02030010 ICITY OF curER-ruao CONTRACTOR'INFORMATI TN
BUD,DINGDMSION PERMI� , , , - •„e _' 't,••.,.a._q h°
1 BUILDINGADDRESS: PERMIT NO
II no'3Z AnoTAbTA av 02(`30010
OWNER'S NAME: APPLICATION SUB DATE
KARF.AT viTF.N 03 f 04 /2002
M
PHONE: SATAkkY NO, CONTROL NO
O 0 oz ARCHITECT/ENGINEER: BUILDING PERMIT INFO
kL” BLDG ELECT PLUMB MECH
u�a u _ r-"U 1_U L_J t___7
L S y Z LICENSED CONTRACTOR'S DECLARATION Job Description
�z_C m thereby affir mat l am licensed under provisions of Chapter 9(commencing
with Section 7")of Division 3of the Business Said ProfURlona Code,and mylicense
ra in con force and effect REPLACE VOIDED PERMIT #01120101 .
x zrea I-menx Class L,ag _ MOVE INTERIOR WALL TO NEW BATHRM.
o2 }te _ _ SOD'ECtnr PLAN CHK REPEAT FEE PAID ON 03/04/2002 .
Z a O L`, ARCHITECT'S DECLARATION
1 understand my plans shall be used as pubic records
icy
ic p o Licensed Professional
n e K OWNER-BUILDER DECLARATION
In I hereby affirm that 1 am exempt from the Convector's License Law for the
C?
which rrzson.(S.it 1 7031.5.I.A Business and Profeaso li Code:Any city or county
dF xF G conssrun,alter,improve,demolish,orrcyav anY awnure
a3e` Punbeauaunted ,..an,1.the pmol,i matllonsach
Contramssuoice s Law hapternt _- r _l
w ich requuu a permn to
mornmen flaunted otheprf Division 3o she Business aml fiessons Cu r9 ,$ Ft; aT00 �'.I'ea t I Valuation
(corruneiuing - -]000)ofDivision3ofineBusinessandCrgicuionsCode) js! .,-,9'1 '_3:•„'YFt!I,:T.+.1'�:1� $0
or that he Is esempi andir. iii and o, or for me stsded,phour oil.Any violation f
-of not mom 1031.5 by a hundred dol for a pemm subjects me apphcam ton aril penalty
�ornm mire man rue nnner<a anlZ,r:($soo). APN Number •: Occupancy Type
°I,So Per of the propert,or my employees win wages is their sole compensation, _ 32620052 . 00
t will do the work.and me structure is not intended or offered for Into(Sec:70W 1. - - - - -- - ' - 1f l UM .4�5 fl E
'Business and Professions Coda no Convenor i License law does not apply to on B fled In$peCil 9�"3 NV w l a
owner of property wbo Wilda as improves meson,and who does such work himself 101 - FOUNDAT SlJ1V
or through his own employees.provided that such improvements are not intended or 10 2 --PSERS
C6fiaetl for site.H,however me l have the rmpro6emrns n sold weir one year or AY 'ZOOZ
complman,the owner-builder will have me burden of proving Jut he did not build or 103 - UFER 4...
Improve for purpose or sate) ,. ..104. -._.REBAR__..__ ......_.. ._..j......... .....
I.uownr ofinepropcny,am Business Said nroficouw Code) Cranon to r ��®��
<onaarv<a J¢pm3eea(see.Iwo.B 10 5 - ANCHOR BOLTS _
owner o and property who ills or The ves tnnor,s i ,
License Law does not apply to an owner of property who)lids or improves thereon,
a
_and wW contracts for wch.pro3ecu who a consrumrttii liarisd pursuant to me . .. .... ,. 10_6 -. ..SEWER &__WATER._..�—. - ,------._ -
contractoesucerucLaw. 202 - UNDERFLOOR 'PLUMBING
1. O l am a mpt urrda Sec. B&P C for this reason
pp "�y��:.�I��py 203 - UNDERFLOOR MECHANICAL
WO ER'SCOI EN ATIONDECIARATION 204 - UNDERFLOOR FRAME
I hereby affirm under Penalty of pr.Uuq one of the following declarations: 205 - UNDERFLOOR INSULATION
y(�0 1 have and will mamuin a Certificate of Consent to salt-insure for worker's 301 - ROUGH PLUMBING
. .q_,j, Compensation, as provided for by Section 37M or the Labor Code, for the 302 - TUB & OR SHOWER
Performance or the work for whin mil arirda aa;titirw. 303 - ROUGH MECHANICAL
0l have and will maintain Worker&Compensation lnsumnbe,as required by Section 304 - ROUGH ELECTRICAL
37W of she Labor Code,for the performance 6f the work for which this pemair is
issued'My Workers Compensation Insurance tamer and Pobry number am: _
_...... , _ _ , . . , .. .-3 05... -..,.FRAME.._.. . ...-.-..- ::.., ..;. .
Cuiiar5• ..: i j •:'(3” i Policy No: .
^".'S.CERT[FICATION OF EXEMPTION FROMWOR%PAS"' � '�. - ,„;3,Q 6�'t-s�IHOLDOWNSy,%a .'•��Y:
coMPENSnnoN.INSUR.wcE '. `^. .(.... .. ...._,_._..._ .,3.07....x..INSULATION__...,.,....._......-. ... _. ... _ ....__ .------......
.-.
(This section need not be completed it dac pemutur««u hutwaea douars 308 '•- NSH'EETROCK • 'c''
($10y.,less) 309 - EXTERIOR LATH
_y ._ a pe; ,rm a issue _ _. . . ... _ - . - .. - . . ,
I<ensr'Ut.rn the rrormana nine work for wmen m.r 'a.l 310 - INTERIOR, LATH•,. - -
snatl riot employ any portion in my summer so as to become subject to the Worker%
CompensationLawsorearrominDate' 311 - SCRATCH COAT
Applicant - - -
NOT1eETOAPPUCANTat.agar malting con Ccnifcate of Ea<mpuon.YOU fioold 313 ROOF- NAIL
0 Q becomemb3ectt°me=1, Compenason provisions of me Labor Code,you must 501 - FINAL ELECTRICAL ENERGY
forthwM comply wrh such provsmns°r this pemus shall he deemed revoked
-ONSTRUCTION LENDING AGENCY .7 " " 502' FINAL- PLUMBING 'ENERGY- -"
E ti v" C
a'> nr he w heeoiwhrser hattthersItii3omisi mEamlendi gagCcyforthe rformance 503 - FINAL MECHANICAL ENERGY na
k7.Q Leodtis Nam• -_
— " '" - ) ' 504--- FINAL BUSLDING ENERGY
Z Lealer:Addresl - - 505 - FINAL ELECTRICAL
0,� icemry to comply rend ms app and connd•uuancesadstat maws Pbons 506 - GAS TEST
OU to l•grins ro comply with all aut and county enumveea end state laws relating
r„I to Wildin gconstruction,andheorinspction uposbnutivcx of this atymenter upon 507 - FINAL PLUMBING
C� rZ
City bovVe).jp nmaS,c.rty fonnspeidkeep umade
a mjudgere so scosts and exTroand keep hamNeu con C ay&omeruno tit sai iguana 508 - FINAL MECHANICAL
- rr nco judgments,costs end expenses which may in any way accave against said 5 0 9
rA Labdi N.,f■lr
n CANT UNDERSTANDS R the NDS A D this perms.
APPLICANT DERSTAN'DS AND Wilt COMPLY WITH ALL NON-POINT' Issued s-C-61 Date
UR EREG IONS. 3 iy
igru rtof Appli. UCo - �4 - Pl VHL YUDL1l.. 4V Vic A.� j
° Re-roofs
AZARDOUS MATERIALS DISCLOSURE
.' Wip the applicant or future Wilding occupant store or handle hvzNcas material ,Type of Roof, _
u defined
Seti Cuperno Municipal Code.Chapter 9.11,and me Health end Suy
Code. 5320Y
` a'i" r .e+ '''•s '.i• . . '
°Yes '°�id°- All roofs shall be ins t6 any roofing material being installed.
Will me applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
I, hazaaous ar contaminants as defined by me Bay Area Air Quality Management
District' all new materials for inspection. Applicant understands and will comply with
,(,�t °Y° '° all non-point source regulations.
`A:.' 1 hivelread me hazardous materials requirements under Chapter'695 of the
Cahfomu Health&Sakty Code.sections 2550.5.25533 and 25534.1 unaersu d that
it me building does not currently have a mount,that It is my responsibility to notify me -
occupant of she requirements which must be met prior to issuance of a Certificate of
D« �<Y. _ Date l
� �3�y�n 2 Signature of Applicant
wriernr.n oil Date All roof coverings to be Class "B"or better'
OFFICE,. _ . .
'APPROVED at
pCCOROANCE WITH THE CITY CE
UNAR INO COD AND ORD4NANCES
f 200? �V_ DAB--
s�sn MUST
�J This se 'ol 44 s.otw -.r
Un
6e kept on rt''I 'a ill drs o and d at on
•;n dtanges or alterations
ul to it isslon from
2'-0"x 4'-11" 6'-0"x 6'-9" 4'-11"x 4'-10" 4'-0"x f'-3" 4'-11"x4'-10"I i:, ;t 4''11".x 4'-10"
• 4'- I99
FT ��c �cCr:tt .5 p�/i,�:;:, I-r P65'�" *o&4.io P2.11 any Pr�sion?' j a"V��`= fq�aranse or.State
O N
( — bath o +
v k BR
BR
Office BR
I I =3-6 -3'-8"'� tT'`
NI '
loseti " N- e
i
5'-6"x 6r-8" ct _
5'-0"x 6'-8" 2'-6"x 6-8" �i"x 6'-8 7LHb1`- "iv `-6"x 6'-8" 2�6v—S"
%._
i —3 2" -..._5' 3-3"—j T- 10'-2"5- 8'-3
TA^ 10'-2"
01'2"
X8,,3•=u— - .8'-3
10223 Adriana Ave,
. — Cupertino, CA95014 March 4th, 2002
Changes to the previous plan
Drawn by Sing-Man Yuen,
the home owner
SUBMITTAL
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