04070044 CITY OF CUPERTINO r.�
BUILDING DIVISION PERNIIT CONTR°ACTOR INFOILMATIO1V
BUILDING ADDRESS: SUMMIT BUILDING CONSTRUCTI USTI"'04070044
OWNER'S NAME: PERMIT ISSUE DATE
AML PYONGWON YI
E: SANITARY NO. CONTROL NO.
(408) 209-2552
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lop LICENSED CONTRACTOR'S DECLARATION O O O O
F 1 Mrcby affirm Nei 1 am fimnaea ander provisions of en.vmr v(Commencing
lob Description
iWwith Satos7")of Division Softhe Business nuf Prufesson Code,and my liccmc is s
to
"`oma inBtneClass force el&" ADD 849 SQ. FT. (MS . BEDRM/FAMI . RM)
Zz DamLicenro Clue Comrxsor
�, ARCHITECTSDECLARATION GARAGE 440 SQ. FT. /CHG GARAGE TO LIBRARY
�i 1 understood my Plans shall be used u public menrds
�yU
3o!`n
Licensed Pmfcssitnal
OWNER-BUILDER DECLARATION
0 Y I hereby affirm o 1 am exempt form the Contractors :A nu law for the
my
m p O following mason Permit
co me Busiass and Pro.demob Code:Any city s county
y$ which rcquims a permit w cnrutrvcL elmr,imPms:,demolish.m repair any structure
=i< prior to its issuance,also requires the applicant for such permil to file a signed statenvent
lost W is licensed pursuant to the prevision of the Cmuracmri License law(Chap¢r 9 Sq.Ft. Floor Area Valu$t�QQO
aro (commencing with Section 7")of Division 3 of the Business and Profession Codc)ur 's'
59 Nat he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7W 1.5 by any applicant for a Permit subjects Ne applicant to a civil penalty of APN Number 'ecu ane T e
not more than fin hundred doll.(S500). 31602048 . 00 P y yp
❑1.u owner of the property,a n my edd'IOycwith wages u their sole compensation,
willdothcworkanldoe atmnum is not intended or pnered far CAC(Sec.1044,Busines ,._'
and Pmfeuiotu Code:The Conuactofm s License,law does not apply an owner of Requiredc
ppenywho builds or imptherconand whodoesswit work himselforthrovgh his JUI't
roroves
owncmploycu,Provided Nm such improvements.not intended m.ff Wfor sale.If.
however,Ne Wilding orimprovcmcnt is sold within one yearofcompleton.Ne owner.
Wilder
r tan Wrtle m eof proving Nat he did not Wild improve for purpose of
Wilde JJ l'I lyVl
I.as owner of the property,am onus and contracting with:i TheeContractors
n td atoms i- Il
ce. the project ISec.1044,Business and Professions Cotler)The.then t es. Li-
ame taw dues oat apply to m owner of property who Wilds p m impmvss thereon,and
whonse Law for such projects with aconvactortU liansetl pursuam mNe Contrxtofs
License Law.
p lam uempt un sec. ,B&PC fm is n
ff f�n n.�i9PE Dam
WORKER'S CO PENSATION DECLARATION
1 hereby alarm under penalty of perjury ane of the following dee tions:
have and will maintain•CertfOeamofennent to ulFinsure for oftesCompcm
sadro.u provided for by Section 3]00 of the labor Code,for the refor.....f Ne
work for which Nu permit is issued.
I have and will maintain Worker's Compensation Insurance,u requited by Section
3100 ofthe tabor Code,for to performance ofthe work for which this permit u ittued. '
My Workces Compensation Insurance carrier and Policy number arc:
Carver: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection teed not W completed if the permit is for onehundmd dollars($100)
or less.)
1 cannily Na in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner an as at become subject to the Workeii Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Ccnilicate of Eumption,you should
become subjett m Ne Worku's Campvnaton provision of the IaWr Codc,you muu
.JZ forthwithcomply with such provisms or Nis permits hall he deemed revekcd.
Z O CONSTRUCTION LENDING AGENCY
[-. I hereby affirm Nat there iso eonuuction lending agency,for Ne performance of
GL the work for which this permit is issued(Sec 3M.Civ.C.)
Lenders Name
}Z Lenders Addmas
U Q 1 canify dot I have read this application and sum that the salve infomratiun is
{I.F correct.1 agree to comply with all city and county ordinances and sum laws relating to
p V building eonwcton,and hereby auNufia mptexntativa of Nis city In enter upon Me
W aWve-memiormtl properlyoat for i I.c maty purposes.
(We)agree to save,indemnify and kap huteless the City of Cupertino against
N in Consequence
ofMeStarting expeuesmit. may in anyway attrve against said City
(„)z Aconseq N'T of Me Starting SNis permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R_EpULA ONS. " n,
ICY ° Re roofs Signu�fcanyContrcmr Dem
HAZARDOUS ATERIALS DISCLOSURE Type of Roof
Will tan applicant or future building occupant some or W ndle Intentions material
as Msfined by the Cupertino Municipal Code.ChaPmr 9.13,and Ne Health and Safety
Me,Section 35532(a)?
El Y. Nt All roofs shall be inspected prior to any roofing materi being installed.
Will Ne a Ecant or mthm building.ecu If a roof is installed without first obtainingan inspection,I agree to remove
11
OP B pare sox equipment pr devices which P
iso ct?soln u
nair conmina11nu//u defined by dm Bay Area Air Quality Managcmcnt all new materials for inspection.
❑Yr( VNu
I have mad the Wrardous mamrialsrequimmenu under Chapter 6.95 of the Califor.
nu Hnalth&SafctYCodc,section 25505.25533 and 25534.I undersand Our frc Wilding
M.not Currently halt s anon,Nu it is my responsibility to noes ly thepant of the _
myui en¢ hm tcmetpdoreuT uanccotaccnj[ pfOccup y. Signature of Applicant Date
AAX
Owner or authorirsd agent Dam All roof coverings to be Class"B"or better