04120005 CITY OF CUPERTINO .,2n4c�# w `?j.:;n ^Y '�+ ` u
BUILDING DIVISION PERMIT "MCONTRA4.TQ INFO &ION • .
BUILDING ADDRESS: PERMIT N004 12 0 0 0 5
7960 SUNDERLAND D
W NER'S NAME: PERMIT ISSUE DATE
JAE-PYO HONG 12/01/2004
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
'+�OpZ LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 em licensed under provisions of Chapter 9(Commencing Job Description
with Sudon 70[10)of Division 3 of the Businam and Profeuimu Code.and my license Is
in(u11 fares and ofrca 7 ' FENCE
bb z License Clay -Uc.«
L
Data
- Contractor -
ARCHIIECI'S DECLARATION
1 understand my plans shall M used u public records /f
era Licensed Professional •'I n
OWNER-BUILDER DECLARATION
I 1 Mr,hy fr..that'I am exempt from Ne Cominumes Litems,law for the
O O following renin.(Scaun 703 1.5,Buuensa and Profestlum Cade:Any city or counry `^`a ties /
which requires a Permit n,omuuct,aM,.improve,demolish,at M141r any structure - $4500
pdorta its issue=.also requires the applicant formueh permit to BN a signed wtement
<
dust Wis licensed parmanttodteprovidnnsoflheContractor's LicenseLaw(Chepur9 Sq.Ft. Floor Area 2� [ Valuation
(commencing with Section 7000)«(Division3 nftW Buaumh4nd PrefnstansCode)tar r��f n O✓
Nat Zip evmpt therefrom-sed the bacu for the,alleged assumption.MY violation of O 1+ 1%D n -
Section 7031.5 by any applicant for a permit subje u the applicant to a civil penalty of , fi pt {tOccupancy Type
not marc than Rw hundred dollars($500). 8 11 / I f
D1,as owns of the property,or my cmployma with wages ad,their sole cmnianation,
will do the ask and Neswaum is not intended mortemd foaale(Sec.7044,Budn•.a �i
and Professions Cade TM Conusaars Liense Law doe net appy n an saver of - Required Inspections
property who builds or improv ther on,and who dmsm ich work himself or though his
own employers,provided that such)mprowme ds art not Intended or offered!formai.If.
however,the building ar Improvement is old within oueyear of Completion,Ne Owens- _ ..
builder wild have the burden of proving Nn M did not Wild o mattow for.purpose of
saic.). . .. ..., ... ___.. -
10
1,uowner of ct property.,Business exclusively Pon cssi dg Cwithod:i Theetl cnntncnn i- ..
' come a dproject(Sec. san nerofand Pofmtons Cade:)ITBCamlractorl LI- -
orae law dace not apply o M.wens of property wM sed p or impose Norton,sed
whocont... I much pn)seta sotto acomrumr(m)Iianeed puuuem w Ne CommooYe
LIConse Law.
01 sae tumder Sec. .B d PC fathi.won
r Data AMI ZO9
WORKER' COMPENSA-n RATIO✓/
I hereby afRon under penalty or perjury arta of the following decla atioe: -
I haw and will maintain a CeNfiato ofComent to self-insum fir,WorleeleCopper.
action,u provided for by Section 3700 of the labor Cade.for Ne perfatmeace of the ,
weak lot which this permit is issued. '
D 1 have and will maintain Worker's Compem ilon ImuranCo,as required by Section
3700.f the labor Goals.for dm,pmformance of the work for which this permit is isseed.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(iris section reed not M completed Idea,Permit Is fm one hundred dollars($10()
or Mss.)
1 certify that in the perfomunCo of cite work for which this Permit is issued.I snail not -
employ any person in any manner an as in become subject to tie WOrkma'Comp rmhon
Laws of California,Dan
Applicant
NOTICE TO APPLICANT,If,after making this Certificate of Exemption.you should
become subject to Ne Worked Compensation provisions of the habm Cade,you must
foMwid,Comply with such provisions or this permit Nall M domed revoked.
LZ,,,y CONSTRUCTION LENDING AGENCY
[+ Ihaseby eMan that dart is a rnnsuuction lending apOncy for Ne performame,of
fY'Fes-, Ne work fur which Has permit Is iuucd(Sec.3097.Civ.C.)
alenders Name
z Leaders Add=
U0 I easily that 1 haw reed this application and mus that de shove mfomtNun u
,w U mmtt I qra n comply with all city and county ordinanw and sus laws totaling to
0 Wilding cons"tion,and hereby authmme representative of this city to enter upon the
above- W",pope"for inspection putpeea
P. (We)agree to save,indemnify and keep harmless de City of Cupertino agaimt
rF'n h liablllmu.judgmenu.costs and expenses which may in any way Accrue against said City
U'Z In comegue of the grousing of this Permit.
^•' APP CA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DateW11
S CE ULATIONS. I I O
34��
Re-roofs
�; iynetue t ❑
HAZO ARDOUSMATERIALS DISCLOSURE Type of Roof
_j Will1M applicant or(Ulm building occupamuom or huNuthsel eNus material
U dclined by de Cupertino Municipal Code.Chapter 9.11,road the Healih and Safety
IDWrictl
.Satiem u53z(.)7 All roofs shall be inspected prior to any roofing material being installed,
Dyes d]t1u -
Will the applicant or future building Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
heurdous air couminanu u defined by 1M Bay Area Air Quality ManaSemenl all new materials for inspection.
y �Dyes tL^uI haw med de hauednummdaWmquimmenuundcrChapur6.95ofthcCalifonealN&S sty Cadc,S.v6.25505,2SS33od25534.Iumdcrsurd Nulftlen Wilding
not tly how a torso Nut it u my rm ormhality n notify the occupant of de c ' ichmuuMmetpdortoissuanceOraCerill0 Occuse . SignatureofApplicant Date
( ) U
nerm. h vedagent ❑,u All roof coverings to be Class"B"or better
I ,