08060055 CITY OF CUPERTINO s », ',;, e. �b ,�3 itis '
BUILDINC DIVISION PERMIT CONTRAGT(TRIINFORMA"IIOIV
PERMIT NO.
BUII-DINO,AOW"TRUNE TREE LN TBD — TO BE DETERMINED 06060055
LRU'S.5N 2A5MbE: k' PERMIT ISSUE DATE
DAVID HWANG 06/20/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHRECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
.1 Wmflume by affiNal 1 am licensed under Provisions of chmer 9(commencing
w+mScctionlgw)oroi>isian3orweRudnevanaProrrisiomcade.andmylice�u DEMO REMOVE EXISTING STRUCTURE AND CONCRETE
6
j-; in fun a Cls and effm
License Class Lin.Contractor PATIO
eFp0 Ditto ARCHITECTSDECLARATION AND WALKWAY
C< �I understand my Plans shall W used u public records
3yU I
g G H Licensed Professional
c or OWNER-BUILDER DECLARATION
E 1 hereby aRrm Nal 1 am exempt from roc Commutes Lianas Law for the
ac following mumu.(Saw.111.3.Busimxs and Profcsu'on Code:Any city or county
Ia� which requires a pewit to emer uct.alter,improve,demolish,or repair any swmure
z prior to its issuance.Man mqutrn the applicant for such permit to file a signed sutomcot
E C
that heisllccruxipuromm'.the provisionofthe Consomme,licenseLaw(Chapm9 Sq.Ft.Floor Area Valuation
5 (eommendng with Section 1000)of Division 3 of the Business mad Prof inns Capt)err $12500
S $ Nu W is exempt therefrom sand the bnih for the alleged eaemPtion Any violation of
Section 103 1.5 by I"applicant far a Permit subjects roc applicant in a civil penalty of
nm more man Eve hundred dollars(55007. 31633032 Number Occupancy Type
L u owner of the ptopmty,or my employers with wage u mev axle compenntion,
will do the wart,and the he Contractors
on ra mors LMed or Law
do tarsale(Sec.1006.Busierof
and property who
Code:The Cam erem,License Law don ma apply lf an owner of Required Inspections
ProPenywW W+providmprovuch improvements
daessuchworkhi arrforNmugnh.
lowver,th Wilding
prrsuchit issemenuartnmimr ofcmoReml for sale B,
however,the Wilding Wmim of emend ahold within one you or avmo+etif r me owtt-
buildtt will have me Wrden of proving dist he did not Wild m improve ler purpose of
sok).
1,as owner of the property,am exclusively conhacting with licensed conuamam to
Manama the project(Sec.7W.Business and Prefassian Cade:)The Contactors U.
1.Law does am apply to an owes of property who Wilds m+mproves therton.and
who contacts for such pmjecu wit a eonaactor(s)licensed pursuant to the Commodes
Licsue law.
I am exr}empt under See BB dI P�C�for�this team
damp
--EORKEROS COMPE SA ON URATION
1 hereby"am under penury of perjury an of the following declaration:
❑1 h:ae and will maintain aCtttiriaw of Coroem to self-inurt farWorkdsCompere
soon, provided fPe Section 3]00 of me labor Code.fm me penfowance or dw
work!errr which this Permit is issued.
❑1 have and will maintain Warmer Compensation Inmmse,as requited by Section
3700 or me Lmor Code,for me peRormmce arms wort forwhich this Permit is issued.
My Workers Compen urnar Inauamu uai,,and Policy number sae:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thuxet+on need not W completod if the Permit is farune hundred dollars(5100)
or 1.)
1 certify rent in the performance of me work for which this Permit is issued,I shall not
emplaymyperam in anyma rte�ojs omc subject to f WorkerYCompenation
Laws oru='A
Dam
App11cN1 -
ND110E APPU NP.If.a0 r make g is enC iricau of Esemptio,ytf�ou should
became subject to the Worimes Con cnsidon provisions of IW lapor Cade,you a=
.JZ forthwith comply wit such Provision or this Permit alWl W drenmd rtwkcd.
z O CONSTRUCTION LENDING AGENCY
(-+ 1 hereby affirm that inert is a consrroctum lending agency for tiw performance of
f$ > the work fur which this peania is issued(Sit.3097,Civ.C.)
dLcMcra Name
z Lenders Address
I>Q 1 anify that 1 have mad this application and sum that the above information Is
F
Marna.1 agree to comply with all city and county ordinances and slow laws misting m
QU Wilding convection.and hemby authasi>e representatives of this city to ants upon the
r U ahove-mentioned pmNny for inspection purposes.
F G (We)agree to nave,indemnify and keep harmless the City of Cupertino against
rA Ilabilities,judgments.costa and expenses which may in any wyamue against saidCity
V z in consequence of due Standing this Permit. /J GL
^� APPLICANT UNDERSTANDS
DSSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date G
SO RCE REGULATIONS. _
Si gnsaum f y '""o�IGxm "g '� Re-roofs
—�PlrexHpAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
IIIYn 9010the applicant or fur=building Occupant atom m handle harudous matonal
liby IK Cupertino Municipal Code.Chapter 9.12.and the Hcalth and Safety
Mon zssW3z(,)1
All roofs shall be inspected prior to any roofing material being installed.
_
Will dm applicant or furan Wilding occupant use equipment or&Ams which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha>ardous air comamiamus a defined by Ne Bay Arca Air Quality Management all new materials for inspection.
Damen
❑Y. -
I have read the hommous materiaismquirtments under Ch mr6.95 ofine Califor.
nis Halm&Safety Cade,Scammu M.35533 sod 25534.Iundcnuvtd muiftic hurtling
don not currently have a tonml that it is my responsibility to roof,do occupant of dm
rtyui tswninn(�mnaWmst Phot m�i/ssumwn ora Contra. 0
roccaP'"9' Signature of Applicant Date
—� / All roof coverings to be Class'%¢"or better
Owner or auahomnd agcm Wto' g