08050160 CITY OF CUPERTINO t ^-
BUILDING DIVISION PEj21yQ'j' kCONTRATQR^II 'kQI2MTIQ
PERMIT NO.
Bu1Lq�IrfD�+I�IMRUNE TREE LN TBD - TO BE DETERMINED 06050160
R'S NAMES: PERMIT ISSUE DATE
DAVID HWANG 07/09/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
0, LICENSED CONTRACTOR'S DECLARATION .
m I hereby affirm dud 1 ase licensed under provisions of Chapter 9(commcmdng Job Description
D vithSmsian101111)ofDivldon7ofNeBudmssa�gProfecsimuCoee,aMmylice�is NEW SFDWL-2 STORY LIVING 2 , 939 ' , PORCH
s in full farts and cRccs
5'q_ LicenseClau Lm.♦ 526 ' ,ATTACHED GARAGE 435 ' .
g r c Dam Contractor
W ARCHITECTS DECLARATION
7 1 understand my place Nall he used as public records
Jyd
k m Licensed Protection!
505OWNER"BUILDER DECLARATION
I Iertby art,.Nal I are ascmpt from the Contractor's License Law for Use
O 0 following season.(Scedon 7M 1.5.Businns and Pmfcssiom Code:My city or county
$ which rogaires a permit so emostract.alcor.W ptnro,demnllN,car mpalr any munum
-xi polar to its issuance.also require the applicans for such permit m fie a signed statement
<
thus kislicensed purwnttoNcpmnSionsOfthe CmUdM1(5licenreLass(Clepuv9 Sq.FC Floor Area Valuation
�� (commencing wish section 1000)orDbLston3nrmeBaamess and Pror mnsCode)or $720000
egg-. that he is esmnpl dendron and the thou for,the alleged ea depdon Any violation of
Sees=7031.5 by my applicant for a permit subjects du applicant to a civil Penalty Of pVVNumber Occupancy
not mom man live hundred dollars($30Q. 31633032 : ' Pane Y Type
Loowmraftlie themsey,car mywPiuyeeswimeageavdcvmk a .Bowmen,
will dome work and the at a Com a nm r Licand oLencmd mrsam(Sec.rots,Boner Of
and Rofemit Cade The Gasaaetor'a ndaisa law does Out apply to an awns of Required Inspections
prop em want th.promimpmsnmumu,andwho mensuch udehimselfedmmugb hu
man den.the Wi Dmvided ten tech ire is mid within
art not oun fs or offered formic.On own r-
however.the building or improvemmt'u sold within aro Sear of comnmtion,the owmr-
Wilem wi0l�ve the Wdco of proving Nat Ise did rot bulb a improve for puryase of
ink.).
ZiI.u er ownof the property am esduivcly contracting with Band mnOston to
uwn de project(Sec.7044,Business and Pmfessiam Cade:)The Cmoaclur's U.
come Law does eat apply to an owner of property who Wilds or improves thereon.and. _ /)
who convects for such pmjew with a comemsods)leaved pursuant W the,Contractor's
IJcese law.
lam mfle,mps undo See / B&PCfar Ws won
VciD.aar el
' WORK31sCOMPENSATIB�RATION
1&why alllrm under Penalty of perjury 9th of the following declarmons,
❑1 ham and will maintain a Cmdfimte of Consent to selNesuu far Warker'sCompen-
scion,as prosmd for by Smtion 5100 of the Labor Code.for the pertmmsece of the
work for which this Permit is banned.
❑1 baro and will maintain Worker's Compensation Insurwz,as tequised by Section
5100 of the labor Code,for the performarce of the were farwhirh this p.is is lame.
My Worker's Compensation Wuraree ems and Policy number ace: -
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This modest recd ros W catnpkmd fine Renu him=handteddollars(8100)
M less)
1 unify thas in the purr..of the work for which this pantie t is issued.I shall not
employ any person in any manmr oasmhcome sublmtmthe Worker'Comp cation
Applicant Laws of Celi ami} u
NOTICE TO APPLICANT: alum mil seg this i$iOnS Of the
LAWT Exemption.you Noun
.J Obecome moms m she WOdsuch Fro Coes or ri,dsm provisions Of the labor Code,you must
fmthwiN comply win such provisiam m mu permis Nall W deemed derokcd.
'Z ` CONSTRUCTION LENDING AGENCY
I hereby affirm dons Bert is a construction lending agency for me peRmma cof
fi' > tau work fm whim thin permit is hood(Sec.3091,Civ.Q
GA Lender's Name
z Lender.Address
U Q 1 certify Nat 1 haws nae mi.appliwia s ad sum thal he show,itemmaden is
(L H cones.I agree to comply wit all tidy and county,ominanm and sum laws mating to
C Wilding convection.ad hereby authdm mIesemmm,,alibis city to mus upon Use
W above-mendomd property for inspection purposes
gy (We)agree to un,indemnify and keep harmless the City of Cupertino agilml f
VI IiaMtiUesfdgmmu,costs ad expmun which may m any way acerin agalmt and City
V Z in eomequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU 'R�EGU�LAaT,I,O,NS.
Re-roofs
Sigmtue ofAisislicinuCconscanclofDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII y t e Cupar m future Wilding mmpaptzom maimthandle Notts anmaterial
time by dse Cupenim Municipal code.Chapter 9.Iz tab sW Health arta safety
.4ecuou 235324)1
❑Yet MNe All roofs shall be inspected prior to any roofing material being installed.
Will the. lirnt of foram Wilding s m ant a If a roof is installed without first obtainingan inspection,I agree to remove
PP g e sen Air Qct m tkwana which P
emit haramnm air conuminanon u defined by me Bay Arta Air Quality Management all new materials for inspection.
District? P
❑y.
1 hove dead the hmardtats maurials rtquisemcoon under chapter 6.95ofthe Ulster.'
nu Resins&Safety Code.seconds,25505,25533 sal 25534.1 undnstvW that if the Wilding
does ml ends hme a musm shut it 13 MY responsibility m ratify the occupant of the
nor hichmtmW�pnarmics..f.Ce,rma car ��. Signature of Applicant Date
notion
OUmc1mmLhsM.d.rrU Date All roof coverings to be Class A or better