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09030086300 ZUZ 7=y r�Z CJ k0 �o gz 50 O 0 zc i>a ~ C.r UC I>~ IS Ha ►r V U2 CITY OF CUPERTINO 7-5 7-. -11 BUILDING DIVISION PERA41T PERMIT NO. BUILDING ADDRESS: 10919 N WOLFE RD KEN LEUNG CONST INC n9n30086 OWNER'S NAME: PERMIT ISSUE DATE PHONE A CONTROL NO. (510)531-5477 ARCHnECT/ENGINEER BUILDING PEP MIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description i hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ProfessGmi Code, and my license is In full force and effect (TUTTIMELON) T.I. INTERIOR E/M/P' S & INTERIOR License Date Contractor CCoont actor DEMO— YOGURT SHOP (116 2 SQ) ; NO RE—RF OR STRUCTRL ARCHITECL'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 beeby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, danolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 12 0 0 that he is exempt therefrom and the basis for the alleged exempdon Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars (SSW). 31605051.YGRT [I Las owner of the property, ormy employees with wages as their sale compensation, will do the work. and the structure is no, Intended or offered for sale (Sec. 7044, Business Required Inspections Ll and Professions Code: The Conuactors License Law does not apply to an owner of property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of txnnpletion, the owner- buiidej will have the burden of proving that he did not build or improve for purpose of sale.Y �I/. as owner of the property, uo exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Cade,)The Contractors LI- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a conttactar(s) licensed pursuant to the Contracors License Law. Oi am exempto B& P C for this n , wner 7 H � Date WoR MPENSA-nONDECLARATION 1 hereby affirm m under penalty of perjury one of the following declarations: ❑ i have and will maintain a Certificate of Consent to self -Insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ' My Workers Compensation hnsumnce carrier and Policy number are: Carrier. Policy No.: CERMCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (3100) or less) 1 certify that In the performance of the work for which this permit Is Issued. 1 shall not employ any person in any manner so as to become subject to the rs' Coppc lion Laws of Cal ifwuda,.pa a '� Applicant NOTICE TO APPLICA after making this Certificate of Exemption, you hould become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this peanft shall. be deemed revoked. I CONSTRUCTION L.ENI)ING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of i the work for which this permit is issued (Se.. 3097, Civ. C) ' L.endces Name Lenders Address I 1 certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and bereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes (We) agnrm to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may In any way accrue against said City in consequence of the gating of this permit APPLICANT UNDERSTANDS AND WILL COMPLY wrrH ALL NON -POINT Issued by: Date SOURCE�c ONS. i � �� �b 2�( t I' Re -roofs sir� atare a A HAZARDOUS MATERIALS DISCLOSURE Type of Roof Type wlil the applicant or future building occupant sore or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and.Safcly Code, Section25532(a)? �/ Yes No All roofs shall be inspected prior to any roofing material being installed. [I L( If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazards air contamina oud by the Bay Area Air Quality Management nts as fin all new materials for inspection. District? ❑ Yes No 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand the ICthe building does not currently have a tenant that it Is my responsibility to notify the occupant of the require,neml,w n creel * rwIssuance afaCertificate of Occ Signature of Applicant Date � All roof coverings to be Class '%" or better Owner orautnorindagent �,e