03020097 (2) CITY OF CUPERT"'O
BUILDING Drv1s1oN PERMIT CONTRACTOR INF®MATION, ;�.
BUILDING ADDRESS: YOON SIL KAE PERMIT N0.03020097 3020097
4Q0 GYPRESS 1)R_
fA.1.qmS-MENGINEER:
R'S NAME:
PERMIT ISSUE DATE
E: SANITARY CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION
U I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
? with Sect�ion]J�))of DiAxmm3.f the Business dProNscounsC and myliceme is
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info fo�d effect:Rp� ,�^
,qz LiceaaCd _/�L;c. ( � � 3 ADD 459 . 25 SQ. FT
3F Date Centra ar��
QQ `` . ARCHITECTS DF'.. ATIOLA N
d 1 undMSmJ my plans shad he usedP21
lic repras
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:Oro Licensed Professional { '
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OWNER-BUILDE ECLARATION
<I 1 hereby al'Orm shot I oro cum'I ommmar'a License law for the I - /\dl
O O following reason.(Section 11131171 Busin and Rnfensinns Cndc:Any city nr county I)
S$ which requires a pcmrit m construct,alt repo,,Jcm}iliih;'m repair anyswaum j {
priormiksiarnme,alwrequirel the app fuquchpepnitlollleaslgnedstatemcnl _ I
mm� thatheisllccnaJpurcuonuothepmvisio I ton's 6t,k �,/law(Chapter9 �j '��.Sgl t FIO� Area Valuation
2F (commencing with Section 7")nf Divieion 3nrthe Business aACd'ryrf .vr;CNej ser f
$ Nat he is exempt therefrom and the haab for she alleged exemption.Any virirxt%,of
Section 7031.5 by any applicant(.I a permit subjects the applicant to a civil penalty of LAher Occupancy Type
not more than Eve hundred dollen(S500).
❑1.as owner of the property,or my employees with wages as their sole compensation. 0 31 9 . 0 0
will do the work,and the enure is not intended or offered rorsale(Sec.7614.Business
and Professions Code:The Canncmrs License law doe not apply m an owner of Required Inspections
property who builds or improves thereon,and who does such work himalf orthrough his
own employees,providcdrhat such improvements are oat intended molfered for a It.If. 101 — FOUNDATION
however,Ne building or improvement is sold within one year of crimPlntion,the Owner-
builder will have the burden of proving Out he did not build or improve for purpose of 102 - PIERS
aale'I. 103 - UFER
o I.as owner of she property,am exclusively contracting with licensed com cmn m
cnnsnct the project(Sec.1004,Business and Professions CWc:)The Convacmr's Li. 104 — REBAR
came Law dims not apply to an owner of prripeny,who builds or improves thereon,and, 105 — ANCHOR BOLTS
who contracts for such projects with a compursuant ractons)licensed pursuano the Contractors
L an.Law. 106 - SEWER & WATER
1 am exempt under Sec. .B k P C for this mason
r �<}� fs ate cP 2, 202 - UNDERFLOOR PLUMBING -
WORKER'S COMPENSATION DEE�glyrloN 203 - UNDERFLOOR MECHANICAL
I hereby affirm under penalty of perjury one of the ((awing declarations: 204 — UNDERFLOOR FRAME
I have and will maintain a Cenlfcare ofConsent to al6insum for worker's Compere 205 — UNDERFLOOR INSULATION
ration,u provided for by Section 37W of the Inbar Code.for the performance of the 301 - ROUGH PLUMBING
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 302 — TUB & OR SHOWERma
37W OI the labor Code,for 0,perforne.of the work for which thWater.is permit is d. 303 — ROUGH MECHANICAL
My Wmkcrs Compensation Insurance amicrand Policy numkr aa: 304 — ROUGH ELECTRICAL
Carrier: Policy No.: 305 - FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
(This sicion need not be completed if the permit is for one hundred dollars(5100) 307 - INSULATION
nr lcssJ
I certify that in the pcjinnournon of the work for which this permit is trucks,l shall not 3 08 - S HEETROCK
employanype ni nymannerarum emyq jec h3j orken•Compemation 309 — EXTERIOR LATH
Lawsaf Caur ate 310. - INTERIOR LATH
A ¢ant �� I T+t
NN CE TO APPLICANT:If.aOcrmagi isCcntfrcemofExamfirm,youshould 311 - SCRATCH COAT
b me abject to the Worker's Compensation previsions of the Labor Code,you must
.,Z forthwith comply with such provisions or this permit shell be deemed mvaked. 313 — ROOF NAIL
Z o CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
E4 1hereby affirmOat thereisammtruninnlending agency lot the perfurmamcof 502 - FINAL PLUMBING ENERGY
6i 7 the work for which this permit Is issued(Sce.3097,Civ.C.)
WCa Lender's Name 503 - FINAL MECHANICAL ENERGY
IL Lender's Address
U O 1ramify that I have read this application and sum that the above information is 504 - FINAL BUILDING ENERGY
(~ Correctlagree to comply with all city and county ordinances and sure laws relating to 505 - FINAL ELECTRICAL
DU building construction,and hereby authorise repreanmtives of this city to enter upon Ne GAStigtST
W shove-memiuned property for inspccuon purposes
a (We)agree tri ave,indemnify and keep hannlcss the City of Cupertino against 0 7 FI_
fn Habiliues,jadgmcmts,crisis and expense.which may in any way same against said City 5 AL
U Z ranting of this hennit. V7/6
APPLICANTefine UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b Date
SOURCE REGULATIONS. s y5
s 510 NAL PLANNING
Re-roofs 54 - INAL PUBLIC WORKS
gnawrc ofApplicaHAZARDOUS MATERIALS DISCLOSURE Date Type of Roo
Will the applicant or future building mcupmi store or handle haarduua..chat
deRmd by the Cupenino Municipal Crack.Chapter 9.12.and the HuaW and Safety
e,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
it ha'sardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
isvin?
❑Yes )<N,.I have real the hmaNtms materials requirement%under Chapur 6.95 of the Califor.
nice Health&Sdf iy C,tl,Section 25505,25533 send 25534.1 undenu d th.if the building
docs not currently hove a tenor that it is my responsibility m manly the uocufac l or the
aimmcm,swhkhm mmetphrir.niruuanmrifacmdrearcr, - � Signature of Applicant Date
Owner m authomW agent �? All roof coverings to be Class"B"or better
r_w,