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04030226 CITY OF CUPERTINO BUILDING DIVISION - PERMIT CONTRACTOR INI''URMATION BUILDING ADDRESS: PERMIT N00 4�0 3 022 6 682 S v ER'S NAME: PERMIT ISSUE DAM / QUEENIE FUNG BUBBLE E: SANITARY NO. CONTROL NO. ARCHITEC YENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH glop LICENSED CONTRACTOR'S DECLARATION gI hereby affirm that 1 am licensed under previsions of Chapter 9(commencing Job Description a>j with Section 70110)of Okvlsion Sof Ne Basin s d Prossio fens Code,mdmylimnseis $'z < fo and if Z TI--BUBBLE TEA ZONE D� ate..e u DamAcxlTEcrs D Cont actor N CONTRACTOR: KEN LEUNGVNIALE �i 1 undcnunJ my plans dull M reed uyuh rceards U Gt; Licensed Professional OWNER-BUILDER DECLARATION 2 I hereby v0irm that I am exempt from the Contractor's License Law for the 0Profession O 2004� O fallowing mason.(Section 7031.5,Business and Profuns sioCode:Any city or county 2 ff which requires a permit to construct,alter,improve.demolish,lir repair my structum prior m its issuance,ileus requires do,mpkicam lydw,h Permit t.fleeaignedsummem pp < that he is licensed pu..or to that provision.!Ne Conlnutefs Limn.Law(Chapter 9 Sq. Ft. Floor Area V I 000 v? $ (commencing with Section 7000)mf Oivision 3 ofthe Businessand Profession Code)to Nal he Is exempt thetefrem and the buss fax Ne alleged exemption.Any vuhnne.or Secdon 7031.5 by any applicantfora purnh.bjecu the applicant to a civil penalty of ppN Number ecu arc e No more than five hundred dollars(S500). 35717012 . 00 PNum P y Typ ❑I,u owner.!de Propmy,w my empl.yen with wegrs u their.le cmnpensatlon, will do the wank end Ne."cuor b mol Intended oroQered rte sale(Sec.7014,Business and Professions Code:The Contractors License law dues not apply m an owner of Required Inspections prepeny who builds or improv Hereon.a nd who does each work hlm.l f or thm ugh his own employees,provided Net seep impmwmenLL K not intended oroRered fmsale.If. however,Ne building or imp.vem"l la sold within..you of completion.the mvoery builder will have hire burden of proving that he did non build or improve for purpose of Ask.). ❑1.as owner of the propeny,am"elusively contracting with licensed conations to construct the project(Sec.70".Business and Profusions Code:)The Conuae.rs Li• mase law dors not apply at an owmar of property who builds or Improv demon.and who con cion for such projects with aconuumr(s)Hamad pursuant m the Contractor's License Law. 1 And exempt antler Sea ,B&P C for this moon Dam WORKERS COMPENSATION DECLARATION 1 hereby aRmn under penalty of perjury ane of Ne following decimations: I have and will for by a CertificateM of Consent I. for a performance aCompcm cation,r provided Pe by S.tion 3700 of the Ubor Code.for the peRonnana of the work for which this permit u tossed ❑I have and will maintain Worker's Compensation Insurance,u required by Section 37M of doe Ulm Cada,for Ne-p If in of Ne wo for which Nispermit is issued. Y Wmkera Cranium Non ensu dd ri'er and P number are: CE IFICATE OF EKEMPnON FROMWORKERS' COMPENSATION INSURANCE (NHsutlon need not becomplcmd ifthe p.est,Is foram,hundred dolts(SI011) or less.) T sentry that in the performance of the work for which this Permit is issued,I shall not employ any person in any manner an As to bmume.bject m the Workcn'Compensation Uwe of California.Data Applicant NOTICE TO APPUCAKr.If,atter making this Ccnifmate of Exemption,you should become Subject in the Worker's Compeasation previsions of the Ube CMC you most .J O forthwith comply with such provision or NMM is Permit all deemed revoked. z., CONSTRUCTION LENDING AGENCY Ihertby allirm that Nem Iu.onstructinn lending agency for Na ped.....of 6i the work for which Nu permit is iumd(Sm.3091,Civ.C.) GELenders Nam. D Z fender's Address U Q I certify that I have read this applimbOr and sue that the about information is Is.!' correct 1 qnn to comply with all city and county ordinances and sok laws meaning to C) building construction.and hereby authorire rcprC.nodv of No city to enter upon the 457 above-mentioned pmpeny for impaction purposes. gy (We)agree 1....indemnify and keep harmless the City of Cupertino Against rn liabilities,judgmcno,costs expenses which may In any way memo against aid City („) in consequcnee a( syn i !this permit. APPLICANT DERS S AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOU CER LATIO Re-roofs Sign rc.f p mramr a HAZARDOISM IALSDISCLOSURE Type of Roof Willdeapplicentorfutumho' ngom.pa rs...,haMlchuudousnded.) dcftned by the Cupertino Municipal Code,Chapter 9.17,and the Hcallh and Safety c,Sc Non 25532(a)? All roofs shall be inspected prior to an roofing material beim installed. ❑Yea No All P P Y g g Will the applicant or future building occupant use equipments devices which -If a roof is installed without first obtaining an inspection,I agree to remove n huardnu air conominanu u defined by the Bay Arca Air Quality Management all new materials for inspection. Disuicl' ❑Yes INu I howney theh®a us materials requirements under Chapter 6.95 of the Califon no H.INe:Salttyco4 ' .25505.25533 ad25531.IunMnstM lhaziflM Wilding dao not rtAS0,haw• t that it u my respomihility m notify the occupant of the reyuire c ih¢hm . ctprior miuuag .racenin"teerQpap ey. Signature of Applicant Date Owner. a.tMrim ascml Date All roof coverings to be Class "Bt'or better