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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 0 �L U- 2 > o ami ami L) (1 a) IL a� �- _0 aEa 3C t y O 0 Cl. % 2 0 � }, 0 0 Q v 0 (} U m Ll- Q m U u O LO z: < IU ^is U '_-_Il 7 IL �i.." 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