01050192 (2) CITY OF CUPERTINO
BUILDINC DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
21067 RED FIR CT R PERFECT CLIPIRTE 01050192
OWNER'S NAME, AI'pidcAPION SUI.DNI 17
KIM YOUNG 4799 LYRIE LN 05/29/2001
TION& 1SANITARY NO. CUNT ROLNO.
4082269990
GKZ ARC111'1'EC'TIHNGINFIiR: BUILDING PERMIT INFO
�O O BLDG l C" YLl1Ml1
L I
r<N
y- LICI?N$EDCON'rkAf:IY)R'SDECLARATION Job Description
^ I Section
Minn.hal 1 an l iucauelunder I'Chancr 9(tomo
hereby prnvi,ioll,=o license
-�°�_° wdnsemtiran]tp(n anrssian3anne Rasinc=t scat rine>,irans tide.one my license '
2� a i iacow°ci;,:."re`� a 'I231 FURNACE CHRNGE CVT & A/C RDD.
3 1° Dom 1j_j2`�tl � Cantrucu,r_n — .l
u
G A HIII EC1"SDECLARAIPON
C-
On,
g 1 undemmnd my plan=shall be used as public records
<S Liccmcd g Prot'c.x,iinal°i e Ee OWN HR.H I)I LIAR DECLA RAI]ON
a1 hereby affrnm that 1 ant exempt from the Conmacn.h license law for the
I-Z� following reason.(Section 7031.5.limmms and promotions Case:Any city or county
S x 0
which colonic,.pct ndo oommamall "oore,doodulknor repair ,structure
to it ' I. 4 :tl p.1' ti liam,li,draut toam,nedablentem
that he laccalwalp t to the provisions oftl t C t Liccaso La (Chapter 9 -Sq. Ft. Floor Area Valuation
(commencing with Section 70bon of Divii an 3 of the Rusttess and Prete.n n.Ede)
o $4041
,that he it cxcmpt therefrom anti the basis for the alleged exemption.Any viilatin
a
of Section 7031.5 by any applicant for after......objects the uppliennt m a civil penalty
,of am mom,than five h,ndree dofams($500). APN Number Occupancy Type
❑I,a,swim,.01m .,,my,se my employee,with w'a,,as mei,tale a,mperosaftnn. 35905020. 00
will do the work,.nal Ib'sro+nm Is not Intended lit offered lot sale(Sec.]IW.
Buout,,s anti Pmrt
rossiams Cosa: he Cammcm„License Law Sats rant uppy to an
Required Inspections
r of pmpmny Who builds or impnd mthereon.and who docs such work himself
oNthrough his own memloyms.pms+ded that such improvements art not indent or 304 — ROUGH ELECTRICAL
offered for .It.If,however, he building or improvement I, ,,lit within ane year of
eomtplcamh the owner-wiles w'Iu have d.a bmeem ofp,oving Thai he did mit hood o, 5®1 — ill ELECTRICAL ENE
improve tar..mote ofaaleA 505 —, FINAL. ELECTRICRL
[11,as r of the property.ant exclurively contracting with licensed contractor=to
.senathe protd(See.7194,Buo and Profs. s Cool,The Caroms.,'.
,ion
1 ec O Law dram un ripply m Ion cis w of a cocas who halides pub lis patient.
and who a.mrm:u for such projects with a cunt,<n.dx)licensed Dursuam to Ibc
1st t Low.
01.,1,ennauber
Sec. .B&I'C for this rtamn
Owner Dat'
WORKER'S COMPENSATION DECLARATION
I hurchy nflinn under penalty of polus,and of the following declaraaam,.
�O I have and rill provided
n a Cenilie Section
of Consent to t mLabor for Worker's FINALE D
Compcnxaveo he provided fir by Smevion 3](X) 0l the Luton Calc, for the C
pmrlimnnnc,of the work for which this permit is iawcd.
❑1 have anti will Inain din Wader's Compensation Inwnnce,a,inquired by Section MAY 3 1 2001
3700 of the tabor Ede,for the performance if the work for which this permit is
,wed My Walker',Compemation Insurance currier and Policy number ore:
,n _.rat b� TO,,,NM o BUILDING
CERTIFICAHON OF EXEMYI ION FROWORKERS'
COhIFENSATION INSURANCE
1'Il... ...geed mol he rr....food inn,peI..it is for n ad madted dulhn,
of(Xv or lesc)t
.1 ecoify that in the pefordence of the work for which this permit i.luued,1
shall not anmploy any Iwnon in'.ury Ivan ur It as ,,bmnmm otnea u.the Workcrt'
Compensation Law,nl Cn1iI1nnla.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
bcrome sdhjccuo the Workcr'x Con.pcnxminc pmvisinns of the Llfa.,sitmin
e.you t
Q 2 fochwith comply with wch ao,i ( nrthis permit shNl he deemed remded.
f Zi CONSTRUCTION LENDING AGENCY
I hems,atfun that them is a aturecimn lending agency for the performance
of Ito,work far wI,i,h Bos 11,'Ili is i.w..I(Sec.3097.Q,C.)
Qlender's Name
Z Lmndcr't Address -
U C 1 mod,II'm I nave rend his application and ,are that the above irE..nmload is
I,. �i cor...1.1 ugme ro comply whi all sty IloIt cowry o ollnances Ind slot,law,,timing
Q C.1 re building conemuction,and hereby suNorire repmrsmmmion,of Ihis city in One,upon
the eNote meminned pmpeny for inspection pmlovas. _ -
(W,)vgrec to save,indcmnify and AaP bunnies be Ciry of Cupertino against
LI VJ liabilities.jade......I seas;In,
I expen=d whmb may is:cry way nacru,npno,t said
U Z City inconsequencetit the this cont.
APPLICANT UND \NDSAND Ws
MPLY WITHALI O'POIT DHIC
sou -e REc IaT
Issued by:
si assfApphemtfCaoDot Re-roofs
I IAZARDOUS MAI'lill DISCLOSURE
w5B the applicant or future building ocmapant slum or handle haoirt! smnmetial Type of Roof
s ddincd by Ibc Cmenino Municipal Gu1e.Ch oavr 9.12,and the Health and Safety
Calc Stadmn 25SC(a)'!
❑Ye= All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future budding occupant use egnlpmcat or do%m%which If a roof is installed without first obtaining an inspection, I agree to remove
n.il nwlmloss ser eolsmtduul.�fired by the tiny Area A.,Q,,"O Mlmnemment
n....hon all new materials for inspection. Applicant understands and will comply with
o*'e^ all non-point Source regulations.
1 have read the ha s,daas malxtiuk m,tiod nen,under Chapter 6.95 of the
Cott'oleia Health A Safety Code,Sections 25505,255;0 and 25534.1 undentmnd fait
if the building Are,not currently have a IcnenL that it N cry responsibility b.notify the
occupant of the requirement,which nm.a he met friar m issuance of a Certificate of
_ Signature of Applicant Date
eroraumat;.waggnt _IZEI" 1—./�n � All roof coverings to be Class `B" or better
��r���iii"` OFFICE