06020042 (2) CITY OFCUPERTINO + "� '� " ' �' �
BUILDING DIVISION PERMIT dCCihIRACQRTdNFRATTQ
BUILDINGADDRM: K & M DEVE?,'OPMENT INC P""mr NG'06020042
7556 KIRWIN LA
iR'S NAME: PERMITISUEDATS
DERRICK LAU 1060 WEST HILL C
PHONE: - SANITARY NO. CONTROL NO.
(408) 253-9787
ARCHITEC IENOINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
±Op LICENSED CONTRACTOR'S DECLARATION Ilob Description
I(Y I hereby refile that 1 am theories!under provisions of Chapter 9(mmmencing
with Section 7000)of Division 3 of the Business and Professima,C my license
s k fid force and «e- / HOUSE DEMO
Z_ Llanre s Lic.• T
i� L-J
I Dam O Contrectar ir✓.,.
ARCHITECTS DECLARA ON
1 undcrmnJ my plans sh used u pvhi meds
a
°u.
LiohQdProf
ao OW -BUI EK LARATI -
I hcrcby alEe 0.171 em uempt the Conte sea License Law far the /t/�
0 O fallowing moron.(Section 703 1.5,BusinesCade:Any city or county
I$e which requires a Permit a Comtruc4 ai=r.Improve,demolish,or repair my museum $10000
Z�^ Prior in its issuance.am inquires the applicantfof=ch permit a frk a signed=semens
< drm he is licensed pursuant m dm provisions of the Conuutura License Law(Chapter 9 Sq.Ft.Floor Area Valuation
5�9 (commencing with Section 7000)of Division 3 of the Burins and Professions Code)or
c — that he ts exempt therefrom and the bub far the alleged eeempdon.Any violator,of
Section 7031.5 by any applicant fm a Permit abjmu the applicant W.civil porosity of Mwwr= Occupancy Type
not mom than five hundred doll.(SSW).
❑I,u mnu of tea property,m my employcu wkh wages u theewlc campemadan,
will one the work.and the muctum b wtimended mnffarem fertile(Sec.70".Biomass Required Inspections
and Pmfesoan Cade The Cant I ken w law does rot apply 0 an owner of q P
property who builds m imptosm theaan,and who does suc h auk himself or through his
own cmployeca,provided Nat web Improvements tie not Intended maRered foraale.If.
however,the Wilding or Imprisonment is mid within am year ofmmpletion,the owner.
Wild.will haw the Wrdan of proving that he did rat build W WProve for Purpose of .
sal..).
0 1,as owner of the property,am ruminatively contacting with licensed cantraomen in
mmuuo the pmkct(Sec.7044,Business and Professions Cade:)The communes Ll-
«me law doer not apply in an owner of property who Wilds of Winewa therms,anit.
who contracts for such projects with a mnuuwrt)licensed personal as the Contractors
Liceme law.
O l on exempt under Sec. ,B&PC for this mum
Dam
WORKER'S COMPENSATION DECLARATION
1 hemby sale under Penalty of perjury arm of the poibwing declarWons
0 than and will maintain a Certificate atonement serif-Wore four WarkeYSCampao-
salon,u Provided for,by Section 37111 of the labor Code,far the perfum u e of thc
work for which this Permit is issued. -
1 haw and will maintain Wukces Composition Imufuae,an inquired by Section
'31M of the labor Cade,fu the,performance off ft work fu whichthis Partbblued.
mpensate.bm�
il
icy
coll 'f 6;V"' "[/'Poll),Nin number/.5.7 .3
Ca e
CERTIFl CO OF SA71ON ON PROM WORKERS'
COMPENSATION INSURANCE v '
(hb room tined out be completed If the Permit is faanchundred dollars(5100)
or las.)
1 canify that in the performarcc of the work for which this permit ts Ionic.l shall M '
employ any person in my mmserso u in become subject to the Workus'ComPanlNao
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.-If,sfmr making this CeNfimm of Exemption,you shmW
became subject an the Workee s Compendium Provisions of the labor Code.you mus
.J O forthwith comply with such provision;or this permit Nall be deemed invoked.z o CONSTRUCTION LENDING AGENCY
gr ' lhemby LMmtharthealaacouLnwdmlendingagemryforthcperfarmarrceof
a> the work fur which this Permit is issued(Sec.3097.Civ,C.)
D]�Q lassoes Name
0. Undoes Address .
U Q 1 mudfy the I Mw read this application aced mm that the+bow hJarmNon b
IL.F coma I agars to comply with all city,and county ordinances and mm laws relating in
OU Wilding construction,and hereby authorise reprcwnutvas of mus city to enter upon the
U above-mcntiuncd property fm Imp.Non P omems.
(We)+gine to caw,indemnify and keep hermleo dm City of Cupertino apiu'
y Iiabllitiu,judgmenu.eosu ant expenses which may In my way accrue agaim'said City
incom() APPLIC Ni UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU S O5 oe7
un Re-roofs
t H vee US MA AIS DISCLOSURE D Type of Roof
S'f
Will the applicant u tum Wil ' occupant aoin or handle becomes owtod
anted by de Cupenirro Code.Chapter 9.13.and de Health and Wcry
t,SoWt15533()7 All roofs shall be inspected prior to any roofing material being installed.
0Yes OX
Will do,applicant car future +ding Occupant am equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
emit hassud ft&d defined by the Bay Arca Air Quality Management all new materials for inspection.
Diwict7
OYca ONo
I haw new the hanfcaus maeriah mquiremens miler Chapter&95 of the Califar.
ma Health&SafmyCadc,Seemans 35305.25333 am135534.1 unicameral tha if the Wilding
Jou out currently haw a=nam,that it is my inspoulhility m wdfy the acumen'of the
inyulremcns which= pfia ofa amof Occu Signature of Applicant Date
oS z a All roof coverings to be Class"B"or better
Ownc aimed a t Dam"