12100115 CITY OF CUPERTINO BUILDING PERMIT
BUI LDING ADDRESS: 18872LOREEAVE CONTRACTOR:ALL SEASONS ROOFING& PERMITNO: 12100115
SOLAR
OWNER'S NAME: YIM SANG 1 AND SONGS 1720 SMITH AVE DATE ISSUED: 10/15/2012
OWNER'S PUONE: 4085292598 SAN.IOSE,CA 95112 PDONE NO:(408)9714455
❑ LICENSED CON`rRACI'OR'S DECLARATION BUILDING PER\IIT INFO: BLDG (✓ ELECT IJ PLUMB(J
License Class Lie.9 C Ci ED
DIECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that 1 and licensed under the pro%isions of Chapter 9 JOB DESCRIPTION:TEAR OFF I LAYER OF EXISTING AND REPLACING OSB
(commencing with Section 7000)of Division 3 of the Business&Professions DECKING 20 SQ,GAS TIMBERLINE CHARCHOL
Code and that my license is in full force and effect.
1 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 ofthe 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 Sq.Ft Floor Area: Valuation:$8460
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued
,\I'N Number:37515016.00 OccupancyType:
AI'PI,ICAN"I'CF:R'1'IFICA"I'ION
I certify that I have read this application mid 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(o enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands mrd will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature Date
❑ ON'NFR-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to my roofing material being installed.If a roof is
I hereby ufiiPm that 1 am exempt front the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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(Sec.7044. Signature of Applicata Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). .U.1.ROOF COVERINGSTO BE CLASS",\"OR BETTER
1 hereby affirm under penalty of perjureone of the following three IIAZARDOUS NIATFRIAIS DISCLOSURE
declarations:,
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Ilealth&Safety Code,Sections 25505,25533,and 25.534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
I have mid will maintain Worker's Compensation Insurance,as provided for by Safety Coda Section 25532(x)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the performnnce of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of done work for which this permit is issued,I shall Hcalth&Safet)'Code.Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation Imus of Cali fomia. If,after making this certificate of exemption,I Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,1 must 1 Date:
forthwith comply with such provisions or this permit shall be deenned revoked.
CONSIRUCFION LENDING AGF UNCI
APPLICANT CF,RT'I FICATION I hereby a0irm that there is a construction lending agency for the performance of work's
I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify 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 ARCIII'1'IiCI"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date