05060057 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT s--CON
TRACTORINk'ORMATIQN
BUILDING ADDRESS: KUO & LEE^ FLM PERMIT NO.05060057
18840 TU
OWNER'S NAME: PERMIT ISSUE DATE
KUO & LEE FLM 18840 TUGGLE AVE 07/2S/2005
E: SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION
�� I Wwby affirm Net l am licanad under provisions of Chapter 9(commencing Job Description
SZ with Smtian70IB)of Division 3ofthe Businessand Professions Code,and my license is
I'- in feltrame andnrcmL ADD 772 ' -LIV. /442 ' -GARAGE &
,M? License Clan Lic.a
afC Date ARCNf GOTS CLARATION REMODEL (ADD MS . BED & BATH/KITCHEN)
Os 1 understand my plans shall M taco as pantie records
LOUG
pro
sLicensed Professional
O
7 OWNER-BUILDER DECLARATION
2 i F I hereby affirm that 1 am exempt from de Conuscmr's License Law for the IN
C
00 following rrssun.(Section LD 1.5,Business and Professions Cook:My city or county
- which requires a Permit to conNam,eller,impsnve,demolish,or repair any structure 44A IPA
-zi print to its issuance,zine requites the applicant for such permit to rile a signed statement
EZQ that he is licensed mosuam to the provisions of Me Conusetur's License Law(Chapter 9 Sq. Ft. Floor Area ,^ `�' llilo
sl- (commencing with Section 7000)of Division 3 ofthe Bssinusand Profaainns Conc)or `00
Q Nat hes exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number CCUv,�❑C T e
not mart Nan five hundred dollars(S500). 37532027 . 00 P' cy yP
I,u owner of the pmprny,or my employers with wzgu as their sole eompenution, I
will do the work,and Ne svuctme is oat intended or olfesad forsake(Sec.7044,Businev `t
and Professions Code:The Contrxmfs License Law does not apply to an owner of Required Inspections I/
property who builds or improves thereon,and who does such work himself or through his
own emidoyaes,provided thatsuch improvements are notimended or offered for We.If.
however,Ne building or improvement is sold within one year of completion,Ne owner.
builder will have the Wallen of proving Nat he did stet build or improve for puryme of
sale.).
1,as owner of the progeny,am exclusively conerae ing with licensed contractors to
canswct the project(Sec.7044,Business and Professions CWc:)The Convectors Li-
cense Law does not apply to an owner of prupeny who builds or impmvcs thcteon.and
who contracts for such projects wit a canlracmr(s)licensed pursuant in the Convector's -
Lkcme Law.
Q l am exempt under Sec.
,r y �� sn�� ,B k PP 7C�far
this'a ... ._."-
Owner_ Ie..�f.(.KA n 1� Date 1 I _
WO KER'SCOMPENSAT70N DECI:ARATION - -"'-
1 hereby afford under penalty of perjury,one of the following declarations:
I have and will maintain a CeniRam of Consent to self-insum for Worker'sCompen-
mtian,u provided far by Section 37W of the labra Code,far the performamm of the -
work for which this Permit is issued.
Q 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Cod,for Ne performance of Ne work for which this permit is issued.
My Workers Companeumn Insurance artier and Policy number arc:
Carrier: Policy No.: _
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu action road not bccomplemd if the permit is hof one hundred dollars($100)
or las)
I CrMfv that in the performance of the work for which this permit Or issued,l shall nor
cmployany person in any muner m rah become sub;emJp NC WorJmrs�per cation
LawsofCalifornia.Datc
— gl� 76C 6•
Applicant
NOTICE TO APPLICANT:If.after making this Cenificare of Exemption,you should
become Subject he the Workers ComPere arms provisions of the Lshm Code,you must
.J ,Z frnhwith comply with such provisions or this permit shall be deemed samkOd,
Z O CONSTRUCTION LENDING AGENCY
[-. 1 hereby dorm Nat there is a emuwctinn lending aVmy for the performance of
fk Ne work fur which mu permit is issued(Sec.3097,Civ.C.)
fA 0 Letut Name
0. z Lender's Address
O Q 1 annify real 1 have mad this application and sum Nu the above information is
H.F Correa I agree to comply with all city and county ardinamen and sum laws relating to
0U building construction.and hereby,audmrie mpsesenufives of this city to enter upon the
yStove-mentioned progeny for inspection purposes.
(We)agree or save,indemnify and keep hassnleu Ire City of Cupertino against
Z
liabilities,judgment,Soaring expenses which may in anyway acetas against aid City
Uz Aconsequence of UNDERSTANDS
ng of this permit
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU 77 NS. p
— 6118 7��/° Re-roofs
Signxtum afA izi; C_ntsador Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building=open,am or handle haartlous material
Us defined by the Cupenino Municipal Code.Chapter 9.12,and Ne Health and Safety
Cale.Section 23332(a)?
Q Yea J�Tla All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or rumre Wilding«cu ant use a If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air mmaminmts u defined n the Ba Area equipment
color devices;whim g
r r Quality Management all new materials for inspection.
District? P
QYa No
I have seal due hvsadao,hU mcrials mquiremcna under Chapter6.95 of the Califoo-
ria Halth k SafctYCodc,ScNom 2 M5,25533 tad 25534.1 understand thatif the building
does not cumady haw a WmML that it is my responal ilily he nodry the axU mt of the
mealrlNuwIthmaRmm_mptp riormimummoracerdramrfaapmcy. Signature of Applicant Date
,�tj,� a,e
Owner or authonzcd agent Dpte All roof coverings to be Class"B"or better
L