00080095 (2) CITY OF CUPERTINO
uuamNG nrvtSIOIS PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
1.238 WEYMOUTH DR CALIFORNIA BUILDER CPPLICATIO 60916095
ION17: - SANITARY NO CONTROL NO.
,JEFF KWOK 470 GIRARD ST 08/14/000,
Q-Z ARCHITEC(ENGINEER: BUILDING PERMIT INFO
te ooc (415) 467-7619 BLDG ELECI' PLUMB Nu:CH
L, u I= u
NLN
LICENSEDa,lm verRAQ'Ok'S DBC e,ot Chapter
Job Description
y_O�O I hereby mfirin Inn'1 u 3 of the
undo.prod is(ans of Ch:mwr Y Mainly p
,,,I lall ba70IX1)ofD visi(n3oflMliasinensand Yrnl'cxninnxCade,and lay Eccn.m
�Sy Ix toruli lbs unJ COccI.
X so hiccnnc Class Lic,b
Us
U:n, Comecon
H + AkClll'rliCl"S DECLARA71ON
03 Iandeltand,nypWm.hanbcnsedaspemicren+nd. TEMPORARY POWER SERVICE
cean O Lievowd Proc,sional
o i OWNER BUILDER DECLARATION
a n v, I hereby affirm that 1 non exempt from the Contractor's License Law for the
H Z i Ibllowing reason(Section 7131.5.Breen os and Pmfussio Is Cede:Any city(r salary
f E❑ which requires a permit ,,congrum,alter,improve,demoli,h,or repair any stmmurc
Or
pr onU,it, ds'(mr,tem, he ppllcu I hounch a L file a,i,ord,mmerat
- 1hell he is 1111U.,edp r...air,I he onevi,ion,ted,,c t ,or,1.1mewlow Ch mer9 Sq. Ft. Floor Area Valuation
(con.n.nctng wish Seen 711P'BofDivision 3otlhcIi+si Masud Prole,,ons Code) '
or Ihn1 he is camp;funct'mm red the husk for Ile ullegM vocalmion.Any violation
(f S,xIam 00315 by any riffle: 11'or a permit subject,the npplicunl m a civil penally
nonnons,hnnfee hundred dollars(SolOn, APN Number Occupancy$ype
❑I.as owner Of me pn,peny.m Ivy emrlayees with wages as mside eralnpen.ano
meris o
n. I
will do the work.and the acis intended Or offered for sale(Sec.THU
Business und Professions Cde:'nr Comeacmr'x License Law does not apply to an Reqquired Inspections
wast of propcny W'ho builds or improves thereon,and who ducts such work himself 3621 1z10Qf8. Old
or through his own employee,provided that wch improvements ale not intended or
altered for sale.If,however,[lie holding ,,improvement Is slid within one year or
enn..lo nn,the twee,-hander xhl hast the hmlearn r revving'hm he did of holder
nopme for purp-c of ,de.). 103 — LIFER
C1.1 of heprown,Il xewrhelycommermgw'mreensedeammela tt 304 — ROUGH ELECTRICAL
a,note,
(See.Ton"O'nee.,and Pe, Ilam Coder Got Commence,
1 d%c Law araet nor apply m Int owner of aroomy who halide sed pursuant
a thin the
and who c+mmcu for such rejects with a commaogs)licensed pursvam to the
01 ur at exe License Ira.
I oexempt under Sec. I'C for this reason
e
Owner U /
W'ORKER'S COMPENSATION DECLARATION //
hereby nffvm under pcnal'Y of pperjury one attire rolluwing dmlaetiuns: Oo
I have and will mnimain it Certificate in Consent In seR-nuurc for Worker'. '
Cnlnr,asrrmn. as provided or by Section 3700 of the Labor Codc. for the
perforo ance of the work for which this remelt is issued
01 have and will moitume Worker's Compensation Insurance,as required by Section
3701 if the Labor Code,fur the perlormonce of the work fill which this permit is
sued.My Worker's Compenamion Insurance cancer and Policy number are:
Cnrricr: Policy Nn.:
CERTI FICA'I'ION 017 EXEMPTION FROM WORKERS'
COM PENSATION INS U RANCE
('nhls section need nut be wn...eo,l it the remit is Iorone hundred dollars
Dl hror less.) '
I cranny that in the perk rn,ance of the work for which this return is issued.1
shall not employ any pine;in any manner so as hs secant subject a+the Worker'
Compensation Laws of California.Dat
Applicant
NOTICE TO APPLICANT.IL after making this certificate of Exemption.you should
hc<(me subject the Wodefs Compensation provisions at[lie Labor Cole.you must
z� p fr nevilb comply with such pra,i oat a his pcmlit shall be deentd invoked. '
V1 CONS I'RUC['I ON[.ENDING AC117NCY
5I hcmhy stti ld,a et, then,is n emu¢nc'ion landing I,cney fm
ore Wllan
rmnce
Ra n(Ina work lire whish IhN Ienait is Issued(S,,.3097,Co.C.)
C. Q leads,,Name
;D 7 Lender's Address
V Q I cenaythat l have mad this application and state that he above information is
Iz F. correct.1 agree to comply with all city and county unhou noes and state laws telling
Q U ;(building canscarbonate,ction.and hereby carbonate,representatives of this city to enter upon
the above-mentimad propeny for inspection purpose..
F. 0• (We)agree to save.Indemnify and keep harmless the City it Coleman against
V1 Iiabiiitie,judgments,coos and expenses wbmM1 may in any way aceee against said
C.j rZi Clly in on,,o n,c ,fine gmn'ia,of this permit.
APPLICANT UNDERSTANDS AND W ILL COMPLY WITH ALI.NON-POINT Issued by: Date REGULATIONS, y'
Sigmnurenf APFlicml/Conm,cvr Dam Re-roofs
HAZARDOUS MArERIALS DISCLOSURE
Whitea,lieant or turn.building occapanl dune or handle broudou,nownal Type of Roof
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Ede,SeeYon 25532(a)7
Oe ❑No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection. I agree to remove
mit h cardous air contaminants us de ined by the Hay Area Air Quality Munagemem -
mtldt7 all new materials for inspection. Applicant understands and will comply with
El yes 11No - all non-point source regulations. - -
I have read the hurmdous materwN requirements under Chapter 6.95 of the
California Henhh&Safety Code,Seen ens 25505.25573 and 25534 1 undenend that
I
lire building does not carnally hove a hrmar.that it is my ov mability ,,ramify the
occupantIs
of the oequircmmrts which mus'h,inn prior h,issuance of o Ccniticme of _
Oc,tia11ey' Signature of Applicant Date
awnerornm cafredagent Date All roof coverings to be Class`B"or better
OFFICE