An application was received from Donger Lei representing Sumi House, requesting permission for a one (1) awning at the premises numbered 359 Huron Avenue. approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutters.

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The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111 www.mass.gov/dia Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_________________________________________________ _ Address:__________________________________________________________________________ City/State/Zip:_____________________________ Phone #:________________________________ *Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information. † Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ‡Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers’ comp. policy number. I am an employer that is providing workers’ compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:____________________________________________________________________________ Policy # or Self-ins. Lic. #:__________________________________________ Expiration Date:____________________ Job Site Address: City/State/Zip:______________________ Attach a copy of the workers’ compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: ___________________________________ Permit/License #_________________________________ Issuing Authority (check one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ______________________________ Contact Person:_________________________________________ Phone #:_________________________________ Type of project (required): 6. New construction 7. Remodeling 8. Demolition 9. Building addition 10. Electrical repairs or additions 11. Plumbing repairs or additions 12. Roof repairs 13. Other____________________ 1. I am a employer with _________ employees (full and/or part-time).* 2. I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers’ comp. insurance required.] 3. I am a homeowner doing all work myself. [No workers’ comp. insurance required.] † Are you an employer? Check the appropriate box: 4. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers’ comp. insurance.‡ 5. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers’ comp. insurance required.] AZ Signs 20 Branch St Quincy, MA 02169 [phone removed] I 4 I Signs & Awning A.I.M. Mutual Insurance VWC10060199272025A 03/20/2026 359 Huron Ave Cambridge, MA 02138 01/06/2026 [phone removed]

Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers’ compensation for their employees. Pursuant to this statute, an employee is defined as “...every person in the service of another under any contract of hire, express or implied, oral or written.” An employer is defined as “an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.” MGL chapter 152, §25C(6) also states that “every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.” Additionally, MGL chapter 152, §25C(7) states “Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.” Applicants Please fill out the workers’ compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers’ compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers’ compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under “Job Site Address” the applicant should write “all locations in ______(city or town).” A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department’s address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111 Tel. [phone removed] or 1-877-MASSAFE Fax [phone removed] www.mass.gov/dia Revised 7-2019

CITY OF CAMBRIDGE Community Development Department City Hall Annex, 344 Broadway, Cambridge, MA 02139 Please fill out this application to indicate the number, type, and dimensions of signage for your building. If you are unsure of the type of sign and/or allowable dimensions, please review the following pages of this application and Article 7.000 of the Zoning Ordinance. Please note the following additional requirements: • All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department certification action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Do not contract for the fabrication of a sign until all permits have been issued, including City Council approval if necessary, for signs in the public way. • Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk must receive approval from the Cambridge City Council and a bond must be posted with the City Clerk. For questions or additional information, please contact cddzoning@cambridgema.gov. APPLICANT INFORMATION Applicant Name: Phone: Email: Sign Address: C ITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION SIGN CERTIFICATION APPLICATION _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ AZ Signs [phone removed] [email removed] 359 Huron Ave, Cambridge, MA 02138

Sign conforms to requirements of Article 7.000: Sign requires a variance from the Board of Zoning Appeals: Comments: Signature: CDD Representative Date L H x Sign text: Sign type: Area in square feet: Dimensions: Placement height in feet: Depth from façade: Illumination: Sign frontage in feet: Area of existing signs to remain: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION FOR INTERNAL USE ONLY PROPOSED SIGN Please fill out the information below and attach a sketch of the proposed sign to the application. Each proposed sign requires an individual form to be filled out. For further information on sign types, see the below page. C ITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION 12 1.5 11.5 15.5 0 Natural (no illumination) Choose option. Choose option. 8 Wall Sign 1'' Sumi House

CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION OVERVIEW BY SIGN TYPE Please note that this guide is intended to provide an overview of requirements by sign type. Sign shall mean and include any permanent or temporary structure, device, letter, words, model, banner, pennant, insignia, trade flag, or representation used as, or which is in the nature of, an advertisement, announcement, or direction and which is designed to be seen from the outside of a building. For further information on specific requirements, consult Article 7.000 of the Zoning Ordinance. PROJECTING SIGN A projecting sign is attached to and projects from a building face, including marquee, canopy, and awning mounted signs. WALL SIGN A wall sign is affixed so its exposed face and all sign area is parallel to the plane of the building. FREESTANDING SIGN A free standing sign is attached to or part of a self-supporting structure and is not attached to any other structure.

CITY OF CAMBRIDGE Community Development Department City Hall Annex, 344 Broadway, Cambridge, MA 02139 Please fill out this application to indicate the number, type, and dimensions of signage for your building. If you are unsure of the type of sign and/or allowable dimensions, please review the following pages of this application and Article 7.000 of the Zoning Ordinance. Please note the following additional requirements: • All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department certification action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Do not contract for the fabrication of a sign until all permits have been issued, including City Council approval if necessary, for signs in the public way. • Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk must receive approval from the Cambridge City Council and a bond must be posted with the City Clerk. For questions or additional information, please contact cddzoning@cambridgema.gov. APPLICANT INFORMATION Applicant Name: Phone: Email: Sign Address: C ITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION SIGN CERTIFICATION APPLICATION _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ AZ Signs [phone removed] [email removed] 359 Huron Ave, Cambridge, MA 02138

Sign conforms to requirements of Article 7.000: Sign requires a variance from the Board of Zoning Appeals: Comments: Signature: CDD Representative Date L H x Sign text: Sign type: Area in square feet: Dimensions: Placement height in feet: Depth from façade: Illumination: Sign frontage in feet: Area of existing signs to remain: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION FOR INTERNAL USE ONLY PROPOSED SIGN Please fill out the information below and attach a sketch of the proposed sign to the application. Each proposed sign requires an individual form to be filled out. For further information on sign types, see the below page. C ITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION 12 1.5 11.5 15.5 0 Natural (no illumination) Choose option. Choose option. 8 Wall Sign 1'' Sumi House

CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION OVERVIEW BY SIGN TYPE Please note that this guide is intended to provide an overview of requirements by sign type. Sign shall mean and include any permanent or temporary structure, device, letter, words, model, banner, pennant, insignia, trade flag, or representation used as, or which is in the nature of, an advertisement, announcement, or direction and which is designed to be seen from the outside of a building. For further information on specific requirements, consult Article 7.000 of the Zoning Ordinance. PROJECTING SIGN A projecting sign is attached to and projects from a building face, including marquee, canopy, and awning mounted signs. WALL SIGN A wall sign is affixed so its exposed face and all sign area is parallel to the plane of the building. FREESTANDING SIGN A free standing sign is attached to or part of a self-supporting structure and is not attached to any other structure.