08070070 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT ",��1�I>I�1��' QR•Z ''- � A�I( NI
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BUIL LNES
G ADDRESS: PERMIT NO.
R04 /�) MADERA DR YOUNG' S 'CONSTRUCTION 08070070
OWNER'S NAME: PERMIT SUE DATE
CIIRNG JUNG HUANG 3.4839 CONWAY AVE 08/21/2008
N@ SANITARY NO. CONTROL NO.
(408) 377-6839
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO EL.EC'r PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
hereby&Mm Nat 1 am licensed under provisions of Chapter 9(commencing
nz1 wiNSadon7OW)ofDivlsion3ofthoRYsimaandNofeaMmuCode,andmyliccmcla ADD 442 TO LIVING SPACE MASTER SUITE,
p y in full force and effect /7 .��/
�I9Z License Cl Lie.g IJ t��Q' LIVING, FOYER, BEDRR, 30 SQ FT TO PORCH, 118 SQ FT
Y Dato clar
AR I'fECTSDECCLARATION TO GARAGE/ REMODEL ENTIRE INTERIOR SPACE, EXCEPT
DEL)E0 1 underaunJ my plane shall be used u Wblic records 1
you Liccmed Profwaional
H 5 OWNER-SUNDER DECLARATION
i I I hereby M M.
that 1 am exempt from the Contractors License Law for the
0 O following neaten.(Sued 703 1.5,Butlmu and Rofrsaem Code:My city or county
$ which requiros•pmmiI to condruc,alar.improve.dismal W,or repair any structure
iy prior b its issuance.aka requires the applicant for each permit to lite a Signed stsumeat
—
< dam his is licensed rarment to the provisions of the Contributes Lice=Law(Clupmr 9 Sq.Ft.Floor Area Valuation
B (commencing with Section 7000)of Division 3 of the Business and professions Code)m $200000
that he Is,amp,therafroa and the basis for the alleged evmpdoa My violation of
section 70131.5 by airy applicant for a permit subjwu do applicant to a civil penalty or �,p�t Number Occupancy
nm roam Nan R.hundred dollare(rSOO). 32635046 .'l7'V' Type
❑i.a owm O(W proputy,m my emplaycra with wa{es u theb wk eampewdon.
will do down k and theatrmtum Is natkunded Or offered formic(See.7044.Busima
and professions Cade:The Contractor,Licence Law dm rot apply to an Owner of Required Inspections
property who builds Or Improves Ihermn,and who dos such wart himself or through his
own employees,provided that such improvements art not inundon motional for mi%IL
however,the building or improvement tsseld widen em year of completion,the owner-
builder wtI1 Mw the burden Of pmvinB NM his did not build or improve far purposes of
sale.). ..
[ I.at owner of the property am exclusively contracting with licensed contractors to
construct the project.(Sec.7044,Business and Profession Code:)The Contractors LI-
cisme law Met not apply as an owner of property who buiks or Improve;themun,and,
who concocts for such pmjeeu with a cenlractor(s)liceused puuusm to site contractors
Uccnre Law.
❑1 am exempt under Sec .B&P C for this reason
Owns Dau
WORKER'S COMPENSATION DECLARATION
I bereby aabmunder pmultyof perjury am of the following deelmg=
w and
1 hawill main a n aCeNRcau orconsom u e
self-Bne fes waames Compam-
sadm,u provided fer by Section 37OO of the Laber Code,for Ne perfummence of the
wart for which this permit u Based
❑1 new and will maintain Workers Compensation Inearmac,u required by Section
37OO of the Latin Code,far the performance of the wort far which this pemit is Wood.
My Waseca Camp usatie Ines sew and Polity num Mr,am'y I`
cmien Polity No.:M M h
CERTIFl T •XEM ONFROM WORKERS'
COMPENSATION INSURANCE
(This section men mumcampleun If the Permit Is formic hundred dollars(gim)
or teal.)
I certify,Out In the performance of the work for which this permit is issued.l shall not
employ any pen air in any manner an as at became subject in the Woken'CompcmMlon
Owe of Caliromin.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certiricate of Exemption.you should
become subject to the Workers Compcnadon provisions of the tabor Code,you mus
z forthwith comply with such proviainu or this Permit Nall be daemon rewkcd.
Z'► CONSTRUCTION LENDING AGENCY
a site wart erewyi�NLswt Nem iso consutcdnn lending agency rte site parfomanmof
Gp Landers Name Permit I.Wised(Sec.3097,Cir.C.)
.7 z Landers Add2u
V Q I aurally that I haw and this application and sum sive the show information is
W E cones I,g.m cmnply with MI city and county"Onsucw and suis laws relating 0 '
O Wilding construction,and hereby authorise repruenatims of this city in enter upon do
W show-mcntionon property for impeNen purposes
pyt (We)agree to saw.indemnity and keep hamkss the City of Cupertino agaimt
v.,VI liabilities,judgments,costs and expenses which may in any wry accrue a{almt said City
O'Z A APPLICANT
of the griming of this Permit
^ APPLICANT UNDE0.SfANDS AND WILL CO WITH ALL NON-POINT Issued by: Date
SOURC&PECIJ1.,kT10NS.
1_ _ Re-roofs
Si{n mO(Appli HAZARDOUS MATERIALS DISCLOSURE or Dau Type of Roof
Will site applicant or future building acupentnme or haMlc havMdous rumored
at defend by ftCupertino Municipal Cade.Chapter 9.12.and the Health and Safety
code,Section 25532(a)?
❑Yes All roofs shall be inspected prior to any roofing material being installed.
1�7J'la
Will the applicant or umre building Occupant ate equipment or deviceswhich If a roof is installed without first obtaining an inspection,I agree to remove
mit bmardaus air contaminants at depned by the Bay Area Air Quality Management all new materials for inspection.
District] (((��� ���
❑Yes I@'kle -
1haw readthe hvant u,catca¢nakrequimmenu Maur Chapter 6.95 oohs CMifor.
me Health&SalmyCode.Sections 9550625533 and 25534.I uMcnwd dist V the Wildle{
data rot c ndy have a umnt.dud It k m NIitY b notify do osupmd of de
nevire uwhkhmuRbemetpdorm' umaisCaufleauof _ Signature of Applicant Date
Lr:ow ar xathnmcd ag rot Dater All roof coverings to be Class'W or better