04090236 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERNIIT CONTRACTQR INFO1tQN' -
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1LDINGADDRESS: ANNA HWANG• PERMITNo0409023U� 6
840 SANTA TFRPqA T)R
NER'S NAME: PERMITISSUBDATE
ANNA HWANG
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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app LICENSED CONTRACTOR'S DECLARATION
�u F 1 Mleby am.that 1 am licensed under provision of Chapter 9(commencing Job Descrlpd
n� with Section7")of Division 3 of the Business and Prideasinm Code,and my license is HNALED
I.fmleChase effect.
REMODEL (1) BATH & ADD A/C
Oau�Clua Convenor .
0 ARCHITECTS DECLARATION NOV ,� �oo4
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�y 1 understand my plans shall be used as public records
G Licensed hereby
ovl BUILDING
OWNER-BUILDER DECLARATION
�a f I hereby.(lien on 11. exempt Businessfrom an TW Conine Co License Law for Ibe
a o which followire uiresrestoa (Secdon Rommo . ut,improve,
vefdemoli Cale: pts city s county
$fir. which requires•permit re cnnsuuct,a@a improve,dcmatsh,ri e sig any structure tcnnn
F y pnmmits issvvgalsontto Melbeappos of forsucthe Cohpermitmfdcae Law(ummcm
a< (that he commencinglicensed Pursuant70th)orDivision of ComrscmrlLicense law(ChoPmr9 Sq.Ft.Floor Area Valuation
$ Met In, s exempt
Section 7000)orbasis for
of Thoeged umpton.ss and Any vi Gstle)of
Met he ts exempt Therefrom and de bol,for da alleged caempdon.Any violation.f
Section T031.3 by any applicant for a permit subjects the applicant to a civil penalty of 35UT0Qtj1ee100 Occupancy Type
not mom Nan five handled dollar(5300).
❑1,as owner oftlle pmpeny,or my employees with wages as their sole compensation,
will do dawork.and theatmetur,is not Intended encircled forsalc(Sec.7W,Business Required Inspections
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and Profr odors ctoYs Code:The ConuaLicense law doa ler apply a e ns an owner of q p
property who WilNorimprovrs thereon.and whodoeaauch work himselfor through his
own employers,provided Nat such improvements ere n nthrooded.,offered for ale If, .
h.wever,Ne building o,improvement is sold within one yeer.f completion,Ne..r-
builder will have the burden of proving that he did not Wild or improve for purpose of
ale.).
❑1,as owner of the property,am exclusively contracting with licensed ro mer fors to
covwcl Ne project(Sec.7044.Business and Professions Code:)The C.nuacter's Li. _
cove law does not apply to an owner of properly who Wilds or impmves thele.n,and,
who contracts for such projects with a comosecmr(s)licensed pursuant to the Cnnwctoes
License Law.
Iarmexemptunder Sea ,B@PCfsrthismmmrDate
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�— /r�j .K�SC.MNSATIDNDECLARATION1�14IM4
1 beleby affirm under penalty of perjury one of the following declarations:
1 have and will mountain a CerdRcee of Coram m alf-imam for WorkehCompen-
ation,a provide4 for by Section 37M of the IsWr Code.for the pen.finenm of the
work for which this permit is issued.
❑I have and will maintain Workces Compensation Insurance,a required by Secdon
1710 of the labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy ble:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE I
(This section need nmbecompleed lithe Permit is intone hundred dollars(5100)
or las.)
1 certify Not in the perfurmace of Ne work for which this Permit u issued.I shall nes
employ any person insY.0L erso.Tp becomja'u.tbe Workeri pe
Comnsation
Law.of ie.Datc�L //'e s�
NOTICE APPLICANT.Jr.after making after Ccnifrca of Exemption,you should
become subject To the Worices Compensation previsions of the labor Cook.you marl
,z forthwith comply with such provisions or this Permit dull be deemed ranked.
z O CONSTRUCTION LENDING AGENCY
[-ice Iheeby M.that dcreis.comurnainn lending agency for the performance of
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the work for which Nie peril,is Wood(sec.3097.Co.C.)
a0 Lenders Name
.7 z Lender's Adder..
V C 1 moify Nat 1 have,cad this appliev0on and stale Nal the above information is
CF correct,1 agree to comply with all city and county ordinances and state laws miming to l
V building construction,and hereby eutbonse mpr.anutiws or this city in order upon the
j.CL above-mento greecd 1. ave for demnif an dee ha /
(Wo)agree m ave,indemnify and keep harmless Ibe City of Cupcnino against
(,y liabilities,jutlgmcnts,co sandeaperues which may in any way anus.9.1.1 said City 1` ,
6j Z inconsequence.fthe granting of this Permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
RCE R REGULATIONS.
U . O�/u
Re-roofs
S t9natumm,of ApplicaMC.n 11Z
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building occupant alom or handl.hamrdoua material
as dented by the Current no Municipal Code,Chapter 9.12,and Ne Health and Safety
de,Orion 25532(.)?Yrs N. All roofs shall be inspected prior to any roofing material being installed.
i�
Will the applicant or funs Wilding occupant tau equipment.,devices which If a roof is installed without first obtaining an inspection,I agree to remove
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no,hazardous air comeminants a defined by the Bay Are.Air Quality Management all new materials for inspection.
District?
❑Yea ON.
1 have rad dee haudnm mncnalsrcquilemenu under Chapler6.95.f Ibe Califon
'a H.Iffi r SafetyCode,Secdon 25505,25533 and 25534.1 understand thatifthe Wilding
not currently have a anan4 that it u my responsibility on notify the becupal of the
royuilemcnts wh' level lmet portion issuance ofe CcniMae of OccunOcy. �/ Signature of Applicant Date
Ownervaummiredagent J p All roof coverings to be Class "B"or better