02100139 (2) CITY OF CUPERTINO S�l "' 11. •' N-
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BmhrylggARDRPROSPECT RD WERN-YAN KOE PERMLTNO2100139
owlWglr*i;:YAN KOE APPLICATITtOS111t1DgffY 2 0 0 2
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HONE: SANITARY NO.// CONI ROL NO.
ARCIII'ILCT/RNGINEI;R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
LICENS17D CONTRACTOR'S DECLARATION
wo Ibriery aBhm man am Recused under provisiom of Chapter 9(eommendng REPLACE FURNAC< hDescription
�<ywith Section of Uivision3nfine Ruiners and Pr�fessionsCmle.and my license is
in full force and effect.
=o�= [LicensemGlaaa Lie." IFINAL.E®
[)am_Contractor
F'^t'ad ARCHITECTS DECLARATION
i Iunderstand myplansshut lla,used asprobe records OCT 2 1 2002
Oyu
r�i 3 u H I uenscd Prnfuccianal
=01 OWNER-BUILDER DECLARATION
am ram<y I hereby affirm that I am crump.fru.the Contractor's License Law for the C 3 0 0 0
�u6a following reasm.(Secdnn)831.5.Business and Pmfessions Code:Any cityor county BUILDING Y
K m which requires a pi,min to amstrua,alter,improve,demolish,or repair any structure
w'w priono Its issuance.also rcyvires mcapplicat ho,oeh permtto lllcasigncJ.statement
�Za
that he is licensed pursuant to the provisions of the Contranse or:e LicenlawlCM1apmr9 3�6Bt.�f®1�AI@� VBlnallOn
at (commencing with Section 70(0)of Division 3 of the Business and Profusions Csalef or
y that he is exempt therefrom a it Nu basis fur the alleged ascription.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of J UAWA;J&PHOccupancy Type
net mom man love hundred dollars(s500). 303 - ROUGH MECHANICAL
❑I,u owner of the propcny,or my employees with wages as their sole compensation,
will do e wick,and me structure is not intended or offered for sale(Sec.7144,Business
mpsr�{Qfr,�f
and Professions Code:The Convsmor's License Law does not apply In an owner of 505 - FINAL
INAL LbL 1l:HLl o ns
property who builds or improves Roman.and who does such work himmlf or though his
ownemployees.pmvlded tha.such improomcimam nut intended oroffered forum.It, 507 — FINAL PLUMBING
however,the building or improvement is sold within one year ofcompletion,the owner- 508 — FINAL MECHANICAL
builder will have the burden of proving that he did not brad or improve far purpose of
sada.).
❑I,as owner of the properi am exclusively contracting with licensed contractors to
conswet me Limiter(Sec.7044,Business and Professions Csvk:)The Conracter's Li.
cense Law rocs not apply to an owner of property who builds or improves thereon,and
who contracts for such protects with a contractor(s)licensed pursuant to the Contractor's
License Law.
I a �.m esem(pyl under See B&P C for oris reason
a say Date /%
WOR R'S COMPENSATION DECLARA'1�pp�1�
I hereby affirm under penalty of perjury one of the to[lowM�Acc].Iran.:
I have and will maintain a Credimme of Consentto self insum for Worker's Compen-
kamn,as Drovided for by Section 3701 of me labor Code,for me pertomtancc of the
work for which this Permit is issued.
ED 1 have and will maintain Worker's Compensation Insurance,as required by Sectio
7]1X1 of me labor Cole,for me performance of me work for which oris permit is issued.
My Worker's Compensation Insurance artier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sccrion need nut becomplctcd if rhe permit is for one hundred dollars(SHX1)
It,,,.)
I eenify that in the Pic rlyp^r�ry�t a of the work for which this permit is issued,I shall not
employany person inan�}tanncrm soft on E6tbpLo the Workers'Compensation
Laws of C�Imn tar DinnS�'
$�
NOnCjt TOA PLICA :II:a tcr4ing this Ccnilicatn of Eacmptinn,you sM1nulJ
IxCo subject[o the r leer's Compensation provisions of the Labor Codc,you must
oZ forthwith comply with such provisions or this permit shall N deemed revoked.
z O CONSTRUCTION LENDING AGENCY
(-. 1 berchy affirm that there is a construction lending agency for the performance of
P4 7 the work fur which this permit is issued(Sec.YAO.Civ.C.)
l[d Q Lender's N.
z Lender's Address
U C) I eenify that I have read this application and sure[hat me ahem adom thin is
correct l agree to comply with all city and county ordinances and sore laws missing in
U building construction,and hereby aurhorim reprcsenutives of this city to enter upon the
[21 ahon-mentioned properly for inspection purp rocs.
0. (We)agree Io rasa indcmmmless fy and keep harthe City of Cupertino against
f' V) liabilities,judgments,c2q and cspenms which may in any way accrue against said City
to conscyucncc of he ming of this perm it 'D /
APPLICANT'UNDP S"LANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date 111
SOURCEREGUL ONS.
(0/ 0
Re-roofs
ignatur ph ndContiDOGS MATERIALS DISCLOSURE as Type of Roof
II the applierm nr future building Occupant stare of handle har..di a mamnal
as defined by me Cupertino M. .pal Code.Chapter 9.L2.and the[health and Safely
Code,Scchon 255321°)'/ I/ " All roofs shall be inspected prior to any roofing material being installed.
❑Yea
Will the applicant or future buildingsccupamusccyuipmetnordevices which If a roof is installed without first obtaining an inspection, I agree to remove
emit mounfous air comma defined by the Bay Arca Air Oualoy Management all new materials for inspection.
District
❑Ycs
I have mad the moodousmaterials requirements under Chapmr6.95 of the Califor-
nia[]calm A Safety Cole,Secdons25505.25533 and 25534.1 understand that if the building
ores not emren[ly have a board,mut it is my mslaansihilhy rt nobly the¢cupent of me
is-immca hicIt mu .0'n to issuance ofd Certificate of Occupancy /� L Signature of Applicant Date
r or aomo ,.eagen O All roof coverings to be Class"B" or better