04040170 (2) CITY OF CUPER'1'INO ` °
BUILDING DIVISION
PERMIT JCON;TRACT0 INEORMATIQN
BUILDING ADDRESS: BJURMAN CORP PERMIT N004040170
PERNUT ISSUE DATE
OWNER'S NAME:
MENG-KUN LEE SHIH-
lip E:
SANITARY N0. CONTROL N0.
831 726-1203
umis
BUILDING PERO
ARCIIITECIENGINEER: yL
BLDG ELECT VMD MPRH
_Op LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing �a
5Stwith$CCrOa ad effec Oivisiun 3 of the Business and Professions Code,end my license is v/�/O
m mmumr,eanaeraet, DRMO (E) POOL
j q Z LieI clue Lie,g
n' Date Conq T'S DE L W ARCHITECTS DECLARATION U
27t IundcrstanJ my plans shall he uscJ upuMic rccorJs 7
tau
g O Licensed Pm(cssi0nal
g
OWNER-BUILDER DECLARATION
9 a f I hereby affirm than 1, exempt from the COomnC's License Law for the
o o following reason.(Seed, ]W t,5,eusincss and Pmfcssi0ns Code:Any city m county
<$� which requires a pmmit to eons Tact,alter,improve,demolish,or repair any structure
°iy primo its issuanre.alsurrquims the applicant(orsuch permit m Gla a signede.aurent Valuation
£x 0 that heislicensedpursuant tothe previsiunsoftheCmarocrm''sLiecnscLow(Charter 9 Sq. Ft. Floor Area
yF$ (commencing with Section7qKl)dDivision 3nfine Businessand pmfeasinns Code)ur
i 3_
that he is exempt Wca(mm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of 3 G'ffA➢N1fn*c 0 0 Occupancy Type
not more than five hundred dollars(5500). _
0 I,u owner of the property,or my employees with wages as their oll campensmlon,
will do Ba work.and the&wctuu is not intended or offered for sale(Sec.]044,Business Required Inspections
and Professions Code:The Contranots License Law docs not apply to an owner of q P
property who builds or improves Neuron,and who does such work himself or through his
own employees.provided that such improvements arc not Intended or offered formic.If.
however,Ne building or improvement is sold within one year of completion,the owner-
builder will haw she burden of proving Nat he did not Wild or nation for purpose of
le.).
JI,as owner of case property,am exclusively contracting with licensed contractors to
consu ict the project(Sec.7014,Business and Professions Codc:)The Contractor's U.
come Law docs not apply to an owner of property who Wilds or improves Neeson,and .
who contracts for such projects with a conualmr(s)licensed pursuam to the Commence,
eian,m
Rforhy
,B&P C for this reason
Data
ECL ON
e of the following declarations:
m to selbinsum fur Wok,i s Comperebar Cndc,for Be performanceof the
work for which this Permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,ss required by Section
37M of Ne Labor Codd,for be performance of Be work for which this permit is issued.
My Workers Compensation Insurance Cartier and Policy numWr art:
Cartier: POl icy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not tecomple¢d If the permit Is forone hundred dollars(SINN
or less'
1 certify that in the performance of the work(or which this Permit is issued,I shall nut
employ any person in any manner w ss m become subject to NC Workeri Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL afar making this Ceninnte of Exemption,you should
become subject m the Worker'&Compensation provisions of the Labor Code.you must
,J Q forthwith comply with such provisions or this permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
1 hereby of lrm than there is a construction lending agency for the Performance of
Cli > the wok for which oris plait Is issued(Sec.3097,CO.C.)
W Q Lender's Name
z Lender's Address
U0 1 Certify Brat I haw read this application and sal,that the ebow information is
U. f-t correct,I agree to comply with all city and county ordinances and state laws relating to
DU building construction.and hcreby'amhorim representatives of Nis city to enter upon the
}U above-mcmmmed property for inspection purposes.
(—' (We)agree to save,indemnify and keep harmless the City of Cupertino against
Ow
N liabilities,judgments,costs and expenses which may in any way accrue against said City
t lj in consequence of the granting of this permit.
APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _
SOURC RE ULATION
Re-roofs
gradim of Pp &HAZARDOUS MATERIALS DISCLOSURE ULractor Dam Type of Roof
Will Ne applicant or future building Occupant store or handle baarJous material
az&flood by Ne Contusion Municipal Cecil.Chapter 9.11,and the Health and Safety -
Cwe.Section 15531anmss All roofs shall be inspected prior to any roofing material being installed.
O 19N.e{Nu
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air contaminants in defined by the Bay Arca Air Quality Management all new materials for inspection.
One'?
❑Yes tX•'u -
I have mad the hvaNnus materials rtyuiaments under ChaPan 6.95ofthe Califon-
riaHealth&SafCIy CodC,Sr000a5255(15,25533 an125534.Iundcmund thatifthe building
J not currently he,.a tcnanL Nat it is my roaroun ihility m rout,the occupant of the
icy 'rements which sbeanol .onO issuanc ofa CCNrl of Qcupancy _ Ignature of Applicant Dale
et, C4 All roof coverings to be Class "B"or better
erornitherize agent Date