05060044 I
CITY OF CUPERTINO f , k~, 5
BUILDING DIVISION PERMITCNRACORF,J.tMTs4 N rt` -
;
BUILDING ADDRESS: ANNE & PYONGWON YIM "A"T"°'05060044
OWNER'S NAME: PERMIT ISSUE DATE
ANNE & PYONQWON
E: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
� 0 PLUMB
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LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby"in that = ne
at I Imeed o
under provisions of Chapter 9(commencin{
nGl n with SOcdan 7")of Division 3 arise Business Aral Professions Code.amy license
In fall fame and affect. and! e
REVISION--ELIMINATING PORCH &
j
License Class; Conuurar
Lee ARCHITECTS DECLARATION ROOF OVERHANG/REMODEL FRONT ENTRY
Y Iundor=ndmyplane shall Wusedupublic weards NO NEW PERMIT ISSUED/ORIG. #04070044
i�
5 ad�a
Licensed Professional
3 OWNER-BUILDER DECLARATION
Conti ON
I beretoy.(Sect Net 1 1. exempt from site C4nlrectmo e:My c taw for the
00
whBehich
reres a Permit t 703 1.5,Business Imp ova,Prode tans Code:My m or county
which its •Pcmlh re so=oras.Blur,improv,demolish,or mash any ttntelum
—i�^ Me,he i u leuwceursu pursuant
to Meres thovisio of forsuchMe Cor Permit w ole s Law(Calrmenl
< thnbeielicunwithScdlwthe provision of nuncwr'ard Prmlaw(ChaPterY Sq.Ft. Floor Area Valuation
�Ls (commenctngwith Setrical ndth Divisloor McABu munp ProfessionsCa de)or $0
Nn he'l.asempt Newfmm wtl the buts far McAmi esemptien.My NobUon of
Section 7031.5 by any opplium for a permit subjects the Applicant to a civil penally of APN Number Occupancy Type
rwl mart Nan flue Invited dollars(5500),
❑I,u°term of the pmpwy,m my=ployces withwges u deb wle c=peflon,
willdO the..it.And the a ntur.Va nm Intended oroRered fmsum(Sec.7044,Bain••• 00
tau Profession Cade:The mthecwh Llcm law alma not apply lf rt owner of �' R q 're� P,G[IOns
propenywho WIIMvided that
such impr wdwha tlmeaachwmk himself mUwugh his fy■IL�1/n/
awn employees,provided that tech Improvements to ne year o comoaered for W mbar.
however.NebuildinguImprovement ithat a Winarcyear or mprew for thepose of
builder will have the burden of proving Net he did Out build Or improv far purpose a(
tale.).
1,as Owner of Ne property,am eaclnslvely contracting with licensed contractors to �— 2005
conslrect Ile pmjca(Sec.7044,Buimst and Professions Code:)The Contncuses U.
censeLaw does naupplr 1.An Carmted, BUILDING
who convects for such projects WN aeonuacuKO llteuad pursuant w de Conuacufa
Cleanse law.
❑lameaempluntler a .B B Pcha b n
Owner_ 3 Data t7
KERS OMPENSA ECLARATIOI
1 bemby e(Rml under Penalty of perjury ow of the following declssmions:
I ham and will maintain a Certificate of Consent to selbinmou fm WarkeYa C=pen-
.b.,As provided for by Section 37M of the labor Code,for Ne performance of Can
work for which Nis permit 41ssued.
❑I have and will mainuin Wmkeh Compensation Insurance,As required by Section
37M of the Latour Code,for the Performance of Ne woh for which this Permit it issued.
My Worker's Compensation Inwrence carrier and Policy number=:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ml6wetion need not bec=pleted bile permit is fmonchuMMet dollars(SIM)
or tcs )
1 certify than In the performance of the.,it fm which this Permit is Whand.I shall am
employ any pare n in any'mwnLcr w a wM.com6 suhlaCl t,the werkmi CampensNon
Law of California.Dale (�MW
A
Applicant (rte -
NOTICE TO APPLICANT;If.after making this Cc 0este of Ewmption,you should
become subject ce the Waher's Compcwtion pmvi ns of Na labor Code,you rows
O forthwith comply with such provitions m be
this permit thall Mounted mkvood.
^Z„
CONSTRUCTION LENDING AGENCY
[-n I hereby affirm Nal them is a rmtsuucdnn lending agency for the performance of
a me wish for which this permit Is issued(Sec.3097,Civ.C.)
6Wi Undeh Name -
z Lender's Address
V Q 1 cea fy ton I have mad this Application and tem but the about information b
ty F cortctt i agree he tempts with all city and county ONinwces and rote law relating to
OrJ building construction.=dherebywthorive rcpresenutives of this city w enter upnn the
W above-mentioned property for inspection purposes
�"IY (We)agree w save,indemnify and keep ham0ess the City of Cupertino against
y liabilities,judgments.costs W eaperues which may In say any atone against hidCity -
in
of
his rmit.
APPLICANT UNDEence or the RSTANDStAND WILL COMPLY WITH ALL NON- DINT Issued by:9102� Date
SOURCE REGULATION;. i^ < -7I'/ P
„Nva✓� 'D I Re-roofs
Signature o(ApPlicwVCon RDD Date
HAZARDOUS bMATERIA antmomDISCLOSURE Type of Roof
WIII the a Cupertino
or future building occupant Aram or and M Health
material
As dented by the Cupertino Municipal Cotle,Chapter 9.17,wtl Ise HW N ted Safety
Cork,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Q<
1Will the applicant or future building Occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
,herudou air conuminsnu Oned by Ce Bay Area Air Quality Management all new materials for inspection.
Disuict7
❑Yee Nu
I have IoW the hvaWms materials requirements under Chapter 6.95 or the Califor-
nu Kral"SafmyCodc,Sections 25505,23533 And 25534.1 undcmand diet irthe Wilding
does not currently haw a Want.that it is my remamNility to notify the ocMmM1 Or Ne
requirements which must W mel prior to l=m"or a Certificate or Occupmey. Signature of Applicant Date
owner or awhamed.go., Date All roof coverings to be Class"B"or better