04110095 CITY OF CUPERTINO _ F $�: �y♦Ry�� ?��T� ��,/ �`'^ /"��?�T.�
BUILDING DIVISION PERMIT Ol\ 1�11CTLtlll,�O1�1YlA' IVL\ ��°, - -
BUILDING ADDRESS: CCK -CONSTRUCTION INC PERhdIT"'64110095
7809 LUNAR CT
OWNER'SNAME: - PERMIT ISSUE DATE
WEIN-PING YU 12204 PLUMAS DR 11/16/2004
- - - SANITARY NO.` -'"— " 'CONTROL NO. •=
(408) 863-0648
ARCHTIECT/PNGINEER: BUILDING PERMIT INFO '
BLDG _ ELECT PLUMB MECH
]
, +100 LICENSED CONTRACTOR'S DECLARATION Job Description .-.
I hcrebY affirm theel am.11mmN under provi&Ima of ChaPmr 9 mmour.ncing - -- P
^� with SCNon7000)orDividon3ofthe Busima&and Profnsinm COde,and mylicenmis _
inmOmrceandeffecL REVISION--IN HOUSE USE ONLY _ -
.iqg Oceeteclav - Coal NO NEW PERMIT ISSUED/ ORIG. #04080249 -
r Dam GDECLARATION ARCHITECT'SDECLARATON RAISE UP FAMILY- RM/RELOCATE-CLOSET- ----
I undcrsmd mY phos ehW W tadtl u Public records '
3 C Licensed Professional OWN_R-BUILDER exempt
DECLARATION
00 1 Wrehy ffl.That 11. exempt rim fm Contractor's License Lew for IW ,.
—
00 following mason.(Section](131.4 r.aineu and w.der it Cote:Any city or county
$ which its mum...h.tocenmucLaIle[improve,deermit1 ear...irmysttucwro - ---
Ell
poor m its iuuan<c.. mquima thcappliaant for mea Permit m Ole LawIsin¢mem __ __ - .
_ < Nel he i¢Iiceneed pursuentm the provialou of the ConuacwrWttnm law(ChmrcrY - S(I.Ft.FIOOr Area .. _ Valuation
- -'
� (cat he is ing motto
Seetion7Und of,basisof rmftW egad exe and on.miiom CMc)of -"-- - $0 -
« mat he u exempt thmfrom and the bora for the alleged exemption.My violation of
section 7031.5 by any appimant for a permit subjects the applmam to a civil penalty of APN Number Occupancy e
not..in thin Bw hundred dollars(5500). P Y TYP
❑I.u owner of Jw property,or my employcu with wegea u thew rola campenuJon,
willdothework,mdtheswcmmisnotimmndedoronemdf.,.ale(See.7W;Busi.
and Pmfeasians Code:The Contractor's Lkense Lew don not apply m an owner of Required Inspections
property who bui lds or i m prove themmm and who dws such wof k himself or through his
ownemployces,provided that such improwmenu arc not Intended oroRere l musah.If, P
_. however,Ne building or improvement is mid within one year ofcempletivn.Ne owner-
Wilder will Form Ne Wrdcn of proving Nn W did not Wild or Improw for in rpom of — —'
u .1.
1,as Owner of tie property,em inclusively contracting with licensed...tracmms On
;C3
act the pmjen(Sec?Oda,Busincu and Prefculon Cade:)The COntncib U. S 1
Law does not apply m an owner of property who Wilds orimpmvn thereon,andontractsfor such projects with a contractor(&)licensed pursuant m lWContraeir'ete Law.
wea0 tuntlu See. ,B&PCT this on
DemW K• COMP 5 lDECLARATI
I eoirm under penaltyo rjury oro ofie following ons.aw and will maintain a Ci n ificam of Content to xlf-iuum for WarkersCompen-
setlet.u provided far by Section 3700 of the labor Code.for the pertartmna Of the -
work for which this permit l9unucd. '-
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 offer tabor Code.for the performance or Ne work for which this permit is issued. '
My Worker's Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(fba section reed nmbecomplemtl if the Permit Is formic hundred dollars($108)
or Ins.)
I cenify mat in the performance of the work for which this permit is Issued,l shall not
employ any person in my mmnerm as to become subject to Jte Workers'Campm eadon -
LawsofCalifornia,Dam
Applicant
NOTICE To APPLICANT:If.after making this Cenificam of E.acmption,you should
become subject in tM Worker.Compensation provisions of the labor Code,you must
.JO fonawithromply with such provision or this Permit shall W deemed rowked.
Z"i CONSTRUCTION LENDING AGENCY
ti Ihemh affirm that them is a construction lending ac
[—t y g g racy for the performance of
E
7 the work for which this permit is iuuetl(sco.7(1 Civ.CJ
QLenders Nanta
D
� z Pander's Adtlm••
U C) I certify that I have mud this application and sum that the above information is '
11. P cortex I agree m comply with all city ad county on iruncu and sum laws mating to
Wilding construction,anti hereby euthonm myrm oammativea of this city enter upon the
�UIn shove-mentioned Picini fat impaction Purposes !
0. (We)agree m ave,immunity and keep ham ems,the City of Cupertino agaiut
w h IiabilWea,judgments,costs and eapemes which may in my way ace=against said City
U Z in consequence of the grantung a thus omit.
APPLI ANT UND STAND D WILL COMPLY WITH ALL NON-POINT Issued by:S Date
SO EREGU
i Re-roofs
Si re of ppli a Dem
AZAR US MATERIALS DISCLOSURE' Type Of ROOF
Will fu applicant or future Wilding ouvpmt score or handle hauNous material
as deftrted by ft Cupertino Municipal Code.Chapter 9.13,..it me Health and Safety
Cam.QYovan23533(q? )7,rNa __ ..__-_ All roofs shall be inspected prior to any roofing material being installed. - - -
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
of,haartlaus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs �NO
1 have mad der haumtmsm rmriaamquim omet under Chapter6.95 of the Califor-
his Health&SofiaCock,Sccuau]3505.25533 and 75534.1 understand Natiftlrc Wilding
Jon not tune Ily ham a tenor at it h m r spamihilisy m notify ter aecupant of ter /- 14/ / /f/�� l (•J�l'w ar
reyuire hich muvW riarii mora Ccnifcam cc m '. Signature etfA ICO Date
I All roof coverings to be Class"B" or better
Owners tar thorivede rat am