06010091 CITY O CCUPERTINO TCYPRESS
BUILDING DIVISION PERMIT CONNFORMATION-BUILDINGADDRFSS: TOTCTION PERNITNo06010091
10326 SCENIC BLVD
OWNERS NAME: PERMIT ISSUE DATE
CHIN KIM 136 VE. SANITARY NO. 2006ROL No.
E:
(408) 781-3109
ARCHITECTYPNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 a
sass LICENSED CONTRACTOR'S DECLARATION IObDe$CrI IIOT
w FC 1 Mreby from Nal 1 am"weed under provisions of Chapter 9(mmmercing P
U widr Secdon7000)ofDivivon]of NC Businm and Profession Code.and mylicenuu
In mum,eandaffec. ENCLOSE 2ND FLR. BALCONY (1301 )
>qz LiccnxClsss Lic.g REMOVE A WALL ON 2ND FLR.
qq Dam Contracts'
'FW ARCHITELTSDECLARATION SANITARY REQUIREMENTS MET
2.779 1 undersand my plans shall he used as public mentis
Sou
Licensed Professional
'ty3 OWNER-BUILDER DECLARATION
Z MSi 1 mosso .an.(Sec that 1 1. exempt from Ne Comlracm o License Law for the,
❑O following moon.(Section 7(n L;B.aw, and Pmfetvoes Code:Any city or county
<m which requires a.mann re crewel,a@a im to,
demolish,or repair any swcure
60,a,licensdpurs u,quires Neapplinnt for Contrch armi'tscense Law
sutement
x
< thatheuliantsedpursuanuodtepmvisionmfdue ConlruwriLicenseLawChapter 9 Sq.Ft. Floor Area Valuation
e t]
a . gwith Semon71ofDivision 3euandProfusiontCode)or $27868
that.e u
(commencing
therefrom andthe heads for the alleged
eumptiam Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
rat more Nan lite hundred dollars(5500).
I,as ewnv of me property,a mY wployev with wages u Ne'c sulc eompevation,
will do the work.and Ne s ucsure If not intended an offered fersale(Sec.70th.Basin.
and Prefesalnna Code:The,Caavutors Liana Law don net pply man owner of Required Inspections
property who builds or improves Neeson,and who docs such work himself or Nmugh his
own employees,provided Nm vch improvemvtu tie notinmmded aroReread forsale.U.
builders.the have
thg aimprovcmvin u old within oro year of amove for the owner- /
builder will have Ne burden of improvement
i Nm bu did nal build or improve for the purpose of
Sate.).
[Q•I,as owner of Ne Property,am exclusively contracting with licensed¢simmer m
commun Ne project(Sec.7044.Business and Professions Code:)The Commavm'.U.
cease Law docs not apply ts an owner of property who builds or improves thereon,and Q/
who contracts Law.[or such projectsprojectswith a cantractoKs)licensed pursuant w Nonvmoi
e Car
ice /
Lw, w�
❑lam exempt under See // ,B&PC(a Nis wan
mer 15 � k
i-ri1 Dam
WORKERS COMPENSATION DECLARATION S/ O
1 hereby Wlirre under penalty of perjury ane of the following declarations:
Q i him and will,amain aCertiliesm of Caruern N xlFinurt for Worter'sCampen-
salion,as provided for by Section 3700 of Ne labor Code,for the performance of the
work for which Nil Permit is issued.
❑1 harm and will mainuin Worker's Compensation Insurance,as mquired by Savors
3700 of Ne Labor Cada.for the performance of doe work for which mist permit is issued '
My Worker's Compensation lasurana artier and Policy number a,:
Carrier. Palley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE f
(Thu section tined not be completed if the permit is forone hundred dollar(SIM)
or Ica.)
I certify that in the Performance of the work for which this Permit is issued,I shall sat
employ any person in anymanner wbxomP subjvtw Ue Works.,Compensation Laws of California. �?
S�rnm
NOTICE TO APPLICANT.If,after making this Cer ifieste of Esemption,you NouW
become subjcv an the Worker's Compbstatiun provisions of the Labor Codm%you mus
.,O foMwith comply with such Providers v Nu pmmlt shall be domed revoked.
z� CONSTRUCTION LENDING AGENCY
[-t I herehyalfrm Nat Vert sea consvuninn lendimgagenry forme pc,icurn.of
the work for which Nu Permit is Wood(Sec.3097.Civ.C.)
0U.3 Undoes Name
.7 z Landce,Add.
U Q I minify that I have read this application and sum that the above infomutian is
U,F^ cancer.L agree to comply with all city and county ordinances and sate laws relating a
oU building construction.and hc¢b,munori reprexnativesof this city to cnm'vlmn Ne
ro,crty
purripa
�4 above-ms,judg dpaxasu farinslcescs which ms.
(We)agree m ma..indemnify and keep harmless the City of CuPeninu against
H h liabilities,Judgmcnu,casu and enpcnsv which may In anyway aecmc againt ssid City
U z in comfit cnee of Ne granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 670 Date
SOURCE REGULATIONS.
Re-roofs
Signature 6(Aypl'
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building occupant store of handle haurdous material
as wrined by the Cupemino Municipal Code.Chapter 9.13,and the HeaIN and Safety
da.Section 8532(07 All roofs shall be inspected nor to an roofing material being installed.6Na
Will tic 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 h.,manus air coolant nana as defined by the Bay Area Air Quality Management all new materials for inspection.
DivricR
t]Yes 6N.
1 have mal the hzaardsms materials roqui,ments under Chapter6.95 ofNc Califor-
nia Health&Safety Code,Section 25505.25533 and 23534.1 undcrsund thaif the building -
does rat currently have a tenon.that it in my resPmrihility m notify the occupant of me
require menu which most be met Friar In issuance ofa Cenifinm of�apenry�I Signature of Applicant Date
/s
Date All roof coverings to be Class"B"or better
Owner or agent '