08030142 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ORANF,ORMATION
BUILgINgADORESS: PERMIT NO.
LOy56 HOMESTEAD RD STE D TBD — TO BE DETERMINED 08030142
IA"R�CHTTECTIENGINEER:
NER'S NAME: PERMIT ISSUE DATE
JOSEPH HUANG 05/23/2008
NE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
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poo LICENSED CONTRACT'OR'S DECLARATION Job Description
aC 1 hereby affirm Wt I am licensed under Pmvuioe of Copses 9(commencing P
=W wiNSectiou]qM))OfDivisionSofNeBusitresutdProfassiomCode.sedmylicenes T. I . DIY YOGURT SHOP INTERIOR SPACE.
in fall face and Ones. -
q Z License class tic.9
DataCommuter
7W ARCHTECPS DECLARATION
o 1 undersand my plait Mall be used as public meards
Rau
y a
Licensed Pmfcsdanel
OWNER.BUILDER DECLARATION
gm I hereby.(lire Nat 11. camps ram led Contramra Cause:Any c Law for Ne
i p O following reason.Permit
t ]on L5,Business and Improve.
de oro Any city m mance
$� which require a permit to construct.ales.Wpmw,dcmmsh,or repair ay swaure
_Z< prior to its issuamo.ala exports to.pplicant for such Permit o 0be.signe mmenenl
Nat o is licensed parm.m m the provisions of de contractors Umna Law(Chapu,9 Sq.Ft.Floor Area Valuation
Y�e (commatcingwiNSccdon]000)of Division Business erW Pmfeuinm Codc)or 4000(]
y the he u exempt themfmm and the basis for the alleged exemption.Any vloladon of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of ^uw�plumber Occupancy nor'm..Nan 0w hundred dollars(000). 32609061 .'�' tf P yT'Pe
I,aowas o(tbe pmpmy,amy wployaa with wage tithe'valecompenation,
will do the .,it.and the much.is not intended oroffemd forale(Sm.7(sa,Bahamas
aRequired Inspections
d Pm(essimts Cede:The Contactofa License: oa
Law does t apply N a owner or Q p
property who builds or ire proves Barran,and who docs such were himself or through his
own cmplayms,paNded dist such improvements tie out into MeE oraffered for ale.It.
however,the building or improvement is sold within ase year of completion,the owner-
builder win have ted burden of proving that he did not Wild or improve for purpose of
ale.).
❑I.as Owner of the property,am exclusively contracting wine licensed conure an to
construct the pmjea(Sec.7064.Business and Nmfrsbar s Code:)The Communes U.
across Law does not reply to a owner of property who Wilds or improm Nemen.and
who conuacu for such projects with a contracce(s)licensed Forecast to the Contraetoh
License Law.
❑Ian eaemtugdsts ,B&PC/ffor, Nu won
Due Sh9r'✓
C SATIONOECLARATTONjp���WIIIMS
ereby affirm under penalty of perjury one of the following dxlaalimu:
l have and will maintain aCcnif se of Cogent to self-iatemfawakersCompen-
mach,as provided for by Sewn 3700 of the tabor Code,far the pesfor s.a(the
work for which this Permit is issued.
1 have ad will maintain Warkcls Compemauon leannoc,u required by Section
3700 of Nc Isor Code,forNe performance of this wort for which this permit is issued.
My Worker's Compemabon Insurance artier ad Policy number m,
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissactim reed out he completed if Ne permit s turn.hundred edian(Sim)
Or best)
I certify,Nat in to parman e a dm wort for which this permit u issud.I s1Wl cot
employ anypermn in my m bccamembjecr N de Wortrss'Compenation
Laws of Calf D ✓
Applicant --
NOTICE To APPLICANT:If,eptr 1��y' g nes Ccnificam acm
of Epdon,you Mould
become subject a Ne Worker'.Campensdtion previsions of Ne Ise Wr Codc,yam must
.J z forthwith comply with such provisions to this Permit Mall be,deemed revoked.
Z O CONSTRUCTONtF.NDINGAGENCY
F IWreby air.du Nero is a cmtmpmirm lading.gercy for use peAurmarce of
a dm were for which Ns Permit is issued(Sec.3097,Civ.C)
0 tenders N.
z tenders Addw
V Q I certify Nu 1 have mod this application and sum Nu the above iMamadan is
I). E carrecL I ogee 0 comply with all city ad county ominam and sue beat elating to
.O Wilding smathcuan,ad hereby amorie rtpewnav,s of this city to anter upon the
move-mmtiooud property far inspection Purpose
F 4 (We)agree m ave,indemnify add lamp ha ssi ss the City of Cupertinoagainst
r/) liabilitim judgmens,cep ad expense which may in my way amus agmtst said City
V z in eonssquctcc of the grating of this permiL
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT .L�
SOURCE cvu �ns� Issued by: Date e
Signuue acanUContrar/ Re-roofs
ao � Dam /
H 1100JSMATERIALS DISCLOSURE Type of Roof
Will Ne appliant or forum Wilding occupert arae or handle haaNma ms,mal
a defined by dm Cupertino Municipal Cade.Chapter 9.12 ad ted Health ad Safety
Y Section 25532(a)T
0I�Na All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building If a roof,is installed without first obtaining an inspection,I agree to remove
Pp l occupant use equipment ser device.which g P
Dist ict'raNne air cataminanu ti defined by dm Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes e1Nu
I have oral ate heated u mamrias mfaimmenu untk:r Dupes 6.95 of the Califon
nor Heallth&SafmYCOdc.Scctiom 25545.25577 anal 75534.1 andencend due ifdm Wilding
docs not cwendY have a UCMML used it u my espeumbnlity m easily use omupar of Ne
¢yuiremcn which muuW and 'arm issuance ef.ccrolem.fo¢vpacy. Signature Of Applicant Date
ownDr or oras o sem p w All roof coverings to be Class'%¢"or better