00040070 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING,kkI][)g,Ii.S.'ROSE BLOSSOM DR PIaRMrr No.
tSCt! O L AJ`::�
OWNER'S NAME IAPPLICNI ION SUB DA1'li
YOUNG KIM 8(0 L•
'HONE: �— SANITARY NO. N k
v a 6 C-4 CK z3
PCL ARCHITECT'/IiNGINEER: L/(r 1013, BUILDING PERMIT INFO
_ 8� BLDG ELECT PLUMB IV II
J I`I -1 I_1 -1
FF6
z Oyu I thereby onion that llvn lirnud under Provison,of Chpter 9 mmnmeneing Job Description
0_tw with Section 70001 of Division 3 of the Business and Prnressions Code,and my licenu
6 Y s J is in lull force and ellc�
C License Class (;J
o a O Dan comentow
ARCHITECT'S DECLARATION
I unde,ohni my plans shall be usnl as puhle,reaorll 1 ALE D
Eco LicensedPro@"ilony REMODEL—ADe. DITION
o OWNER-BUILDER DECLARATION MAY O 3
1 hereby affirm that I am exempt troth the Comment's License Law for the 2001
r z following reason.(Section 7031.5.Business and Professions Code:Any city or county
I :] which requires a permit to construct,alter improve,demolish,or repair say structure
a
prior o its issuance.also requires the applicant for such peanut,file a signed statement
a 3— that he is licensed punu:mut)the prow f ious(if the Comments,License l.aw(Chapter 9 UILDI
mnmmercmgwhnSeerme700foofDivision 3 it the Btoma,andProbesann.Cadel Sq. FL Floor Area nat050000
e teal he is exaopl mererm:n and the has..R,r the alleged eserpllon,Any w union
ill Seaton 7031.5 by ar,::pphcam lima pencil"ah"o"s the upplicmn to a visit penalty �pN �pn�3
M not more mlive e hundred dhllaras5wl. •359@�iSIG 1. 00 Occupancy Type
EI 1,is ownerofine property.or my nnployces with wages as lheirsole compemation o77¢t4¢'
will do the work,amt the swcmre is not intended or offered for sale(Sec.70 W.
Business and Professions Code:The Commctor's License Law does not apply to an Required Inspections
owner of property Who builds or imposes Hart and who does such work himself
through his own employee...provided that such improverneah are not intended or
uttered for sole.11,however,the building or impnocn,ent is sold within one year of
completion,the ow:: ami der will have the burden nr proving dal he did not hold or
improve purpowo 101 — FOUNDATION
❑1,as owner of the property,tun exclusively cotnucting with licensed contractors to 102 — PIERS
rostrum the project tsec.70,14.Business and Professions Calls:) Fire Contractor's 103 — LIFER
License law does not apply to an owner of progeny who builds or imposes thereon.
sad who commas for such projects with a contractions)licensed portant to the 1.04 — REBAR
Centucme s License law.
❑I am exempt under Sec. .B&P C fora his .,an 105 — ANCHOR BOLTS
Owner Data106 — SEWER '8- WATER
WORKER'S COMPENSATION DECLARATION
1hereby amn,torder Penalty of erjti,,onaolife felnwin,thelmanm,.: 202 — UNDERFLOOR PLUMBING
n 1 have and will maintain a Certificate of Consent to self-insure for worker, 203 — UNDERFLOOR MECHANICAL
Comperrenim, as provided for by Section 37W of the UW, Cude. fee he 204 — UNDERFLOOR FRAME
performance of the work for which this permit in issued.
205 — UNDERFLOOR INSULRTION
❑00af and heI,h.nwins. Worker's rfonnauee a he
or ,cyulrtJby Senior 301 — ROUGH PLUMBING
3JW of the Lnbur Code,liter the perforn nce nl'tht wad or which Ilii,permit is ,�
E„seed.Mk.
y,nittxah:maearrierandPnhcy mother me:. 302 — TUB & OR SHOWER
car,i"_Ng Lwv/41__,%rn?i'i�oi�t'G wo3ts_ 303 — ROUGH MECHRNICAL
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
(rus,<cdon need nrlthe tamplefed'dthePermit isrhrmehundred dollars 305 — FRAME
Ib W)or las.)
1 cosily that in the performance of the work for which this panni)is issued.1 306 — HOLDOWNS
amen not employ any person in why unnerve so In become subject I,,doe Workers 307 — INSULATION
Cou,cronion Law,of cmitarnm.[)ate
AppWwl308 — SHEETROCK
NOFICETOAPPLICAN'1':IL after making this Cenificam of Esemplior,Ynu should
z became suhjeamthe W'orker'.Call,nsmanprovisionswHeLadle,Code.you must 309 — EXTERIOR LATH
O O forthwith comply with such provisions or this pemhit shall be deemed revoked.
F ^ CONSI'RUCTION LENDING AGENCY 310 — INTERIOR LATH
rent'::fho,hmmmereis acan,m,ttionlcedmg agency for the performance 311 — SCRATCH COAT
eI'the work for which Ilii,permit is motel(See 3097.Civ,Cr
a p I,emlar,Mrshe 313 —. ROOF NAIL
Z I,ander',Addra,
U O t amity that l have ned mis apdirmio.and sum that be above information is 501 — FINAL ELECTRICAL ENERGY
Fcomer.1 agree to comply with an city and county ordinances aml,um lawse adding 502 — FINAL PLUMBING ENERGY
U In budding construction,and hereby amhorve eepreantaives of this city to enter upon
y w the a1. meatlonedproncnyforInspectionpurposes. 503 — FINRL MECHANICAL ENERGY
r L (Wm)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgment,costs tied expenses which may in any way action against said 504 — FF 1 IV9L BUILDING ENERGY
City in U 7a. All1AC NTUNeaofnhANDSANDWI p:mm. 5@5 — hP1�IAl--ELECTRICAL_ 7
SONCANTUIL IIO'1'ANDSANU WILL COMPLY WITH ALL NON.PRINT Issued by: Date O•—e/
SOURCfi RMULA'I'IONS, y'
Signature of Applicancenuador rate Re-roofs
HA]ARDOUS MATERIALS DISCLOSURE 507 — FINAL PLUMBING
wuthe appBcanlmfuture Wilding«swat,whelanelenamhdea,maretial Type of Roo 08 _ FINAL MECHANICAL
os defined by the Cupenim Municipal Code.Chapter 9.12,and the Health and Safety
Calc,Section 25532(0)1
El Yea N" roofs shaRe ins eget 6r tip' MV
material being installed.
will the:y,pl was m hmnm building uccupunl u,a eyripmtnt..r devices which I a f is iOSvtal'fed-witF1 R st d9la 111V lPffispection, I agree to remove
•mit hamrdou,.a i,.....,.minims a,relined by Ise Bay Area Air crudity Munngcmem
`. rice at new ateMi4foHnFpp1dtlf_ AWB1atltdnddFlBM and will comply with
I . ' 0Yes N" all to -po t source regulations.
I have am the hoar ors mnmraln militiaman,under Chapter 695 of the
California Health&Safety Gd,Sections 25505.25533 and 25534.1 runaround that
if building dna not awards,have a tenant,that if is my responsibility to roily the 3
:mtapant..r me reynhmnhem,wmmhmol rte mm priorw issuancem.h Certificate of
O y Signature plicant Date
—� All roof coverin lis to be ass "B" or better
O umnriaJ agent D:IIC b
1 OFFICE
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING,kkI][)g,Ii.S.'ROSE BLOSSOM DR PIaRMrr No.
tSCt! O L AJ`::�
OWNER'S NAME IAPPLICNI ION SUB DA1'li
YOUNG KIM 8(0 L•
'HONE: �— SANITARY NO. N k
v a 6 C-4 CK z3
PCL ARCHITECT'/IiNGINEER: L/(r 1013, BUILDING PERMIT INFO
_ 8� BLDG ELECT PLUMB IV II
J I`I -1 I_1 -1
FF6
z Oyu I thereby onion that llvn lirnud under Provison,of Chpter 9 mmnmeneing Job Description
0_tw with Section 70001 of Division 3 of the Business and Prnressions Code,and my licenu
6 Y s J is in lull force and ellc�
C License Class (;J
o a O Dan comentow
ARCHITECT'S DECLARATION
I unde,ohni my plans shall be usnl as puhle,reaorll 1 ALE D
Eco LicensedPro@"ilony REMODEL—ADe. DITION
o OWNER-BUILDER DECLARATION MAY O 3
1 hereby affirm that I am exempt troth the Comment's License Law for the 2001
r z following reason.(Section 7031.5.Business and Professions Code:Any city or county
I :] which requires a permit to construct,alter improve,demolish,or repair say structure
a
prior o its issuance.also requires the applicant for such peanut,file a signed statement
a 3— that he is licensed punu:mut)the prow f ious(if the Comments,License l.aw(Chapter 9 UILDI
mnmmercmgwhnSeerme700foofDivision 3 it the Btoma,andProbesann.Cadel Sq. FL Floor Area nat050000
e teal he is exaopl mererm:n and the has..R,r the alleged eserpllon,Any w union
ill Seaton 7031.5 by ar,::pphcam lima pencil"ah"o"s the upplicmn to a visit penalty �pN �pn�3
M not more mlive e hundred dhllaras5wl. •359@�iSIG 1. 00 Occupancy Type
EI 1,is ownerofine property.or my nnployces with wages as lheirsole compemation o77¢t4¢'
will do the work,amt the swcmre is not intended or offered for sale(Sec.70 W.
Business and Professions Code:The Commctor's License Law does not apply to an Required Inspections
owner of property Who builds or imposes Hart and who does such work himself
through his own employee...provided that such improverneah are not intended or
uttered for sole.11,however,the building or impnocn,ent is sold within one year of
completion,the ow:: ami der will have the burden nr proving dal he did not hold or
improve purpowo 101 — FOUNDATION
❑1,as owner of the property,tun exclusively cotnucting with licensed contractors to 102 — PIERS
rostrum the project tsec.70,14.Business and Professions Calls:) Fire Contractor's 103 — LIFER
License law does not apply to an owner of progeny who builds or imposes thereon.
sad who commas for such projects with a contractions)licensed portant to the 1.04 — REBAR
Centucme s License law.
❑I am exempt under Sec. .B&P C fora his .,an 105 — ANCHOR BOLTS
Owner Data106 — SEWER '8- WATER
WORKER'S COMPENSATION DECLARATION
1hereby amn,torder Penalty of erjti,,onaolife felnwin,thelmanm,.: 202 — UNDERFLOOR PLUMBING
n 1 have and will maintain a Certificate of Consent to self-insure for worker, 203 — UNDERFLOOR MECHANICAL
Comperrenim, as provided for by Section 37W of the UW, Cude. fee he 204 — UNDERFLOOR FRAME
performance of the work for which this permit in issued.
205 — UNDERFLOOR INSULRTION
❑00af and heI,h.nwins. Worker's rfonnauee a he
or ,cyulrtJby Senior 301 — ROUGH PLUMBING
3JW of the Lnbur Code,liter the perforn nce nl'tht wad or which Ilii,permit is ,�
E„seed.Mk.
y,nittxah:maearrierandPnhcy mother me:. 302 — TUB & OR SHOWER
car,i"_Ng Lwv/41__,%rn?i'i�oi�t'G wo3ts_ 303 — ROUGH MECHRNICAL
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
(rus,<cdon need nrlthe tamplefed'dthePermit isrhrmehundred dollars 305 — FRAME
Ib W)or las.)
1 cosily that in the performance of the work for which this panni)is issued.1 306 — HOLDOWNS
amen not employ any person in why unnerve so In become subject I,,doe Workers 307 — INSULATION
Cou,cronion Law,of cmitarnm.[)ate
AppWwl308 — SHEETROCK
NOFICETOAPPLICAN'1':IL after making this Cenificam of Esemplior,Ynu should
z became suhjeamthe W'orker'.Call,nsmanprovisionswHeLadle,Code.you must 309 — EXTERIOR LATH
O O forthwith comply with such provisions or this pemhit shall be deemed revoked.
F ^ CONSI'RUCTION LENDING AGENCY 310 — INTERIOR LATH
rent'::fho,hmmmereis acan,m,ttionlcedmg agency for the performance 311 — SCRATCH COAT
eI'the work for which Ilii,permit is motel(See 3097.Civ,Cr
a p I,emlar,Mrshe 313 —. ROOF NAIL
Z I,ander',Addra,
U O t amity that l have ned mis apdirmio.and sum that be above information is 501 — FINAL ELECTRICAL ENERGY
Fcomer.1 agree to comply with an city and county ordinances aml,um lawse adding 502 — FINAL PLUMBING ENERGY
U In budding construction,and hereby amhorve eepreantaives of this city to enter upon
y w the a1. meatlonedproncnyforInspectionpurposes. 503 — FINRL MECHANICAL ENERGY
r L (Wm)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgment,costs tied expenses which may in any way action against said 504 — FF 1 IV9L BUILDING ENERGY
City in U 7a. All1AC NTUNeaofnhANDSANDWI p:mm. 5@5 — hP1�IAl--ELECTRICAL_ 7
SONCANTUIL IIO'1'ANDSANU WILL COMPLY WITH ALL NON.PRINT Issued by: Date O•—e/
SOURCfi RMULA'I'IONS, y'
Signature of Applicancenuador rate Re-roofs
HA]ARDOUS MATERIALS DISCLOSURE 507 — FINAL PLUMBING
wuthe appBcanlmfuture Wilding«swat,whelanelenamhdea,maretial Type of Roo 08 _ FINAL MECHANICAL
os defined by the Cupenim Municipal Code.Chapter 9.12,and the Health and Safety
Calc,Section 25532(0)1
El Yea N" roofs shaRe ins eget 6r tip' MV
material being installed.
will the:y,pl was m hmnm building uccupunl u,a eyripmtnt..r devices which I a f is iOSvtal'fed-witF1 R st d9la 111V lPffispection, I agree to remove
•mit hamrdou,.a i,.....,.minims a,relined by Ise Bay Area Air crudity Munngcmem
`. rice at new ateMi4foHnFpp1dtlf_ AWB1atltdnddFlBM and will comply with
I . ' 0Yes N" all to -po t source regulations.
I have am the hoar ors mnmraln militiaman,under Chapter 695 of the
California Health&Safety Gd,Sections 25505.25533 and 25534.1 runaround that
if building dna not awards,have a tenant,that if is my responsibility to roily the 3
:mtapant..r me reynhmnhem,wmmhmol rte mm priorw issuancem.h Certificate of
O y Signature plicant Date
—� All roof coverin lis to be ass "B" or better
O umnriaJ agent D:IIC b
1 OFFICE