05120108�WZ
OCOC
�<W
_7—
J�FU
e0N
ao3
GO
YEN
-2>
yF�
F"
IL
Z
Z Q
a >h _
d A
Z) Z
J
OF
Ha
�z
7
CITY OF CUPERTINO
T ��'
7
CON 'CTOR IN
BUILDING DIVISION PERMIT
,:-t.
...e,.. g 9. r` tz. c -: �i, s s.. •.env' .;:
BUILDING ADDRESS:
OLIVIA SANG
PERMIT N005120108
Q70 STEVENS CRY RTA
.R'S NAME:
PERMITLSSUEDATE
OLIVIA JANG
19070 STEVENS CRK BLVD
01/19/2006
NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S
Job Description
ride, provisions of CON
1 hcmby that 1 am under Chapter 9 (commencing
ft
p
Hu and onions mi
with Section )01111) of Division J of the Businuv end Profcsiuv Code. and my liccnm is
) of f
in rat] mc.andafma
RELOCATE GAS METER /REPIPE GAS LINE
Liens. Class Lic. N
DoM Contractor
ARCHITECTS DECLARATION
PERMIT 405110142 VOIDED REFUNDED 127.56 ON THIS
I understand my plans shall he used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
1 kmhy affirm that 1 am exempt Tram the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or County
which mquiru a permit to cansnuct. alter. Improve, demolish, or repair any attraction
prior to its issuance, also requires IM applicant rat such permit to file a signed sutemem
that he is licensed pursuant to the provisions or be Contmctur's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7C M) of Division 3 of the Business and Professions Code) tar
$1000
that he Is exempt therefrom and Nc basis for the alleged exemption. My violati on of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number
Occupancy Type
not mom than five hundred delta. (55110).
P Y YP
I] L Of the property, or my employees with wagns azndeit Cole eompensaness
o thowa
will Ncwo Professions end the ahuaart u noes Lice d ore @Cod fm solo (Sec. 1000, owner o.
and cads: The License Law aces not apply lf an owner or
Required IDSpeCt10HS
wh booted, who
ws booted, bimseeedthrough his
property wyees,
�J
aneeeuchwmk
Own provided
awnemploheWildi Wilding or provehimprorcm within Me not our of at offered for We.
wmOIf.
builder . the building or improrcmenu¢ old within ott year or owner
a (of
Improve
builder will Aarc the haN[n of proving that he did not Wild or impmvc for pmpom of
pu
We.).
❑ I, awur of the Property, exclusively confessions with conwctosa to
Jam/
:) Theed
o a4,
consrua the project (See.
See. 70 , B of and Code:) Theves
�y
to net property who
atom law does not apply loan owner of propeny.who Wilds or improves boned. ltd
and
t/
who contracts Comun.
for such projms with a convumr(s) licensed pursuant to the Convectors
Lace
License low.
Bk PC for this mason
❑lam exempt antler Sec�.p
^
r H "l Data V114,
WORKERS COMPEN ON DECLARATION
1 hereby aRrm under penalty of p do, one or the following declinations:
1 brew and will maintain a Certificate of Consent to self -insure for Workers Compcm
sedan, as Provided for by Section 3700 of the labor Code, for the perfonnime of the
work Tar which this permit is issued.
-
❑ 1 have and will maintain Workers Compensation Insurame. as rcquimd by Section
3100 oTNe labor COdc, for the performance of the work for which Nis permit is issued.
'
My Worker's Compeoaalion Inedom. comic, and Policy number am:
Cartier. Polity No.:
CERTIFICATE OF EXEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(ihu maim nee door W completed ifthe permit is forou hundred OCR. SIM)
or less.)
1 certify that in the performance of the work for which Nis remit is issued, I shall not
cmplayany person in any7hermasb Ccum, subjccl to IN, Wafter? Compensation
Laws of California. se (�� 4�
Applicant ,-:C
NOTICE TO APPLICANT: Iffd eking this Cenificate of Exemption. you should
becane subject to the Wortcr's Compensation provisions of the tabor Code. you must
foMwi lh comply with such Provisions or this pefmil shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that then is a connndi inn lending agency for One performamc or
One walk for which Nis permit is issued (Sec. 3091, CO, C.)
Land.r's Nam.
I<MCfs Address
I certify that 1 have mad this application and stsle that the shout information is
correct. 1 agree to comply with all city and county ondinarl.es and scale laws relating in
building convection, and hereby auNOfia mpmmncatimt of this city to enter upon the
abovomentiuned property for inspection purposes.
(We) again to save, indemnify and keep harmless the City of Cupertino against
Liabilities , judgments, costs add expenses which may in any way accuse alpaca mid city
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.-
Ham � f /(Q /O
Re -roofs rye^
-`_ /
&gnuun of AppbcanUCOntrador Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will tite applicant or loran building amipantatore orhoulc hvardous macho
az defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety
. &.firm 25532(x)7
❑Yes ❑N.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devim which
If a roof is installed without first obtaining an inspection, I agree to remove
it hwardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
istrict7
❑Yes ONO
1 have read the himarduus materials mquimmenv under Chapter 6.95 of the Caiifor.
ma HealN&S9CLYCCdC. Secvms 25505, M533 and 25530.1underscand thdl iflhe Wilding
does not Currently hew a tenant that it a my matemahility to notify the occupant of the
,eMinmens which must rent prior it) issuance of a Ccnificae of occupancy.
l�/n x
Signature of Applicant Date
All roof coverings to be Class "B" or better
O
Owner m soOnasd agcrl b.. —