06020128 --------------
CITY OF CUPERTINO a ti •�. s''"`' ` m' `"
BUILDING DIVISION PERMIT .CL1£�'I']2A(:'T � yTrd ,, :
j`.hru, ' tru'n. vel.. 'a C S?t•;
BUILDING ADDRESS: + PERMITNOO 6020.28
945 TILSON AVE
NAME:
'S' : PERMIT ISSUE DATE
NAM KEUN OH 07/11/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHI'IECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONfRACTOWSDECLARATION Job Description
18� 1 homey M.that 1 me licensed under provision of Chapter 9(commencing
with Section 70110)ofOivulon 3 of the Business and Profusions Cade.end my]I,..is
+=Bi in full SFDWL-2 STORY (2239 ' LIVING/GARAGE 473 '
z umnmclasa ,I� Lk.N�7�E,��Z SANITARY IS SUNNYVALE' S JURISDICTION
ipCo."
`` Dam ARCHITECTS DECLARATION
L 5y�y 1 understand my plans shall W used as public«cnNs
PyU
SQA Licensed Pefcaaianal
a 5 OWNER-BUILDER DECLARATION
i I hereby Affirm that I em exempt from the Convector's License Lew for to
OO fallowing mean.(Section 703 1.5,Business and Pmfnssions Calc:Any city at county
3$Pi which mquires A permh to cataract,alter,Improve,demolish.Or repair any someone
-zi prior 4siu iauence.also require lM applicant far ouch pefmiuo file aligned summem Va%&M641
that helalicenwdpunuanaaothepmvislotofde Conoactor'a Ui =taw(Ch2pteT9 Sq.Ft.Floor Area
tl (commencing with Section 7000)of Division 3 ofthe Businaeand Pcefcainns Cade)m
$ that he is eaempt therefrom and the basis for the staged meemption.Any violation of pp
Section 7031.5 by any applicant for a permit subjeea an
the appliel td A Civil penalty Of 3 7�N N T8erO 0 Occupancy Type
not mom than fire hundred dollars(5700). 14 0 u
1,u owner of the pmpctry,a my tmPloyeca with xgn as te'v sok eompeaation,
ad Pmfcuwdanuk.Canaddeth:eThe Cannelton LinadnedaeLaw door-1 apply Maa Of Required Inspections
owmanywho buildsmimpmtmuch ,orb who mea hinted a hinuelfmthn saehu
however,
the
Wilding
that such improsold wat art not east o rd moBertd far ale.es,
�uilder thebuil the uimpewmantusold did Arm)ear of core poortlemvea-
s le.). cath love de burden of psuNng that k did nm tank m improve ran purpose Of
0 1,u owner of the Property,at exalutiwly cunuacting with licensed cenuanms me
eanuun de pmlm(Sec.7044.Business and Professions Code)The Cooesmfs V-
cane law dome not apply m an owner of property who builds at impmw thereon,and.
who com eca!for such pmjecte with a conhrater(s)licensed pursuant to the Convatark
Lkehue law.
Iamaemptunder See ,BkPCforddsreawn
rDee
WORKERS COMPENSATION DECLARATION
I hereby afiam under penury Of perjury ane of to following dechntiam:
0 1 ham and will maintain A Ca flee of Comment to el(daue for Worlmes Compen-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work far which this permit Is issued.
cava and will maintain Werkefs Compensation InAmmm,u required by Section
3700 of the labor Code,far the performance of the work fm which this Permit Is lamed
My Workeel C cep nation lnsueece ca at and Policy number are:
Carder.
Policy No.:
C^RTIFl TEOFE%E MURFROMWORKERS'
COMPENSATION INSURANCE
(Thu roman some oat becampked IfIle permit 4 foram hundred dedi(5100)
or hats.)
1 certify that in the performance of the work for which this permit is issued,)shall at
employany person in any manor so a u become subject a the Workrn'CMPCMss m
Lowe of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CehtiRute of Escmp,don.you should
taxme subJm m the WorkeYa Compensation pmviaons of the LAW Code You most
.,O forthwith comply with such provisions atol
ons mUs Permit l W dcomal kW
mw .
Z� CONSTRUCTION LENDING AGENCY
[-h I Wray almnm that there Is a construction lending agency for doe perfarmuhce of
ai 7 the was for which this permit Is issued(Sec.3097,CN.C)
WM Q Isnders Name
Z Lamice Address
U Q 1 certify that I haw mad this application and num that the above infomudun he
U. Fconal.I agree to comply with all city and county ordinances and sum laws relating to
U building convection,and hereby a uthoriser<Pmaceaaives of this city to enter upon the
LT7 shove-mentioned Property for inspection purposes.
g3. (We)agree to ssw,indemnify and keep harmleas the City of Cupertino Against
tr In liabfi?C-Mr�
menu,costa endenfing elpcasu which may in enywayacorw againaaid City
U 7 :CnPcUNDER;TANDS Aof hND WILL COMPLY WITH ALL NON-POINT Issued by: Date
rte• SOGU
Re-roofs
SI6 rAppr mor Dam
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding oecupant amrc Or handle haallous material
e0ood by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section25532()7 All roofs shall be inspected prior to any roofing material being installed.
0 Yn e a
Will the applicant or future building Occupant has:equipment of devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hvaNnue air caoumianu As deRncd by du Bay Amo Air Quality Management all new materials for inspection.
Marla? /
CYu �CNu
Ila real thehvudaw macdambrcquirtntenu trader Lhepteri95ofthe Gli(or-
nisHmel aleaycode.Secdmm25505,25533sm125534.Iwtdemaeatatifwehufdmg
does not u ant Y hew:•mile tut It u my mpm bliity m codty to oecupano Of d/tc
mquim n ichmost be mrswaateof&CatificaueofOcmtpeaq.-�O Signature of Applicant Date
Owner au arise qen Dam All roof coverings to be Class nBn or better