02060088 (2) CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT CONTRACTOR,INFORMATION:
BlbiOgNaADbRF�BLANEY AV K & M DEVELOPMENT INC PERMI'rr9.2060088
&'A.N&rC CHOU 1060 WEST HILL CT APPLICATO)61PIQLT�2002
IQNI:: (408) 253-9787 SANITARY NO./ CONTROL NO.
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
op LICENSED CONTRACTOR'S DECLARATION A
hereby efRmthat lemlicenscdunderpmvisimm�tchapmr9(commencing NEW SINGLE FAMSeJ ��ING
with SectimI701hot Diesinn3uf the Bui and Prnlessianscad,andmy license is
in lull forso direst. �j� C LIVING SPACE 2609 SQ. FT
ZoaZ License Cl�S�' Lic.N
oz- DamSc I cmr t�f GARAGE 431 SQ. FT. 39 SQ. FT
mm4 / ARCIIITE ECLARATION
K oZZ 1 understand mfplans shall M used as public records v
Licensed Pmfcssional
a'1= Oat I am OWNER-BUILDER adDECLARATION /
I hereby.(tient that 1 1. excmpl load she Comas Cod :Any c Law on NO
9600 follovwhichingrcason.(Salon]B3LS,Business and
prove,deolih..,ec i,mity onlaumy o!/
which myuircs a pnmit m nmstruct,alter,improve,demolish.,,r sepal,any straw¢
pZi prion,,its ismance,alsurequires the applicant for such penmita.f lc a signed ffatemem
rggmm< that he,,licensed pursuant to the provisionsnfthe Commcmr's License Law(Chapter 9 Sq. Ft. Floor Area $3 0Y®I0a[ion
(commencing with Stearn TO))of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis fur the alleged exemption.Any violation of
Session 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of RgWb`gU_ Occupancy Type
not more than five hundred dollars($500).
❑1,As owner of the property,or my employees with wages as their Aide compensation,
will do the work,and the atmemre is not intended or offered for We(Sec.]MG,Business
and Professions Code:The Con ammes Licerue Law does not apply to an owner of10 2 - PIERS egwred Inspections
propeny who builds crimprows thereon,and who does such work himself orthrough his
Own employees,provided that such improvements am not Intended oroRered for sale.If. 103 — UFER
however,the building or improvement is mid within one year of completion,the owner- 104 — REBAR
builder will hive dm burden of playing than M did not build or impma for purpose of
We.). 105 - ANCHOR BOLTS
01,as owner of the property,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
convect the project(Sec.](111N,Business and Profession Code:)The Contractor's Li-
cense Law does not Apply toanownerofprogenywho Wilda ormeamvesthereonAnd, 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a maintains)ficeresed Persian to the Commences 203 - UNDERFLOOR MECHANICAL
License Law.
I am exempt under Sec. ,B A,P C for this reason 204 - UNDERFLOOR FRAME
rte, Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby all'mnander penalty of perjury one of the following deelaratimm: 302 — TUB & OR SHOWER
I bays and will maintain aCerificate of Consent to self insure for WartersCompen. 303 — ROUGH MECHANICAL
Initial,As provide)for by Section 3]00 of she Isbor Code.for tmantt he pe,forof the
walk fm which thisrermitisissued. 304 - ROUGH ELECTRICAL
❑ I have nd will maintain Workkv'a Compensation Insurance,ss required by Section 3 0 5 — FRAME
3]110 oIth LAW,Cod4 for the performance of the work for which No permit is issued.
My ,,r Tac�o�r +e man histrourica caaTRTad Idicyara`W 306 - HOLDOWNS
Carri . j ^/ MDIs No.:/5 3Za—c' 307 - INSULATION
,K_CE TTI)J,,TE OF EXEM NFROMWORKERS'
(This sm4imne?m be completed if the roman is r one hundred dollars III An 309 - EXTERIORI INSURANCE 308 — KLATH
ode's.) 310 - INTERIOR LATH
1 certify Nan in Ne performance of the work for which this permit is issued,l shall not 311 - SCRATCH COAT
employ any pnum in any manner so as to become subject o the Workers'Compensation
Laws„f C.Iiforpi..Datc 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:It.attar making this Cenilicam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Lmor Code,you muss 502 - FINAL PLUMBING ENERGY
zfonhwith comply with such provisions or this permit shall M domed revoked.
0 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I heathy affirm that them is a construction lending agent'for Be Terf......f 504 - FINAL BUILDING ENERGY
C the work tar which this pemritisOwed(Sm.W.Cit'.C.) 505 - FINAL ELECTRICAL
W z
Lender's No 506 - GAS TEST
Leonder's AJJmss
U1 nary that 1 have mad this application and some than are about information is 507 - FINAL PLUMBING
w0 Ucorrect.I agree to comply with all city and county ordinances and slate laws relining to
building construction,and hereby autholim represcrilativa of this city it)enter upon the 5 - FINAL MECHANICAL
W above mentioned property for in,cedit purposes. 59 — FIN E
(We)ag.u,save,indemnify and keep harmless the City of Cupertino against
y liabilitics.judgmenu,costs and eapenses which may in any way same against said City 5 N G
V 7 Ihis Permit.
Anconsequence T of the gonatin,of UNDERSTANDStAND WILL COMPLY WITH A NON-POINT Issued b)51 W0RK6 Date �
S CE REGO IONS.
�. Re-roofs603 - OF BATTENS
ngnawrcn IIAZARDOnue"r MATGRIALSDISCLOSURE Da Type ofl�[p� - ROOF IN-PROGRESS
Willapplic tor,fmlie building occupannsmre nr handle haiudous materiel
fined by no Municipal Code.Chapter 9.12,and are Health and Safety
e. Dyes 2ss32(a)'' All roofs shall be inspected prior to any roofing material being installed.
u
Dyes
Will she applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir haaamous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Distrito] 'J(n
❑Yes �1
1 have man the haaanl os materialsregmiremenu mule,Ctei 6.95of theCelifor-
.is Heldub n SafelyC]e.Sadom 25915,23533 and25531.1 u d is if de Wilding
Jin nm cuncndy he I.Nm it is my alienability to no occupant of the
c ircmtmsaidd usl4 Iprinr In its cc ofeC or,t, I cup cy. Signature of Applicant Date
9 Z7 Z
wnermauth„,iced aynl Dam All roof coverings to be Class "B”or better