04110046 (2) CITY OF COPERTINO
BUILmNG Drv]SION. - --PERMIT �ACONTRACTOR INFORMATION ,: - -
��-a:aw..,. .. ?A.x'bsw-I:.E.^amt; ^?t 4..�:a d•;x .S' m.
BUILDING ADDRESS: - - PERMIT NO.
YOUNG JU CHOI 04110046
QAX.ATUN'jPERMIT LSUE DATE
ONE.
ffu SANITARY OLNo.
ARCHITECT/ENGINEER: - -+ •-• -
• -,.•BUILDING PERMIT INFO '
BLDGELECT PLUMB MECH
0 0 0 0 -
no0 LICENSED CONTRACTOR'S DECLARATION '
I hereby affirm Nal 1 am licensed under prOwsions of Chapter 9(commencing _ - - _., Job.DeFINALE)
rllaf n
with section 7(M)mfDIAM.03efdm Business and Professieos Cude.andmylicemei, � B �t\��
n• in full fume and effect. ���...1110 1k DDDaaa 666���
LicenseClna Ue.. REPLACE SEWER LINE
❑ Dam Cohurzmr -
-E'�` ARCHITECT'S DECLARATION DEC 2004
I< I understand my plans shall W used as public records
is
3 0 LkenseJ Pmfnssional _ pq I y ®I�G _ -
g OWNER-BUILDER DECLARATION (®J L _
<F I Wmhy.(Seco the,1 1. ucmp,from tW Chenvrk,Code:
Any,Law for,W
co following tion.Permit
7onstr Business and Pronssium Cwlo:Any city or county
ifm Pi which requims a pcmil to ronswcl,alter improve.Jcmalish,or repair any atrvaom
F¢i prior in is issuance.also requires Ne applicant for such Permit to file a signed atammcm
< Npursuant n
al he is LicensedpursuanotheprovisioofdeConlraclohseLaw Sq.Ft. Floor Area Vanua
toe$ (commencing with Section 70110)of Division 3 of the Business and Professions Code)or -
a,3 Net he is exempt therefrom and elle bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicants to a civil penally or e Occupancy Type .
not mom Nen finhundred dollars(5500). 3 . 0
❑L u owner of the pmperr.mm cotimemisid yces with wags u ah,(Sec.
rota.Business
usm _
will do thewons andthe he Con is Leri Limpesor Laoffew
tires,ed n not
to an Bai,+rOf
and property
Professions Code:The Contsxmfa License Law don mol apply lf an owns of Required Inspections - -
proany who W ildaor improveuch im n and whodoes aaheral mr self or duosals-his. _
own cmployvs,pmviori Nm wchimis sold nuartnhet ear ofdmpemd rhea saner. "-
builder.Ne Wilding orimpmvemastis sold
will have the Wrdcn of proving Nat W did ms Wild or improve fu puryase of
sock.).
1•as owner of tW propert,am uclmively convening with llappid ronuacmrs to
co umse,the Pmj,c,(Sec 70a4.Baines and Pmfcsiom Code:)The Convector's Li-
am Law docs not apply in an owner of property who Wilds or improve Iheemn,and.
who contracts for such projects with a convacmr(s)licensed pursuant in the Contractors
License Law.
lane amp,un Sec .B k P C for this ration
Owne
R R'SCO IONDECLARATIO
I hereby affirm under penalty of perjury ane of the following declarations:
I have and will maintain a Cenifiros tiuself
of Consent -insure for Workers Compce-
ration,u provided for by Sa,Wh 3700 of Use L i W,Code.for the Performance,of the
work for which this permit is issue.
I have and will maintain Worker's Compewtion Imururce,u required by Seekon -
3700 of the Iator Coal for dte performarutt of Ne work for which this Permit is issued.
My Worker's Compensation Intimi¢caries and Policy number arc:
Cartier. Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE
This section recd mol W completed if the permit is touch,hundred dollars(Slip)
or less.)
I certify That in the performance of the work roe which this permit is issued,I shall mol
employ rsno inanymanners xsw mmesu�6l1cCL Oe Workers Compensation
monis.Dal I �b Ll
Applicant I � �]Q�
E TO AP I A .IL tamg ¢
r ma ale of Exemption,you should
G` p e object w the Worker a Compensation previsions of Ne labor Code,you mat
.J z f0 ,h comply with such Fmvisihm or this Permit shall W deemed oumked.
Z O CONSTRUCTION LENDING AGENCY
PI hereby affirm Nal thea is a comvuction lending agency l'nr the performance of
x> Bte work for which this permit is issued(Sec.3097,Civ,C.)
4 A Lenders Name
7 z Lenders Add.
U C I certify that 1 have rod Nis application a"cute that in.above information is
OF correct.1 agree to comply with all city and county aNinuras and sum lawn relating to
C.e building consvucsion,and hereby audinirc representatives of this city to enter upon Be
Na shove-mentionedmases
property for inspection pp
(Wo)agree to save,indemnify and loop harmless the City of Cupertino against
.F., In liabilities,judgments,costs and expenses which may in any way accrue against said City /
CJ z his Permit.
APPLICANT UUNDEnsequence of the RSTANDSting of IAND WILL COMPLY WITH ALL NON-POINT Issued by: Date �l
SOURCE REO TIONS.
Re-roofs
Signature I pp ouan constrict ale
HAZARDO 5 MATERIALS DISCLOSURE Type of Roof
tll the applicant or fown:Wilding occupant store or'.,I.ti 'al
u ned by the Cu,,O into Municipal Code.Chapter 9.12,and I N and Safcly
Cal.Se yes 25572(4)? All roofs shall be inspected nor to an roofing material beim installed.
❑Yon �No
P P Y g g
Will thea licans her future building oau m use equipment or dcvixv which
If a roof is installed without first obtaining an inspection,I agree to remove -
pp g pa 4uipmc
mit havardpus air conmminams ti dcCined by No Bay Area Air Quality Management all new materials for inspection.
Mittel? 2
❑Yea Iy Nu
1 have real the hmallous materials requirements under Chapter 6.95 of the Califon
nia Health A Safety Code,Section 25505.25533 and 25534.1 understand Out if the Wilding
Joe nm cuncmly Fav,a unanc Net it b my responsibility m nattily IW acupant of Nc
me. me sw ' mus,b� prior m issuance of a cerdreate of Occupancy Signature of Applicant Dale
Owner dr am, sed gen,, Dam All roof coverings to be Class "B"or better
x Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: { PERMIT #
2 f6+0 Ga on L .� rl l n 0, CA �-,-o I
OWNER'S NAME: oun U C o PHONE #
GENERAL CONTRACTOR: / FAX# \
I am not using any subcontractor �y
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
c Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
6wf�er/Contiacor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
B. A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work,(complete section below)
Contractor Address/City Phone # State License # Type of work to
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: °
Job Address: &k `o n eY- �n° 611T�ol t Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertin Bu1ild
Department.
+Is
City of Cupertino Building Department
CITY OF 10300 Torre Aven
C U P E Q T'N 0 Phone: (408)777-3
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensatiorle
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Verytruly yours,
Building Department,
City of Cupertino •
Printed on Pe yded Paper
I
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
I�
CUPETINO PERMIT APPLICATION FORM
APN # 32— / Z Date:
Building Address: op/I
2 844 O C L +o h C o Cl
Owner's Name: I Phone#:
oul'1 ,TLA C.Ao 6� —� 7`J—SSSZ
Contracto� � Pho ens
l�4 bun .Sin C�0
01
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg Elect ❑ Plumb ❑
Job Description:
Residenti Commercial ❑ i
Cost of Project:
Qty. if
Appliglable Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures ' PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING