06050130 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'rP'h`�Qt�^1IQRItFO hL�LYAtIA. IFN '
BUILDING ADDRESS: YUNG S BANG v PERMIT N0.06050130
18940 NEWSOM AVE
OWNER'S NAME: PERMIT ISSUE DATE
70 YUNG S BANG
E: SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
yap LICENSED CONTRACTOR'S DECLARATION Job DescriptionFFy 1 hcmby affirm Nat I am licensed under provisions of Chmacr 9(Commencing
? S withSection70M)of DIAAon3ofte BuAnessud professkm Code.aMmylkomad.
awe infull ftmerod affect
REVISE BATHROOM AND. LAUNDRY ROOM EXCHANGE
j Z Lkeom Clue Lk.0
DamContractor
ARCHITECTS DECLARATION
I T understand my Pins Hull be upod u While meet&
> U /
SwO LmOuld Professional
1v, OWNER-BUILDER DECLARATION
2 0 I herebymaw .(Set that 1 am exempt from the les ams Co Ucum City
C for de
Oe knowingmann.(Saito 7onstr Business andpe.der mCade:Anycity stem. O
3
39! which rets Isu a permit a Construct,ft alae improv,demobs.ri e&sig any suumum
zSA pdwmincensed ,at,urequirof thovisimexnt for nmhparmi' Laccru Law(stammcm
0 that(Com lancing edWwtuttotheprevislomOfththefluncesandPmelaw(Chodur9 Sq.Ft. Floor Area n
2 � (rommencingwlt therefon7Wid d basis for
oftheBmdneuand ProAny vi Cade)of
tl drat he i rumps Nem(rom said Ili naris for Ne alleged eumpliao.Any violNon of
Session 7031.5 by any applicant for a permit subject,the applkut m a civil penalty of -iAW *Tuu Occupancy Type
not roam dun apo hundred dollars(5500).
❑I.uownerofdupmperty.mmywployea MNwagmudebsukeanpemNOn,
will dothewons and the he Coret,no,Limm o apo does not apply
70th, Owner or Required Inspections
and arty who
Code:tha Canveemra License law doss not apply m rt owner is q P
propertywkbuildsoelamproteaell Ire n,andwho doessic twork MmaelfedNfauyh hIce
own a however.
the n,provided that such Improvements wit ase ne col o ed oroffomplem vA toe We IL
however.the aw,the
burden
Of pmut t,hold MOIn one year o(comole for the Owner.
Witter ill Mw,de Wedu o[proving that he did not hdk o impure(a Dugeu of
tale.).
❑1,as Owner of she property am exclmively contracting with licensed ceneratwn in
cemtsuct the pmjem(Sec.7044,Business and ProkWons Code:)The CWmno's U.
come law docs not apply to an owner of property who builds or improv u1emen,and
who contracts for such pmjems with a conuacwrD)licensed pursuant to the Contractors '
Lkens Law.
❑I am cuumpt under See .B d PCC1 n
er Dames / O
ORKER' OMPENSATIONO RATION
1 hereby alarm under penalty of perjury one offt fallowing deduulonr.
❑I nave and will maintain aCeNOmm of Coment m wlf.isum for Woftes Compeo-
ueitn,out provided for by Section 3700 of the labor Code.for the pe foemsmce of the
work for which this penis is issued.
1 Moe and ada maintain Workers Compensation Importance,as required by Section
370(1 of the labor Code,for the performance Of the work for which this permit In Issued. '
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thishenlru recd aotbe completed If t e permit to faom hundred dollars(3100) v
or leu)
I certify that In the performance of we work for which this permit Is woad.I shall not
employ any person in any muuereo m IeclmPe Workers'ConpemWon
laws of Califami
Applicent
NOr7CE TO APP ANT:IL r makiry Udo moue of Exemption.you smolt
ec
hone subject the Workers Compensation provision of the labor Code,youuew
m
.J O fforthwith ctmPly with such Provisions or mi WnnB shall be deemed revoked.'z► CONSTRUCTION LENDING AGENCY
[-+ Thereby affirm that dem In a consumetnn lending agency farthe performuce of
a
we work for which this permit is Issued(Ser.3097.Civ.C.)
LQ Landers Name
z Landers Address
U Q 1 cenify that 1 haw mad thin application and sloe that the above taformadon Is
Uw F correct.I agree to comply with all city and county ordinances and sum law&relatin[On
DU building eonrmction.anal hereby suthorim reptesentaeives of this city to enle"Ptt the
U .hove-mentioad Pm,,Iy for ionpection Purpues.
py (We)acme to now,indemnify ud kap henniess the City of Cupertino actions
VI liabilities,judglownm,coon and expenses which may in ray way acsrue aga of said City
U Z in consequence of eM graeung of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE ULATIONS.
d Re-roofs
Signuum of limn aO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy appllania future bpalCoeaupueroe err and the
hruNoumace
u dcOaA by the Cupertino MunlNpal Code.Chapter 9.13,and the Hnith utl Safety
de,Salton 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 'El No
Will the applicut or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasardnm Ar conumimmu as de0md by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yon �NO
I have mW the humdum mrerialsmquirement,umkr Chopeed.95 orthe Celifor.
-is Net]"SafetyCOde,Sections 25505.25533 uu17S534.1 tendennM thuirdm building
docs not currently have a lonam dud It i my responsibility m notify do acupent of the
req 'm ms when murk armissaanccan ceN tf evpancy Signature of Applicant Date
o
Owner or aurnuired neem tww All roof coverings to be Class"B"or better
'