04060093 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CUNTRACT'QRsIN ORMAT'ION .
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BUILDING ADDRESS: CIVITAF CORP PERMrrNo04060093
11837 UPLAND
PERMR LSSUE DATE
OWNER'S NAME:
CHUNG & SULIN YEH 270 R MAIN STREET 1i /90,n4
SANITARY NO. CONTROL NO.
NE:
(408) 399-4949
BUILDING PERMIT INFO
ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH
p O
fop LICENSED CONTRACTOR'S DECLARATION Job Description
I h rcthy affirm the,1 am limned under pro ons of Chapter 9(commencing
with n'x1f111)of Divisum3of0 Buainez fessums Code.and my lice..i9
in full andefra VVVVVV REVISION--DETAILS & POSE /BEAM
urn cl Lica
NO NEW PERMIT ISSUED/ORIG. #01080098
Dame Contnudor
$ A cwTEcrs DEC MIT—
I
YYG undo as y Plan]"(W=4 a public records
YWU
3 Licensed Professional
s.0OWNER-BUILDER DECLARATION
j�I 1 Wrchy s1Rrm Nal 1 em exempt from the Conueme,License Law for she
E n O following semen.(Section 703 1.5,Business and Professions Code:Any city or county
]�3 which requires a permit to moms 1,slot,improve,demolish,lir repair any structure
t-Ze poor toiuWisdom.Also rtquiressheapplicantfor Such Permit tofile asigned statement Vadtla
£�S Cthe,heislicensedp....nuotheprovision]offtConnector'sLicenaAw(Chapter9 Sq.Ft. Floor Area 5"o00
y,S❑F$ (commencing with Section 7000)of Division 3 of she Susan=and Profusiosn Code)Or
�5••
that he is exempt thomfrem and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a anth subjects the applicant.a civil penalty of APN Number Occupancy Type
not mom man Rw hundred dollen(S500). 36603061 . 00
❑I.as owner of the property.or my employees with wages as their sole compensation,
will domework.andae he Commences
Lim.
iLau,
Out apply
weer of Required Inspections
and Prty wh oto Cade:The Conuacon. red he Law aW oat apply lf an rwar is q P
propertywhobillIdaarimprovimpr,andwho aressolh work orofffer duuugh his
owanvet, yW,provided nonsuch remens is semanu are not intended
c oroaertd for matt e(. /
hawcvu,me building rrden or proving sold within tea year.completion,me owarf
Wilacr will have tem burden o!proving Iles he did nal build or improv for pury]ue of
tale.).
1-)1.m owner of me properly,am exclusively com Wang with licensed moment m to S
coluwct the project(Sec.7044.Business and Profession,Code:)The Contractor'U.
1w
came Law does not apply in an owner of property who Wilds or improves mercon,and, C_A
whoLafor such Projects with eeomrectaKU licensed pursuant to IW Conu.lofa V
1
License
Law.
0 ach contracts tem exempt under Sea ,BkPCfor mit rcmon
l
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Worker's Comport-
Tfition,
orkei sCompert-
tion,as provided for by Section 3700 of the Lather Code.for me performance of the
work,for which this permit is issued.
❑1 have and will maintain Wokees Compensation In.rancq,as mquired by Section
0 me lsWr Cade.(m me perfano of me rk for which cols permit is issued.
��efa Com�pemTa'�o'o�n In.nna carr end iry nomb�r am: ^
mer. No: (7 t/
CERTIFICA •OFF PfIINFROM WORK
COMPENSATION INSURANCE '
a flints section head not W completed If the Permit is for one hundred dollen p$104)
lir lcsW
I unify that in me performance of the work for which this permit is issued,l shall not n
employ any person in any mannerao as to become subject to the Wmieri Compensation
Law]of California.Dale
Applicant
NOTICE TO APPLICANT:IL after meting this Certificate of Exemption,you should
become subject to the Worker's Compemetion provisions of me Labor Code,you muss
Z forthwith comply with such provisions or this Permit shall be deemed dw tem.
z O CONSTRUCTION LENDING AGENCY
[r Iberchy affirm that men is a construction lending agency ter the perfurmanm of
y dm vers for which this permit is laved(Sce.3097,Civ.C.)
W Q Isndces Name
Loodso,Md.
az
VQ Ittnee conihaw readthis ty and aounandsummal me sWveinformation is
W F bunacL 1 agree ct comply with all city and countyntainmas and sum laws r upon de,Or, albovengeutionedrn,and hereby eumarimrepsesenutiwsaf Niscity menmrupnn me
W show-(We). . 1.crtysave for insPcction Purposes,
hie /
(We)agme 1.save,indemnify and keep hay in m the City of ag artier against (//
TSA Ileblliom,Judgmcnu,cosu and expcnsm which they In any way cc=agnn[I.id City /1
U z in consequence of the&ruling of this Permit. l //
APPLICANT UNDERSTANDS AND WILL COMPLY WITW NON-POINT Issued by: Date (((„ f
P EREGULATIONS. I'
�'/f— Re-roofs
si�9y off Applic�an�UCo�nuumr Dam rI
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fulum Wilding occupant store or handle haesNous mammal
as deflncd by the Cupertino Municipal Code.Chapter 9.12.and dm Hcalth and Safely 4�
Code.Section 75533(.)7 , All roofs shall be inspected prior to any roofing material being installed.
•� GYm TIO •`
\ If a roof is installed without first obtaining an inspection,I agree to remove (Iy//44•--.
Will the applicam or future building occupant use equipment or deviceswhich
it haardous air comeminanu as de0ncd by the Bay Arca Air Quality Management all new materials for inspection. `
suicR ,
Yes
1 have reed the hmardnuss 25%5lercqui and
255 under dumanhapter 6.95 it me Calding
ria Hcolth&Safety Calc,Sactiom]SN15.3553r and75534,1 unmrsuntl mullme for the �.
Jars not cu wa onena mos it u my responsibility mcupant of me ray
rcyuircmc WM1iehmv]lWmdprlorinl9]YNCCofaCerdBe01C foe panty. Signature of Applicant Date
ser ar aamoriaca.sent
AIII`Dal All roof coverings to be Class "B" or better