07100088ry OF CUPERTINO
BUILDING DIVISION PERMIT
ADDRESS: - PERMIT NO.
700 STEVENS CREEKK BLVD KAS HOME IMPROVEMENT CO. 1 07100088
OWNER'S NAME.
JUNE JANG
PHONE:
3m
ARCHITECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
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
n full force and fleet
�icensc Class Lic. #
)arc ContractorFt ZnA
A HIT'ECI'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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 forsuch permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
not more than five hundred dollars (3500).
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the sLRtcture is not intended ar offered for sale (Sec. 704:, Business
and Professions Code'. The Contractor's License Law does not apply to 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 improvement 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
sale .
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.
❑ I am exempt under Sec , B & P C for this real -n
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self -insure for Workces 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 pert- anee of the work for which this permit is issued.
My Worker's m ensation�psutanc carrier and Policy number are:f��
Carrier. Policy No.: ,� �`T"�2„": Q('.
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not he eomplctod 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. I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency ror the performance of
the work for which this permit is issued (See. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
conecL I 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
ahove-mendoncd property for inspection purposes.
(We) 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 consequence of the granting of this permit.
APPLICANT UNDER ST NDS AND WILL COMPLY WITH ALL ON•POINT
SOURCEREGULATION 6�
Signature of Applicant/ ntractor rDate
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as dcrincd by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes o
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes u
I have read the hazardous materials requirements under Chap Ler 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
docs not currently have a tenant, that it is my responsibility to notify thep of the
requirements which must be met prior to issuance of a Certificate of Occuiocuncy�
Owner or authorized
3140 W
(714) 992-6861
DEMO AND 1 NEW WALL
Sq. Ft. Floor Area
36906008AENNumber
Issued by:
Re -roofs
Type of Roof
PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
Job Description
$400
Required Inspections
BUILDING PERMIT INFO
ELECT PLUMB MECH
Valuation
Occupancy
Date /01—
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 "B" or better
CITY OF CUPElaTINO
DEMO
CUPEKHNO PERMIT APPLICATION FORM
APN #
BUILIDNG
Date:
Building Address:
BSEISMICOM
Owner's Name:
BUILIDNG
Phone #: ��Q p _ �q 9I , /� 3,OD
r BSEISMICRE
Seismic Residential
BUILIDNG
Contractor:
�
License #: sa11 5 `T 9D
Contact:
��. Kms-
Phone #:
3 o r75"0
Applicant/Contractor:
Building Permit Info:
AB -Id
le Plumb
Mech
Jo Description:
Residential:
Commercial: Y lyd 1 l�
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
}
AIYL
Valuation:
Type of Construction:
Occupancy Group:
Qty. if
Applicable
Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg Permit Fees
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
r BSEISMICRE
Seismic Residential
BUILIDNG
f BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG
CITY OF
CU PEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:l9 -7DU 5; teems cyeek 01
I
PERMIT�� U ��
OWNER'S NAME: amu,,
PHONE #��-
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
j�� ID /0 god
Owner/ Contractor Signature Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
j�� ID /0 god
Owner/ Contractor Signature Date
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