04090294 CITY OF CUPERTINO ^' e :�s ,p r " `•'" ' `° "'
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION .-;
rax 4Ai,'2
BUaDING ADDRESS: TOTAL CONSTRUCTION PERMTFNkb4090294
303 q( FNTr BI-SIT)
WNER'S NAME: PERMIT ISSUE DATE
SUNG K LEE 136 ("YPRP.RR AVF. 2.107/200c;
NE: SANITARY NO. CONTROL NO.
' 408 781-3109
AR CHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOO LICENSED CONTRAunderpDEConsofCON JobDescri tion
Lu I ion 7 )of that I Am licensed under provisions or Choana 9(commencing P
with Section 7g1U)of Division 3 of Nc BuslmvarW professions Chun,and my license is
in full forte and If
5 z Lieenseclaa Lt.g SFDWL-2 STORY (3507 LIVING)
^�es D'm IARCHM c IRAMON GARAGE-639 SQ. FT. R&A,
I undersand my Plana mall he useJ a Public records
zi
30 Licensed Professional
OWNER-exempt RDEthe Communes
om un
I 1 Munn.
Affirm on 1 em exempt Dam 0m Cwrions Yd License Law for the
TOO followingguiresa (Section 703 1.5,Business and Prof&muli Code:Any city scounty V im` r O
$0 whim requires A Permit re cnvuwt,aloe est fvw,demolish,fire a sig any 9v)turt v Yl
prior m its isswnca,alsorequiresto the tiro applicant for such permit ro rile signed sulcmcm
a (colicensed Purwaol7000)ofprovisions ofthe eBuanessanavclaw(CMp¢r9 Sq.F[. Floor Area
m $ (commencingcimpt Section7000)and ft basis f r of me alleull exam d on.myonsCMc)or l�
Net he ts ncmpt tMrt(rom and the bats for The tllcged exemption.My violation of t\
Section 7031.5 by any applicant for A permit subjects the applicant to a civil penalty of APN NumberOccu ane Type
am more than five hundred dollars(5500). P Y
01,As owner of the property,in my employees with wages As their sola compensation, 35702007 . 00
will do the work,and No structure is not Intended or offered for (Sec.7GM,Business
And Professions Code:The Contrs.7ofs License law don WE apply to on owner of Required Inspections
piopenywho builds orimproves Burton,and who doessuchwmk himselforthrough his
Own employee,provided that such improvements An,notheonded or offered forstle If.
however,the building or improvement is sold within one year of wmpleuon,No owner-
Wilder will b rve Ne Wrdcn of proving than M did not build or improve for purpose of
sakJ.
❑1.as owner of the property,am exclusively contracting with licensed crntraerem to
construct this project(Sec.7016,Business and Nofecones Code:)The Comment".Li.
rave taw does am Apply As in owner of property who Wilds or imprors Berton.and.
who concocts for such pmjecu wits a comracods)licensed pursuant he The Contractors
License Law.
❑l am exempt under Son ,B&P C for this moaner
13011 cr Data
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under petalty,of perjury ore of she following deelarauons: .
have and will maintain a Certificate of Consent 7o calf-imam for Worker's Compen-
n,a provided for by Section 37M of the labor Code,for the performance of the
for which this permit is issued.
have and will maintain Worker's Comiammir n I....a required by Scomm
of Ne labor Code,for Ne fer omance or the,work forwhich Nis Permit is issued.
Worker's Compensation Insurance cartier and Policy number amer. S'r..+� �.i0j Policy NO.: / x2/34�20
CERTIFIC TE OFEKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusection eednotE cMPlcad ifthe Permit is form=hundred dollars(SHAI)
Or Ina.)
I ceniry that in Nc performance of the work for which this Permit B issued.I shall not
employ any Person in any mannerso a to become subject to the Worker:Compenae0on
Laws of Calif.ird .Dao
Applicam
NOTICE TO APPLICANT:If, per making this CcnlOcaa of Exemption,you should
become subject An the Worker's Compensation provisions or the labor Cock.you most
.,O forthwith with comply with such provisioor Nis p)mnil shall b)domed rtvakcd.
Z M CONSTRUCTION LENDING AGENCY
F'� I hereby arm that there is a convection lending agency for Na performance of
fY tint wok for which this permit is issued(Sec.3097•Civ.C.)
GA Leadeea Name
Z) Z Tanner's Address
U Q I certify that 1 haw mad Nis city
sod coup and sum Nu N)above information Is -
0 U )mrtCm I agree N comply with all airy oral county Ordinances and sou laws relating e
�U Wilding construction,and herby auNoriu rtessa uwu of this city An color upon Nc
W abovwmenuoned" Pen"for inspersiont keep hs.
(We)ager ave,indemniTY and keep harmless Bu City of Cupenin0 agsivt
M N."ftus.jmg n .emu aadespcnw which MAY in anyway accrue agaivtsaid City
U Z in cmr7segmnce f graming of this permit.
APPLICANT DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by. Date 2 ,2 -0-)
SOURCE E LATIONS.
Ic , r'O Re-roofs
Si a icamucis oac pDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W11 Applicant of future Wilding Occupant Amm or handle hacrumn maoritl
As defier y the Curci ito Municipal Code.Chapter 9.11,and the Health and Safety
rade.s< es [rNo
zss31(.)7
❑YeAll roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant us)equipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil hazardous air contaminants As dcfncd by the Bay Area Air Quality Management all new materials for inspection.
Dmirictt P
❑Yes JQNo
I have road the heaunhas in s aquirtmenu under ChAPe"6.95 of Ne Czlilm.
niaHealN&Safoycode,Secuo 5.75533 and 25336.1 undersand Nu irNe building
docs om caren0y have A¢era At it 6 my n spovibili7y in nouly Be Occupant of the
myuimmcnu which ass be priartuissaan)ean crnirwaro err QeapanI Signature of Applicant Dale
Owner oranlint Ili ud Dae All roof coverings to be Class"B"or better C
CITY OF CUPERTINO
BUILDING DIVISION PERN�tT ,CONTRACTOR INFOItMtiiION >
T:IT
BUILDINGADDRFSS: TOTAL CONSTRUCTION PERMIT'904090294
VT
ER'S NAME: PERMIT LSBIIE DATE
SUNG K LEE
PHONE:
SANITARY NO. CONTROL NO.
. (408) 781-3109
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
il00 LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm that 1 am licemed under provisions of Chapter 9(commencing
z� with Section 7W0)ufDoinn.SofRC Busiemmid Pierce ...,Code,and my license is sk
immndmas erfect. />j �, II'2�r1 SFDWL-2 STORY (3507 .LIVINCC
License class. /t- USI Contractor e
w Date _cumaewr GARAGE-639 SQ . FT.
y '''IIS'' ARCHITECTS DECLARATION p�
y p Q 1 Understand my plana shall he used u public mentos
DyV f
3 o t] Liccnsctl Professional •x y _!/'
OWNER-BUILDER DECLARATION
T6 �fs
I hereby alirm that I am exempt road the Contractor's License Law for The C n�
O C following reason.(Section 7031.5,Business and Professions Code:Any city or county
m� which requires a permit to construct.aIMr.improve,dcm0lish,of repair any structure p
FZy prior it its issuance,also require the applicant for such permit to file a signed suumern U
sec that he is licensed pursuantto the pmvisionsof the Civancwr'sLicense Law(Chapter 9 Sq.Ft. Floor Area000 .
pFG (commencing with Section Division 3 of dhe Bitmocasand Paressim eCade)or 1[,r
i $ Nat he is exempt therefrom and Ne basis for the alleged exemption.Any violation of V f za.9
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penally of APN Number Occupancy Type
not mare than fire hundred d011ars(5500). 35702007 ��
❑1,as owner of the propcny,or my cmployeas with wages u their sale compensation,
will do the work,and Ne structure is not intended or offered for sale(Sec.70,14.Business
and Prod summe,Code:The Conmcwrs Licence Law does not apply w an owner of Required Inspections
property who builds or improves thereon,and who doessuchwork himself or through his
own employees,provided that uch imprommenu are not intended or offered for sale If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sal..).
❑I,as owner of the propcny,am exclusively conuacting with licensed consmears to
construct the project(Sec.7044,Business and Professions Cade:)The Contractors Li-
cense law dors not apply to an owner or property who builds or improves Reason,and
who comets for such projects wit a eonractor(s)licensed Formation 10 The Con ractots
License Law.
❑Iamexemounder See .B&PCfor Rismason
net Date
WORKER'S COMPENSATION DECLARATION
1 hereby of r n under Penalty of perjury one of d o following declarations:
l ham and will maintain aCcrtificete of Consent in self-houre for Worion's Compen-
sation,as provided for by Section 37W of the labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as,required by section
3700 of the labor Code,for the perfamanee of the work for which this permit is issued.
My Worker's Compensation houmncc carrier and Policy number am:
Cartier. (''Y..kl. tiN.� Policy NO.:��V/3k-2-"
9l CERTIFIC TEOFEXEMPr1ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hccomplctcJ If The Permit is fmonc hundred dollars(5100)
or less.)
1 out that in the performance of the work for which this permit is issued,I shall not
employ any person in any manneren az to become subject to the Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CcniMam Of Exemption,you should
became subject to The Workers Compensation provisions or the Labor Code,you mus
.JO forthwith comply with such provisions or tis permit shall M deemed reveled.
z CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that dere is a construction lending agency an the performance of
fYi the work for which this permit is issued(Sec.397,Civ.C.)
aA Lenders Name
,a z Lender's Address
V 0 1 certify that I base read this application and sum Net the above information is
Ig, (•-I correct.I agree to comply with all city and county ordinances and sum 13WS relating to
O V building construcproperty tion,and hereby authorize mprescnutivcs of this city in enter upon the �e(�//�[�q—`qty(/' /
ahovcmemiunetl J.=for inspccuon whichpuripmes.
y (Wc)agm{tq a ,on
amady and keep intruders Re City ad Culandoo against �—
pl liebiliucs,jutlgm n .cess and expenses which may in anyway accrue against said City �T
(•J Z in consequcncc ftc granting o(thispermit. —�
^I APPLICANT,[INDERSTANDS AND WILL COMPLY WITH ALL NON"POINT ISSUed by: Date
SOURCERE-ULATIONS.
—� ✓�/1 "'7 :W° Re-roofs
SigoId.c OPA p mmVC .tax c 'Dam
/I HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wall the applicant or future building acolonnaded,or handle hams dous material
as defined y Live Cupertino Municipal Code.Chapter 9.13,and to Health and Safety
•odc,s. 'ten 25532(a)?
❑Y.a p-No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanodms air contaminants in,defined by the Bay Arca Air Quality Management all new materials for inspection.
D'suictl
❑Ycs CJ NO
1 have mail the hazardous masrequimments under Chapter6.95 of The Califor-
nia Health&Safmy COJc,Smuonyij505,25533 mrd 25534.1 understand dm ifdNc hniding
does not cumemly have ¢a. k'dat itis my responsibility to andly the occupant of the
requirements which nonel< etpriarwi<umme(accrdrcamafacup—mcy. _.Signature ofApplicant Dale
�/ ��✓L '1N'"IJ'
Owacroraohon daFbT— s– D� All roof coverings to be Class "B" or better