 1 Will the applicant or future building uccummsmre or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Heald and Safety Cents.Scotian zssu(a? ❑Yc. All roofs shall be inspected prior to any roofing material being installed. IGRqu Will de applicant or future building occupant var equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove t havasdaus air contaminann az derecd by do Bay Area Air Quality Management all new materials for inspection. Irict? ❑Yes Al h I have mad them udosss materials mquimmenu under Chspmr&95 ofms Califon nia Health&SarctyCock.Socuom 25505.25533 and 25534.1 understand thatifdm Wilding 0.oat currently have a tenant.that it h my ponin ity untmufy dte occupant of tine mquimm mw i hmuN met rior.i cc of aecNrmamarQeapartey. Signature of Applicant Date 11 All roof coverings to be Class "B" or better nc rant odve ag t \ Date CITY OF CUPERTINOr ,. r '1` BUILDING DIVISION PERMIT kC01NTRACTOrk INFORMA TION BUILDING ADDRESS: PRRMn'N`0 411017 2 R11 KIM FRSNAME: PERMIT ISSUR DATE GRANERA DARLENE A AND ANTH NY 004 PHONE: SANITARY NO. CONTROL NO. ARCHITEC AINGINEER: BUILDING P13RMIT INPD ❑LDC ELECT PLUMB MGCH uoo LICENSED CONTRACTOR'S DECLARATION jOl)DCSCfIPIIOn C I hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing b witb5ection7)(IID of Division 3 of NC Business and Profession.%Code.and my license is ca imm�mrceandermm. RELACE 2 WINDOWS (KITCHEN ) J112Z License Class I.ICJI Zjcy nam Contractor ARCHOECT'S DRCLARATION IunJcfstanJ my plans shell lid U,adPublic used es puhlie¢cords JyU 3 LLLiccnud PNfcssinnel / `ms OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Ci mmeho's License Law for the ��/ 00 fnllnwing reason.(Section 7031.5,Business and Professions Code:Any city or county Xwhich requires a permit N construct.alter,improve,demnitsb,or repair any structure 3500 F26 prior to its issuance,rush requires the applicant for such Permit to Ile a signed statemrd x mat heislmensedp camod,tope prnvrainnannhecnmmnorsLieensevweluoer9 Sq.Ft. FlPoufica, 00r Area alualion a is exempt ith sereirion and D asisf the al a ed exe prion.Any vo Cnde)or that he is exempt themfrom and me basis for me alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects me applicant to a civil Penalty of -3-WWiTutnbkirU 0 Occupancy Type not mort Nan fiva hundred dollars(3300). P Y YP ❑I,as owner of the propeny,or my ernldoyees with wages as their sale compens Kinn, MH do the work,auction structure is nut intended or offered for sale(See.7044,Business and Professions Coodc:The Conuacmr's License Law does m[apply m an owner of Required Inspections property who he Ids or i in prove thereon,and who does such work himself or mmugh his own employees,pruv filed that such improvcmen3 are not intended or offered for sale If, however,the building or improvement is sold within one year of complcrion,the owner. builder will have the burden of proving mat he did not build or improve for purpose of salt.). I �af 1,as owner of me prnpdny,am exclusively contracting with licensed mnuamors In some,the project(Sec.7W.Business and Professions Code:)The Contractor's Li. cense Law does not apply to an owner of progeny who builds or improves hereen.and who contracts for such projects with a mmrectats)licensed pursuam to drd Contractor's License law. ❑ l do'ce���s"him ei sec. Q Rh PCfnrthis mason rak Der y. , [_ A n, _Data _7, •.f•1 . I,Wool ft' COM .N TON DECLARATION I hereby off der penaltyM perjury9necdo fnllmoom,declafaiome sat❑Ina m and provided mai by aCcni 37W of me LabtoCode,for tfor Worker'scempcm Work for provided for by Ss issu d. of me labor Code,for me Performance of the work for which mice permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 37M of the Labor Code,for the performance of the work for which this pvmrir is issued. My Workcls Co.pensation Insurance cuhicir mad Policy do her am: Carries Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not bcccurreled ifrhe permit is forint hundred dollars(tit00) hr less.) 1 candy that in the peffnrmanee of the work for which this penult is issued,l shall not employ any person in any mannersn as br become subject o the Workers'Compensminn Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making his CeNficam of Exemption.you should become subject to the Worker's Compcnwtion provisions of the Lvhor Code.you must .JO forthwith comply with such provisions or this permit shall be deemed rcvnkad. CONSTRUCTION LENDING AGENCY ,;"I .�. I hereby affirm that there is a construction lending agency for the performance of C1i > he work far which mjs permit is j abed(Sec.3097.Cj,C.) W Q Lcme,Name = z IxSRCe Address V Q 1¢oily that 1 have read Nis application and state diet the above information is W F correct 1 agme m comply with all city and county commences and also,laws slain,to p U building construction.and hereby a thmifde repreecmativrs of mil city to color upon the �Ce xbovcmentinned Property for inspection pnrphses. (We)agree N save,indemnify and keep harmless the City of Cupertino against V) liabi lilies,judgments.costs and ea U% ,hisponses permit, may in anyway accrue against said City V z m PLICANT of DERSTAgranting of this permit. �( APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date ((( SOURCE ggEGULA�IONS. l a 1 < , I/_fl0/ Re-roofs St4gnaw-ofA pitr HAZARDOUSMATERIALSDISCLOSURE Data Type Of Roof t Will the applicant or blood building occupant store or handle harardous national ddhned by the Cupertino Municipal Code.Chapter 9.13,and the Hczlth and Safety ,de,Section 25533(x)7 All roofs shall be inspected prior to any roofing material being installed.Pct Will mea applicant or future building occupant use e t ar devices which If a roof is installed without first obtaining an inspection,I agree to remove np 6 P Area n emit hazardous air cnnmminanu as defined by the Bay Aron Air Quality Management all new materials for inspection. Diavin? ❑Yes Ko 1 live read the bavallois materials mquiremcna unecr Chap¢rii 95 of the Califon Dia Health is Safety Calc,Sections 25585,25533 and 25534.1 unJersmnJ that if the building docs not curtendy hmai a winam.that it is y ponsihllity he notify me occupant of me mquircm9 tswt hmst met prior wiry d of a Certificate of adaprney Signature of Applicant Date o�ar&Sup-ikc•'a ab 1�Z .m ��'� <! 30ata All roof coverings to be Class "B" or better m ver rcJ p t Data - a v i xL ,,, •mamaao`��;lua�� IN 11,4W old a Q .'c�slues 'iu ��l ua1�7�c—� . �� M4 M4 vi u qv cay a4 A �.�e_ • . 'U3f�9i5 h Jl:'i G30'3'Jtl r � ` IP I ' U./ ti 5 AOS 9 vmq, �1