05110083CITY OF CUPERTINO
BUILDING DIVISION PERMIT1O1;TRAxC'Qi2,I�,
�t.MA"CTU1,
BUILDING ADDRESS:
SUMMIT BUILDING CONSTRUCT
MTN005110083
10629 RAND
OwNER'S NAME:
PERMIT ISS A 05
PYONGWON YIM
979'PINTO PALM TER
2005
E;
SANITARY NO. CONTROL NO.
(408)209-2552
ARCHr1EC17ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hereby aHlrre Inst I am luemed under pmvid m of Chapter 9 (commencing
with SAcma 7000) o(DiviNon Jof the Businrav and Pro(eninnx Code.md my license 6
I. full fora andenett
REVISION -FRONT ENTRY WAY TO COMPLY WITH
License Clara Lt. M
Dam Convseu
301 SETBACK/ORIG. #04070044
ARCHITECTS DECLARATION
1 uMcmend my plans %hall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 herchy affirm that I em exempt from the Commodes License Lew for th
following rtaan. (Section 703 1.5, Business And Professions Cade: My city or county
which requires a Permit u construct, slur, impmw. demolish. a mpoir any structure
prior In its in... Abu requires the applicant fornuch Permit to rile asigned statement
Conuacufs License Law 9
Sq. Ft. Floor Area
Valuation
Man he is licensed pmmant in the provisions ofdte (Chapter
(commencing with Section 700M of Division 3 of the Bmimmand ProfaNans CMA) w
$ 0
Ina he is exempt thcmfrom and the bests for the alleged campdoo. My violation of
APN Number Occupancy Type
Sation 7031.3 by arty Applicant for a permit subjects the applicant in a civil Pendry of
not mart dun Bw ham m l dollars ($500).
❑ I. as owner of the property, or my employes wish "Sea utheb role eompensedon,
98
willdo Newark. and the svunurt boot thundedeao02rtd faraAk (Sec. ]OM, Bugnw316e21948
Required Inspections
roil Professions Codc: The Conuecmrs Lkeme law des not apply u .n Owner of
q P
Property who Milds or im brow% thereon, and who does such weak hlnuaf or through his
own employees, Provided than sueh improvements art not Intended arn0ened far s.la IL
however, the building err improvement issold within am year OfamplNs, the owoer-
Mildea will have the burden of proving Wt he did not Mild or Improve far purpose of
tau.).
/
❑ 1, as ower of the property. exclusively convening with limned cdmneter%u
\•<�J`
ee.704 . Bamas Code:) The Convenors
comwn the Project (Sec. 7014. Business rod
whalans
at imProw Nems, And
ams taw don not apply an in %war of property and
S
who (m such pmkns with a conuseurtal licensed Wrwam u Ose Convrclaf,
mateny.wno sed p
C '`
\
se Lace
License taw.
❑ i am exempt u . B dI P C sea Nb mason
owner Dau
WO A LARATION
I km a1B oder y of Perjury of the following dMantims:
w and will metal. •CW state ofComem An selfdmum far WorkeesCompen-
u provided four by Section 37M of the labor Code. (ar the performance of the
wart for which this permit b Issued.
❑ 1 neve and will maintain Worker's Compensation Insurance, as required by Section
"'0'the Labor Code. far the performance of the work far which this Permit is issued.
My Worker, Compensation Incur na artier end Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This nation sed nm be compteted If the Permit bfarane hundred dollan(SIM)
or lea)
I certify that in the performance of the wort for which this permit is issued. I shall not
employ any person in my number an as an become subject An tau Wortcra Compensation
Law. of CNIfmm& Dau
Applicant
NOTICE TO APPLICANT: If, eAct making this Ccaincm of Exemption. you should
become subject to the Worker's Compntseuon provisions of the laMr Code, you muse
forthwith comply with such provisions of this permit shall he demand revoked.
CONSTRUCTION LENDING AGENCY
1 hereby %M m that there is a construction lending agency fm Ne performance of
the work far which Nis permit b Wood (Sec. 3097. Civ. C.)
'
Landers Name
Lender'sAddmn
1 «nl(y Out I ban read this application and sum, that the show Information is
eO1fCn. I agree in comply with all city and county ordinances and rote laws relating to
building conswnion, and hereby notarize mprmenutiw clubs city to enter upon thea
.hove -mentioned pmpeny for Inspection purposes
(We) agree to save; indemnify and keep humless the City of Cupertino against
liabilities, judgments, costs and expenses which may in my way ams against said City
in APPUCgANTeof the UNDER�tINDS ANof this D WIrmit LL COMPLY ITH ALL NON -POINT
Issued by:91ta�&o Date
REGUL fy
lC.,
IVWSOURCE
Re -roofs
Type Of ROOF
Signature of'
r Case
H RDOUS ATERIALS D SURE
Will the applicant or future building occupant mor bundle hawdam matertal
as defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
Code, section 35533(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yea No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Om:uPam tau equipment Or devices which
hawdnue air contsminanu as defined by the Bay Arca Air Quality Management
all new materials for inspection.
let?
❑Yes XNu
I have mal the humd.s smaurlab requirements under Chapur6.95 ofthc Califoo-
.is HOLM a SafclyCodc. Secuan%35505,35533 od25534. 1undcutsnd that l(Oe building
does not currently haw a unam that It b my respomlhilily u badly the accupant of the
requirements whi uu be met prior to iuuancc of Ccrun cAto of Occupancy
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner
a oar asmm m
LOA