04060194 (4) CITY OF CUPERTINO si,12w
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BUILDING DIVISION PERMIT f1Tdxq
BUILDING ADDRESS: ELIM HUANG PERMIT"°04060194
22195 VIA ("AMIND CT
OWNER'S NAME: PERMIT ISSUE DAM
ELIM HUANG
SANITARY 9 CONTROL NO.
ARCHITECT2NGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MEOCH
LOO LICENSED CONDIACR3R•SDECLARATION JobDescri tion
1 Mreby of ind MMI 1 em licensed under provisions of Chapmr 9(commencing p
with Section 7M))of Divldon 3 ofthe Business mud Pmfeuluna Code.and my Ilcenm Is
5 mfull tome Zed nffea DEMO
m
Z LiaClass I.M.g
Dau contonow
e ARCHITECT'S DECLARATION
Y I undersand my plans shall he used as public roads
ao Licensed Pmfmiond
^ .] OWNER-exempt frDECLARATION
E Q I hereby.(Som on I am exempt Imre the Contractor'soLicense Lew for the
EQ O whichfollow
reason.Permit
t 703 1.5,n.Business and Profession Code:Any city or caunry
9�+ which require a pmmil m camtmcl,eller.impmw.Mmollah,m repair anY structure Rnon
12 prior in its issuance,Alm mqulms to applicant for such permit to file a signed statement
s< thnkislicensed pursuant tothe pmvishmsofthe ConBacur'sLiccnse LAW(Chapter 9 Sq.Ft.Floor Area Valuation
38 (commencing with Section 70D0)of Division 3 of tite Businmand Professions Code)at
Ihet be is attempt themfmm and the basis for the alleged ewnpt an.Any violation of
Section 7031.5 by arty applium for a permit objects Me applicant in a civil penalty of Q`1ii181ber0 0 Occupancy Type
M,more Men Ross hundred dollars($500).
❑I,as owner of t e property.or my employces with wegas as Meir mle corep rmatlon,
will da the work and Mestmeum is na utendedormlfered lensed.(Sm.7044,Business Required Inspections
and Professions Code:The Corse s'.License law does ml apply u e an owner of q p
property who buildscrimpmves lhmrean,and who doeasuch work Mmselforthrough his ju
man employes,provided pr such improvementswithin
arcmyoundedmpledn.f owner.
however.Me building wimpmwmentls ,he did nut year of[ prove for
owner- I builder wiB kw the burden of proving WI k did not beild a impmw for purpose ofssk.I.consu
❑1,ru owner of ct properly. B sinus and cantrasins with:)sensed conmemra l. !
,A.La d esonot (Bele.711,114,n .of and Professions Code:)M Cs Extreme.
Lb
censclawdesnotapplyuts owrterofpmpeny whesedPhilds oama,ut sMecon,aed.
whoconLacu fw Bah pmjew wIN a conummr(e)licensed purwam u the Conumtoh
is rase Lew.
latn exempt under Sec. ��� ,Bd:PCfurth moon
-rte D.te
ORKER'SCO SATI I.ARATIGN
1 kmby eEw under pc fly of perjury one of the falbwing declarations:
wand will mdnWneCmulle sof Commal m self-alum far Worker's Compen.
station,as provided for by Section 37M of the Labor Code,for Me performance of the
work for which this permit is issued.
❑1 Mw and will maintain Worker's Compensation Insurance,as required by Section
37M of Mc Labor Code,IW MC performance of the work(a which this perlall Is banned.
My Worker's Compensation Insurance prier and Policy number am:
Center: Policy Na.:
CER 1FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Mia section coed notkcorephoad!If flim permit Isfmonehundreddollara($100)
or Ius.I
IcargEythate c performance of Me work for which this permit lammed.i"I not
employ any pc ymanncrmameEut3jatro�WorkeWCompewasion -
LawaofCWfo ).Date d- F
N�A Iican _
APP Af , R J mating n p whaomau of LAW Exemption.you Mould
e
subject u site Worker's pemtion previsions of the labor Cede,you muse
.�z foMwith comply with such pm Binns or this permiuhsil be domed mvukcd.
z y CONSTRUCTION LENDING AGENCY
[r I Araby dram Met them ice construction lending agency for the pmfmmmauf
CYi> the work for which this permit is banned(Ser.3097,Cih,C.)
W�Q Lendces Name
7 z Lnuims Addmm
U O I email,that I have read this application and sum MAL the above information m
com=lag=u comply with all city and county ordinsom and state laws relating u
0 building consuuesion,and hereby suthmda reprmnutiwt of this city at enter upon site
W above-mentioned property for inspection purposes.
y (We)egrm to raw.indemnify and keep harmlm the City of Cupertino against
Vz) liabilities.judgments,cow and expenses which may in my way amus against said City
ey
C) APPLin ICANT UNDEof the RSTANDS ANDof WILLWILL COMPLY WITH A L NON-POINT Issued by: Da
OURCE REyOU1LA
(J `r' Re-roofs
signuum of ApplicandCon Mor u
HAZAR OUS MATERIALS DISCLOSUR Type of Roof
Will me applicant a Mum building acupantuom arkndk hrasaow materiel
u defined by to Cupertino Municipal Code.Chapter 9.13.and the Health and safely
C
oYo;n53:(.)7 �" All roofs shall be inspected prior to any roofing material being installed.
Will the applicant at future building occupant am equipment or devies which If a roof is installed without first obtaining an inspection,I agree to remove
Masaous sir comeminmu as dc0ned by the Bay Arm Air Quality Management all new materials for inspection.
isuict7 `/
❑Yee mNu
I haw maul the huaaowmwriala requirements undo CMpter 6.95ofthc Cdiur.
nmHealth&Sdcty Code,Satiate355115.35533and75534.Iunac dthisIfsit Wilding '
dors Out to Mly haw a unan4 that I,' m rcapansihilily to notily du occupant of the
require. hichmuu prioruiuvance CadOcayaf
ed of Applicant Date
Owner or wlhorir<d agent L a All roof coverings to be Class"B"or better