06030124 CITY OF CUPERTINO a �- �'-s ..� F xaiwr w �'
BUILDING DIVISION PERMIT SCO a RA.CTOR INFORMATION '
BUILDING ADDRESS: ALEX HUANG PERMrINo.06030124
10201 VICEROY CT
NER'S NAME: PERMIT ISSUE DATE
ALEX HUANG 04 /07/2009
"
"ONE:
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
+op LICENSED CONTRACTOR'S DECLARATION Job Description
I bench,affirm that 1 am licensed ands,provisions of Chapter 9(Mmmcncing
tI with Section 70M)ofDivision 3ofdac Business and ProfessionsCode.and my tiCcose is
in full to=andefkct. REVISION-REMOVAL OF FRONT COLUMNS/ADD ROOF OVER
In. Lice° cel"' I""comfoamr EXISTING BALCONY. ORIG PERMIT #06010020
FO DaM ARCHnECTS DECLARATION
fwanti uanJmypinsshallWu JupublicrtcnN NO NEW PERMIT-IN HOUSE ONLY
s o t; Licensed Professional
OWNER-BUILDER DECLARATION
iy I hereby affirm Nal 1 am exempt from the Contractors License Law for the
O O following reason.(Section 713 L5,Business and Pmfesiov Code:Any city or county
<m which require a pcomi.ro construct,a1Mr,improve,demolish.or¢pair any swctum
�a i prior m its Tensed p asuml to ros tiM applicant for Coumtoit m Bens,,Law
suumem
s< ((commencing
ommen ingwitPurstion7 NcprovisionsofNeCommness ndProelaw(CM1ade)or Sq.Ft. Floor Area Valuation
e F G tat the is camwiththere cam and theof Division Am ftMRusiness prion.fAn in ns Code)or $0
y 3$ Nal M u exempt Neref10111 and the basis for the ellegrA exmoption.Any violation of Y
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom Dun five hundred dollars($5001,
i,v owner of Jk prop¢,,army uoployca with wage az Heir sols cmmpevadon,
will do Ne wodc4 and the structure In Mt Wandcd Or Offered fso.ale(See.7074,Business
and P,nfflVons Code:TR'ConametNs LIRM1R Law M=MI apply M N OWMr of Required Inspections
property who builds or improve Nuhn.and who dots such wark himself or through his
owncer.thes,provided prvemimprovementsart an intendedafrofferandmplado.for sale E.
however.the Wilding oralonof rdmuMldwithin Me year of wmPkdoo.the owner.
auto.).
will love Jas WrdM of proving Nat he did Mt Wild Or improve for puryose of
sok.).
C�(L a,owner of Ne property,am eaclusively em musam,with licensed Mnvsmrs m
construct tit pmlca(Sec.70,14,Business and Profedons Cade:)The CMhzcmh U.
cove law door not apply m an owner apropenY who Wilds or improv themen,and.
who contracts for such projects with a conmcmr(.$)licensed pursuant w the Counselors
License Law.
❑Iameemptunder Sec .B&PCfmdM;mmm
mer Dau fY O
WORKERS COMPENSATION DECLARATION
1 hereby anon under penalty of perjury one of Ne following declmauov:
❑I love aM will mainuin a CutiBaM of Conscntmself-insert fas WorkersCmmpen-
smion,as provided for by Section 37M of the Labor Code.fm the performura of UM
work for which this permit is issued.
❑I have and will maintain Workers Compensation Inam na,at mqumed by Section '
37M of the laborCodc,for On pertormmce ofthe work for which this permit is issued. '
My Workers Compenution hxsurarux carrier and Policy number art: -
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ITuuection mcd not W completed if the Permit is foronc hundred dollars(SIM) a
leu)
1 certify Not in the performance of Ne work for which this Permit If issued.I shall not
Lawyemploy anyperson in any manrc/ rwuWbe}O�melttbjrFt to Ne Workers'Campevation
laws of ny person Dau
Applicator
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.You should
become subjas b the Wmkers Compcnsation provisions of the Labor Code,You muss
O
rforthwith comply with such provisions or this permit shall W doomed revoked.
Z ; CONSTRUCTION LENDING AGENCY
[••i Ihereby&Mm that Isom is a construction lending agency for We performance of
C Ne work for which this permit is issued(Sat.3097.Civ.C.)
lid Lenders Name
z Lenders Address '
V O 1 unify that 1 have read this application and vaM that the move information is
G, H comem 1 agree to comply with all city and county on inoses and sum laws relating to
OO building constmCion,and hereby authoira mprescnmdvu ofthis city to enter upon the
r U above mentioned property for inapeetion nu,many
(We)agree to ave,indemnify and kap harmless the City of Cupertino against
►h limulidea.Judgments.costs and eapmocs which may in any'w'ay seem,again,sued City
O z APPLIC
SOURCE REANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
G�'�ATIO�NS�.
Re-roofs
HAZARDOUS
SigSignatureSignatureof ApplicaR Dam
NATARDOUOUS MATE RIALS DISCLOSURE Type of Roof
WIII the o Cuan,Of future Wilding e.occupantmanc 9.1 or haMlc hauardous material
as defined Sec by dM Cupertino Municipal Code.Chapter 9.11.and the HcaIN and Safety
otic.Salon 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya „ (�t.'n
Will thea applicant future Wilding rat mase If a roof is installed without first obtaining an inspection,I agree to remove
pp e w ea Air Qu tet devices winch 8 Pe
emit ha menus air canuminanu az defined by dM Bay Arta Air Quality Management all new materials for inspection.
DixnicO
❑Ye INNO
I have read the huaNuv materials requiremcm under Clupmr&95 mf Ne Califor-
niaHwith&Safety Cade,Sa7iats MS.M33md2534.1undcrsundthalifdc Wilding
docs not currently hart a Mount,that it u my respovihilisy M notify de,oaupam of the
reyuirtmenu which..pc metPoor missuance efa CutificaM of OccupanO Signature of Applicant Date
Owncr M amhmimd agc� 'Dow All All roof coverings to be Class"B"or better