00120065 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A DURESS /� �•x� PERMIT NO.
1;8761' HANNA DRIVE �� K 00120065
OWNER'S NAME: p APPLICATION SUB DATE
YANG ilErr 1.2/1. 1/2000'
PHONE ,/ �-257 —gd3/!(( SANITARY NO CONTROL NO.vim S�
m00 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB ECH
1=1 =1 — LJ
' LICENSED CONI RACD)It's DECLARNI'ION
1 '10b DeBerlp(IOB
Q = hereby miiml Ihnl 1 nm liversetl under prmisinns of Chuper9(commencing
Fat with fall forkes.)nf Division7nllhe Bu,iness and Professions C,dc.and my license
'x2' is in troll force.ataelreeL nn J�,,,1 INSTRI_L SEWER CLEANOUT
m 0 2i V License Clnss Lic.It <�.�J C/ -
?q.5 Date Contmemr
µ0< ARCHITECT'S DECLARATION ,
J undecvl roof Plana shall he used ns public record,
ypi
w6'0 Licensed Professional
x o
RATION
OWNI -BUILDER I
I hereby R that I m scrapt u'llim CImpamr
ill I1 I 8 I If,•nr be
following reason.(5 , 703 i ns IProfessions Coale:Any city or county
u'it y , permittocon,r ct h p ve.den lith p any.wwmnro , , :. I ,I ap,d ,
man I dp,mr d n mo Ian
c I , rxI Low(Chaplet 9 Sq. FFloor Area V' ualion
from g with sec, ]upp, ,Division1 f t Business L g and Profession.Code) / " U 0
oand for r thm he is eserna thi...a, the basis the alleged exenodion.Any violation
of Section 7031.5 by any applicant for a permit wbjems me applicant to a civil Penalty
of not more than five hundred Jonars S500). APN Number - Occupancy Type
❑1,it,t,wneranhe11apaty,ortnyemploy'r,'id,wageuto,dom" lecnmpemaaaam, 37529014. 00
will dm the ware,sail he..huelam i,art 'Imandm m murrd'ris sale flee.WUJ, Required Inspections
Business and Professions Cade: Be Comremarice
',Low lawoe
ds not apply ,,on
owner of property Who builds or improves,nemon,and who does such work himself 105 — SEWER R WATER
or through his own employees.provided that such improvements arc not intended or
offered four,ala.It,however.the building or improvement is sold within one year ft ?02. — UNDF_RFLOOR F'I_I,IMBING
completion,the owner-builder will have the burden of proving that he did no,huild or
in"ovefyrpama,eoi,ale.), 301 — ROUGH PI-LIMBING
El1.as owner of the property.an,exclusively nuwcdng with licensed eontrai.in S07 — FINAL F'1_UMBIPdG
constrict the does
no(Sm. it)a Business and Professions Code:)The Contractor's
License nstri law Jams nut apply n,an owner ss property 'it builds e:improves thereon. /
and who contracts for such projects with a commeor(s)berried pursuant to the
nwcmr's License law.
O -
❑Duna exempt under Scu. ,❑k I'C rnnhls rmson -
Owner Doe /
WORKER'S COMPENSATION DECLARATION O
1 herby affirm under Penalty of perjury tine of the following declarations:
0 I heva and will'mniraia u CcriOrom of Consent (11 wifi aur,for Wit sort
Compcoxmim,, as provided for by Sinn 3700 of the Lobos Code, Our the
perfornunce of the work lin which this permit is issued.
01 hr's and rill maintain Worker's Compensation Insurance,a,re u rod by Section
3701 of the Labor Cale,lin the performance of the work for which this permit is
mel My Workers Compensation Insurance eerier and Policy number are:
Carrier. Mid Policy No.:
/CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need nm M completed if the pectis is for one hundred dollars
(51001 or less.)
1 cedlfyahm in It Purfannanee of the work far w dch Itis permit'u is,neJ,I
shall not employ any person in u y matJt it Y hr m suhjele hs the Wnrken'
C'mvemmion Laws id Ent' n 'n�D. �b�l d/
Applicant_ 7—2llA
NOIICETOAPPLICAN'1,1,atmr akmg 16,5 cmhcmc nl� I:xempuon,you should
becoar subject m the Worker's Compensation provision,of the I.uMn Colo,you now
Q tornwith comply with such Po visions or tit permit nhu11 he deemed mvokeJ,
CONSTRUCTION LENDING AGENCY
0.a } 1 hereby affordw)i,b that Chert is issued
Sec.
lending agency fw Inc performance -
Lethe wad for Yich this pennil is issued(Sec.30N7,Civ,C.)
0. Q Lender's Nano
� z Lender's AJJres
V Q 1 etadr,that 1 have rend this oppilcmion and.wate that,he shove Iaf"madim,Is -
rat F emme,.I agate On romply with all city and county ordinances and ,.at laws miming
V m building eomlmetion,a..d hearty auNorix fiepm,entadsesofthis city m ercripn
} W the aluve.n¢naoned popery for inspection purrows. . .
ro, Wee)agree to save.indemnify and keep hemdess the City of Cupertino against
to liabilities,judgments,Costs tod erpeams which may in any way rector against said
fJ ,City in conscyrencc of the gmnti ng of this permit -
SAtP LICANr UNDERSTA rDS � WI OPLY WP IN—T
S Lf , Issued by.��
�� Vf�G0( ate
� �
Boom oAplcum/ComaeorIF note
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant arfuture building accident store orhandle vo:mousmatedal Type of Roof
as definal by the Cupaniao Municipal Cole,Ch.,p,ar,9.12,and die Health and Sammy
Code,Seed25532fa)^
OYes All roofs shall be inspected prior to any roofing material being installed. '
Will the applicant armanrcbuilding recupamuse apparent or devices which If a roof is installed without first obtainingan ins ectic'n, I agree to remove
emit hazardous air comaminents as defined bythe Bay Area Air Quality Maoa'marnt P ler
uvudco Yes CKL:tho all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have mad the hu Code. materials s requ505,25 33 a antler 4,1 un &95 d the
CaliforniaiOlWealth ff adSafetyium Code.sections 25505,8533 and 2553).I understand thin
iftheied o t damsaltcure miyhaveatectum,rhinitis myresponsibility to notify the
occupied of the rcl:ircmem which mu t prior as isquunre of Ce ificate of
(oer.'nae' Signature of Applicant Date _
for amhodeed agent Da,e All roof coverings to be Class "B"or better
OFFICE