02050148 CUP
RTINO
CITYBUILDING
c DIVISION CONTRACTOR INFORMATION:
PERMIT
BL{ILDISIGA T)SkK SPRING CT PERMIT No, 02050148
O)n14'�`(7AMKER-CHUNG AND CHEN LIH- N AUSCf'l')"2i'bRS2
PHONE: U SANITARY NO. CONTROL NO,
OCO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
<i r O C_J I__I
LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under-provisions of Chapter 9(commencing REROOF
i- with 5eamn 000)of Division 3 of the Busines. raj Professions Code.and my license WOOD COMP
i ; in full A¢It a d<if I aJC
iz a I,i rnsc Qft no�J.9y ,
'Oa.
to RC SI5tC oM_TION�.. IPr/
1 a a ARCHITECT he.Oil.,'Cublic o ON ��
�4 I andermand my plain.,ran tx asea x panfie reanre,
C o Licensed Professional FIN A L
SO
OWNER-BUILDER DECLARATION
w w,h I hereby affirm that 1 am exempt from the Contractor i License Law for the
Icc o fallowinguire,. (comma IDBusiness and Professions Code:Any city or county
which q ape I n< cep demolish. reps anysomeone, M
a 3 LO prior t t ' n h re ...hater.
q the applicant h permit file a signed statement �Y �. $8'S 0 Q
'Ind he RlcmW laturem,to 0,pro, t of the C t t License,La (Chapter 9 Sq.Ft.,FloorAre f---jTs ry g��/� Valuation
(commencing stn sect on Al00)ofD '. 3 f,h e(n., dProfessions Cede) . ' •. l`t3'6'652'064 •�O,k•• ,y '1. • �LV�IV�A
ur that he is exempt Iherefn i a d the hast,for the alllged exeinpl mi itt Any adm
-of Section 703 IS by any applicant for n permit subjectuthe applicant to n civil penalty
'oft,.,mare roam five hundred dollar,($500). APN Number .e.. Occupancy Type
_0Laston, fflacprnpery,ormyemployees wanwagesaxlheir,ntecourpem.aaon. 305 - FRAME
will do the work, ad the swaure is not intended m offered far sale(Sec.7041,1.
TE F'I
Business end Pndosion,Code:The Contmaor',License Law does not apply to an P��'nspeCllon$
r of properly Who build,or impmaea mrcor
a ,and who dues each work himself 601 - R00 F
o
serr through his awn employees.provided that such improvements arenot inlander or 602- __-ROOF _-PLYWOOD_NAI L-
or(esed for cele.If hbwi'ver,the bullring or impiovemcnt is sold�wiwithin-one year of -
completion the owner-builder will have the burden ofproving that he did not build or 603 - ROOF BATTENS
improve for purpose of sale.).
m 604 .-. ROOF IN-PROGRESS
co Lim owner of the prrpc7,am Business a contracting with licenced cunvecmm m
_
consumer the oejen (Sec. to a Business and Professions Coded improves
Contractor'sthereon,
License Law dies .f apply m m owner of propcny who builds ser improves thereon, "
%. _and.who conuacts.for such projects.poi@.a conwnorts).licensd pursuant.to the _ _ _.. .... ....
Convuctoh License Law.
❑I am exempt under Sec. ,B'&PClor this reason
0" Date . . .. , .
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certificate of Consent Or self-insurt for Worker's
Crfomonee of,he amaim. ;is work for whichrovided far bhisSecti I,is issuued( the Labor Code, for the
p p mi
❑I have mid'will maintaii worker's Compensation Insurance.u required by Section
37M of the Labor Code,for the performance of the work'fdr which this permit is
issued My Workces.Cpmpe2.sItain Insurance car er and Pol'y mbar me
e .YI'AERFI/n/D'':' +Policy Nd/ S'W !7/ /Y»389P f r .. tt k• ! 1. 1'i '.CT.I t t h•i s'•• '1
CERTIFICATIONOF.EXEM NFROM WORKERS't s 1 t', - s _ •'-
COMPCfJ$ATION .111. .INSURANCE" _1-.,_ _. ........ _. _ __.._. . ._....._._
(This section need net be completed if the permit is for one hundred dollar. 't ' ' `.t,,,.. t _
(5100)or Iess.)
I.cenify Nal in the perfomt5nec sof the work for which"hi,pemtit is issued,1
'hall not employ any person in any manner,so as to become subject to the Workers' '
Compcnmtion laws of California.Dam
Applicant '-
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should
became mbjecuo the Worker's Compensation provisions of the Labor Code,you must
C) 0 'Zittiream I p y with such provisions or this permit shall be deemed revoked.
Z t
CONSTRUCTION LENDING AGENCY ' - -
F' ` 1 hereby export that them is a construction lending die agency for performance 't
Lear "
e work for which chis permit is issued ISec.3097.Civ.C.) __ .... - .. ....
(� emfer's d
7"z Lender's AdAddo ers •-. .. ._ ... ..• •.. I'
V. O 1 ready that I have read this application and state that the above Information i,
cortca.1 agree to comply with all city and county ordinances and state laws slating
f) to building construction,and hereby imhorice representatives fthis city,.enterupon
. } W the above-mentioned pratemy for inspection purposes. ..
E. p. (We)agree,.smlave.mand keep harmless the City of Cupertino against
n•t W liabilities,judgments,costs and expenses which may ser any way acne i gma,l said
t C.J Z City in consequence of the granting of this penno.
'•' APPLICANTUNDERS'AND A.' WILL COMPLY WITH ALL POINT Issued by: Dale
URC- It )S/-z 3 o y:
Si w A tanUContne me /
gn, p , - Re-roofs
t - HA9AR S AdATER1A1 5 DISCLOSUR d
' WIINee'Ccant r but�dgoccupantstiliofndthandle Healthanmaterial Type of Roof .. .._ _ .._- . . ... .. .
•C de.Sed iby on 25'Cupertino Municipal CW Chapter 9,12.and the Health and Safay .r ,
Cad Section 25532(a) ,' '�} +' J:, �' r i I, .•, ,t, ;1 :.,
OY. ' I. Na'�.t ^Z.,�I 11 1 .
_ All roofsshall be inspected prior to.any.roofing.material,being,installed.
Will the polio t or future building p t use equipment ord ces wmeh If a roof is installed without first obtaining an inspectlori,Itagree.to remove
emit Incurious contaminants d fi cd b5 the Bay Aria Air Qua]ity M nagement
District? all new materials for inspection. Applicant understands and will comply with,
r
Elye, -- 1 '. - all non-point source regulations.''
`V f 1 have read the hamNous mencrals,regmremcros'under Chapter R.95 of the
Califomin Health&Safety Code.Sections 25505,25533 and 255341.1 understand that
if Ne building does not currently have a tenant.that it is my m,v mmbiliiy to notify the
Occupant of the requirements which mum be met prior to issuance of a Cenificme of
Occupancy.
- � - ' r' Q � Sign of Applicant Date _
p admii:ea agarol tial All roof coverings to be Class"B"or better
-
.. - .
._. i. _.-.: ..... ,...i .::. OFFICE'