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09040061ad �0C �m 7<6 E3E�� ?�C : U., �O� n�- �pC Kee y f 0 z Qui W a a U w 0 F U CITY OF CUPERTINO r�� tT PERMIT�� h ; I�INITIQ�N� BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 1151 S STELLING RD TBD — TO BE DE—TERMINFT) 09040061 NER'S NAME: PERMIT L1SUE DATE 0 9 9 PARK §JNfItAUtX0? CONTROL NO. PHONfPA=E BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is ADD LIVING RM 2 NDF LR in full force and effect , License Class BEDRMS (9 0 0 SQ) &PORCH (5 6 SQ) REMDL UNDER 2ND Conti Date Contractor ARC DECLARATIONpublic STORY *ONLY ABOVE GARAGE , RE- RF (4 SQ) & HV STRUCTRL I understand my plans shall be used az public rccnnls all be used Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's 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, demolish, or repair any structure ! prior to its issuance, also requires the applicant for such permit to file a signed statement he is licensed to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that pursuant (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $95000 that he is 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 Occupancy Type not more than five hundred dollars (5500)_ 36222016.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (See. 7044, Business Required Inspections and Professions Code: The Contractor's License Law does not apply 10 an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If. however, the building or impmvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of 7sa I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. 1 I am exempt under Sec B & P C for this reason U'� Date ,vner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 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 Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner sob . to the Workcrs' Compensation Laws of California. Date I !t—�L Applicant NOTICE TO APPLICANT: If, affel making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY on I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued (Sec. 3097, Civ. C.) ~ Lender's Name Lenders Address I certify that I have read this application and state that the above information is -" corrccL 1 agree to comply with all city and county ordinances and state laws mlating to -" building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes (Wc) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in of the of this permit. ` Z consequence granting -� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date U -t SOURCE REGU ONS. �- 01 Re -roofs signature of pp roan n n Date HAZ DOUS MATERIALS DISCLOSURE T of goof Type Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Section 25532(a)?� All shall be inspected prior to any roofing material being installed. ide, ❑Yes P " roofs 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 hazardous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection. District? n� ❑Yes c 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the Date prior to issuance of a Certificate of an . 1✓� requirements whit4agen Signatur.- of Applicant � All roof coverings to be Class';W' or better Owner or authorizeDate I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 1 151 S STELLING RD ' %VNER'S NAME: JOANNE PARK ,,WNER'S PHONE: 4088737019 LICENSED CONTRACTOR'S DECLARATION License Class Contractor Lic. # I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harnless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9. i 8. oature Date 11 OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (See. 7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter -i the above mentioned property for inspection purposes. (We) agree to save _imnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signwture_ /1 Date CONTRACTOR: BAEKS BROTHER PERMIT NO: 09040061 CONSTRUCTION 180 ELM CT APT 1014 DATE ISSUED: 05/26/2009 SUNNYVALE, CA 94086 PHONE NO: (415) 308-7071 F_ BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH r— RESIDENTIAL COMMERCIAL JOB DESCRIPTION: ADD LIVING RM,2NDFLR BEDRMS(900SQ)&PORCH(56SQ)REMDL UNDER 2ND STORY*ONLY ABOVE GARAGE,RE-RF(4SQ)& HV STRUCTRL Sq. Ft Floor Area: ' Valuation: $95000 APN Number: 36222016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date•t�—�� RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectiones 25505, 25533, and 25534. Owner or authorized agent: ..&19AAA Date: O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional