00110001 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
NIIILDING ADDRESS: PERMIT No
1021 NOVEMBER DR FOUR SEASONS HEATING R A/C00110001.
VNEWS NAME: APPLICATION SUB DAPI;
WOO BENG—YU AND MYONG S 22850 SUTRO ST 11/01/2000
I IONE: SANI'TANY NO. CON'TIIOL NO.
(51.0) 886-3112
G®Y ARCHITECI'/ENGINRER: BUILDING PERMmINFO
1.w C BLDG IiL13Cl' PLUMB MECH
H j LICENSED CONT'RACTOR'S DECLARATION
'o n o I hnchy it i....mat I asst hcenwd undc.......i,rit,of chapter')to„mmeteing Job_Description
F,�,�� witb Scninn)I0ro)of Uivixinn3nf the❑u,inus,and l'mfc,.ion,Code,and my license
,,,� , as, ndelr m. go 7_)�3 . FURNACE CHANGE OUT
nU Liccnve C ass Lic,M
h bare./��C� Gmtrudnr
LLQ ARCHITECeI'L'DECLARATION -
I I a en in n,y plmwrrll r�ie used:o nW,re reams
ad
p o Licensed Prom,mad
OWNER-BUILDER DECLARATION
I heraby uf1i.'...thin 1 on exempt Inn,,she Cnnnnoor'x Licenm law Ibr the
h-z fallowing nuson.section 7031.5.Rminn,and Pnaession,Coss:Any city nr loamy
r C which requires a permit,o construct,alter,improve,demolish,or repair any structure
uu,a� prion,,its..nuance.ukOayuireslhe'lppllcant In sachparnd is file a signed”ailment
- that heRficcowdiaoustoI(,the pmvm"o. ,IthcCourro "IJcenvol.o,(CI'aplo`9 Sy. Ft. Floor Area Valuation
mommaneing w ith Section 7100)of Division 3 of the Business and Professions Cdle) $1
or.hit he i.,viand thenfnvn and the hasin lir the alleged exemption.Any vinedion
of Section 7031.5 by airy applicant lin a pcmhit nuhN,I,the upplicout w a civil I,vunity
of connote than live hundred dollars($50f.
APN Number Occupancy Type
❑Lmowner ol',hapmpn,y... ...y,noployers with wngasastheir suit,co..apasmioa, 362'.16001, 00
will dist the w'od„and the ouncuumis not intendedor oflered for nate apply
Business and 'mfcsions Code:Tc Contractor's Licew,I,aw Jan nn apply to an
Required Inspections
of pr,openy w ho hau
d,ar hall va,momma,and who bit,,uc,walk dn.,elf 204 — UNDERFLOOR FRAME
nr through bio two nndo,ve, provided that.such improveracnw am not intended or
offered for sale.If.however.the building or impm eaten is vdJ within one year of 301. — ROUGH PLUMBING
uompletion,the owner-hnilder will have the burden of proving that he did not hold or
npar.cf......11fL1f"'°''' 303 — ROUGH MECHANICAL
01,as awns anhe property.aine.chiskelycantmelmg with licensed contractor,to 304- — ROUGH ELECTRICAL_
conxnuet the nmjeo Isci.mats Baines,and Prmb„ren,Gdao'noe C...acro.
License 41w does not apply to an owner of pmpehy who builds or improve,merem,, 505 — FINAL ELECTRICAL
andwho contracts file such project,with a comractons)licensed punuam to the
C...,.r:letncs I.Imm1•Law. 507 —' FINAL PLUMB I NG
0 loin exempt unser Sec ,Ii AI'C It,,this ma son 508 — FINAL MECHANICAL
Wistar
WORKER'S COMPENSAI'ION DECLARAION//—Oa
T 51.4 FINAL_ PUBLIC WORKS
I hereby atfina under penalty of perjury one of,he farming declumd(...
IcHillel:
1 have and will maintain a Cenilicam of Consent to,elf-inatm for Worker's
nntpcmction. as provided for by Sections 3100 of ,he Luhor Code, for the
mnorn,mn of the work lot,hich this)annul Is mala.
1 have and will maimain Worker',Compenvtion Insurance,as requited by Section
700 of the Labor Cude,t'or the ry:ffour:uat,of In work fur which this pent,is
sued.MyW fess Compensation Insurance carrier
No r�mNSS1'il�y n�unMr ort:
!” I JiIr I XIIMITIUN p1211M xR,`cc
COMPENSATION INSURANCE -
(Tds wedin need um be conq,lwed it he per nit is list one haulrud dollar,
($I off or less.)
I certify that In the perh,rmancu it the wore tur which this Island is issaed,I
chat,Ire amplify say person in any manner err as In laarome wb vo d, he Workers
Compensidan law,of Califnmia.Date
Appliavn
NOTICE'm)APPLICANT:11,.1mrinion,to,Cenilwa..of Etmoul a.you shoold -
became,kit hi to the Worker,Compensation provisions of the I-abor Code,you rust
Q 0 foloulah comply with such provi,innc or his pem,it.hull be deemed mvokcd.
f � CONSTRUCTION LENDING AGENCY
I hereby affirm that them i,a consume tion lending agency for the performance
Ot the walk for which this perms is ko ed(Sec.3097,Civ.CI
6. Q 1,ender',Nana
Q z Lender:Adkins,
f..) Q Ieunily tha,I have mad,hi,up,shcaaon and state that Ie above Infom,o......i,
4. E- correct.1 agree to comply with all city and canny ordinances and slum taws wining
Q V m building cotolm,linn.and hcmbyatuhorim opmsamnivmnf,his ahym enter upm
�y ray] Ole above-tuenunned p,,,,city fm hole elf I pntpnay.
F„ As IWe)agreen,ewe.indemnify aml keep harmksn the City of Cupertino against
U (n liabilities,judgrauds,cost.,and cxpemes which may in any way aecme against said
"L chy in nalncyue he gm.uing m mI,nem'
AI'PLICANI' NI iRs'ANUSAND Ilii. :OMPLY WfJJ 1 ALL NON-POINT -�. /
SGURCE RE ,UI .Rl (� Issued by: `f° Date (���-Uy
.
Slgnamrcofn liras✓Conhuc,nr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the apNic n„r team hildmg oar mans...re nr handle ha..ardoux niumnal Type of Roof
us ddlned by the Cohn inn Municipal Gide.Chapter 9.12,and the Ilculh and Safety
Code.Section 25532(x)'!
O Yu, X1N1 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
,nit hnnrdous air continuous is as defined by the stay Area Air Quality Management
rutin, all new materials for inspection. Applicant understands and will comply with
0`"e, xNo � all non-point source regulations.
I bmc read the haaartlnu,.......rind.,regare men,.,under Chapmr 6.95 of the
California Ucult l k S.m y Gds Scnio..,25505,25593 still 25934,1 wWcr.tm,Jlhnt
if the building does not curet hmc a wrams that it is my responsibility to namify the
1 apan.of the r• tent,which nn t prior m ixu.ancv of a Cenificme of
kcup:mc
Signalureo(Applicant Date
ow„ori„ m age.mt Dam All roof coverings to be Class"B'r or better
OFFICE