00050191CITY OF.GOPERTINO
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TRACTOR RINamp FVT C' O ®RIVI' AYT'I� Os N#. # • „?
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BUILDING DIVISION ,
tp .N
Bm Dlt'gT965 AL'MADEN -CL •
FALCONE AND SNYDER CC
PEq{tIL"0
5
OWNER'S NAMG
LEE YU -CHUAN AND LI'N.W
650' ".LINCOLN AVE
AP PLICATION SUB DATE
05/26/2000
'IONS. "' - -
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SANITARY NO. CONTROL NO
4
a ARCHITECT /ENGINEER:
409 % 292. -9705
BUILDING PERMIT INFO
HIAG ELECT PLUMB MF.CH .
LICENSED CONTRAC FORS DECLAIIAI ION' -
- Job Description "
I hereby of ... .but l fi used J pr .. astir pt -9 (contravener,
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wiih Section 70001 l Division 3 fthe Easiness and Pme,suman, Code, and e, 1'cenre
is in full force a t0
LI ansc Clan , C� i Lio #
Do
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RCHII F;CI "SDECLARATION
daill be
anderderam, pon, sed ate pubbc record
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FURNACE /ADD A/C
License JP, :.1
y OWNER—BUILDER DECLARATION
Ithereby ration th,Ia . ..,I bhe Cmandernarr, Lateme Law for the
4 fold g (Set e7031 5 B e P' f -. C Je A Y q tY
•t ' ✓ t 11111, -
❑ whwh .... imr a permit constram, after, p demolish, or mp y 'artrumv
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prortotsssuance ,also requires the appinvan for such peon G) We aegnui statement
_
S Ft. F100I'Area
9r-
%�amo
hi he licensed ' bromant 1. the p nwikims of tl Cltr , t' License Low (Cnapfer9
(co ' gwlthSeln7000 )ofDiviion3Of @eBun' . n dPofesamr4Curl
or that he empt therefrom and the basis for the alleged exempfon Any violation
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ofSection 70315 by any applicant fur a prourit subjects the applc.n in a civil penalty
of not more than Five handrul donors ($500)
App1���i
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OCCU anc e '
P Y TyP
_
5. 00
- p owner o a
a,
4
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lark, ad the .,
will d 3n,1n.
will our, ,,lot intended
the k nth the . t met Ire ` t intended [f ❑ let
offered letole le (S 7044
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n d P f ss Citric: The Contractor', 'E : L d t pply t
a( apply
- r . v *Required Inspections
ow
owner of properly builds thereon, nJ h J h k hi If
or through his a ply .. provided
cu th - h p d
t' fended
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•'
town
off creJ for sale. If, user, d,e bulldog imp n i
n r s sole wadi n one your of
r '
i efnom
emnpletinatheo'e,ifselldor. will have the burden of praving,hm he did nut build or
' - ... ...
— ROUGH PLUMBLNG
maprnvell,rparpnvenfsale.) .
,'301 .
ID1.a.s owner ofthe property, am excla.;vely contracting with licensed contmcmnue
303 — ROUGH MECHANICAL'
caustrnet the project (Sec. 7044, Business and Professions Code:) The Contractors
304 — ROUGH ELECTRICAL '
. License Law does not apply era an owner' of property who builds or improves thereon,
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and who contracts for,sum pr iects with a centmca rs) licensed pursuant m the
SQi5 —. F I MAL EL.ECTR I CAL'
Contractor's License Law. ..
+
.o lam exempt under sec. ,B &refor his rcasw'
507 — ''FINAL PLUMBING.-
"}
'FINAL_
Owner Dale ''
5013 — MECHANICAL_
WORKER 'SCOMPENSATIONDECI.ARAI'ION
I hereby vlRnn under penahy of perjury one nf,he following dcdaradons:.
I have and will nminwin a Cedifiane of Comcan mself- insure for Worker's
Ga p t a, p twoled for h) Scefiam 3700 at the Labor Cide,3m, the
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,pert fd work lot hhthis p u:': -J
r
Ih .:will t Worker's Compensation ' I 11 Jby Sectors
a
W of (no Labor Code, for the performance of the work for which th s permit is
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- 'a and Palley number are
aimreJe M;AT
t '
Lrironyur
Carir '
l
Print, Na.: J
CFKI1171CATION OF EXEMPTION FROM WORKERS'
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COMPENSATION INSURANCE
"r.. .• '•
(TI -. eactinn need not he complmnl if the perm t ds [ ohundrW Jnllury
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($100) or less J
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I c ,rem J a f �i nt the cork Ind which this permit :rued I
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shall note (y yy tner so as m become subject m the Workers
L
- r s•
- Cumpcns: on f a. f
'
Applican,
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NOTICE CAN' If, alter tnaing fiFsVeltilaund of Paemptlon, you should
become euhjem to the Worker's Compensation provi -sirens of the Labor Code, yea must
forthwith comply with such provisions or this permit shall he deemed revoked.
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jc0 STRUCTIONLENDINCACENCY "•'
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I hereby afltem Ih t h re is a conswninn leading • ge y for hc pertnrmanm
.fine work for which rids tannh is issued (Sec. 3097, Cis. C.)
Lender's Name
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mark
' I unify t o I have rene this appllcminn unJ state Ihm the vbovo informminn is
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rce,. 1 urea to cam th all sit J count nmllnu es and rum laws relatin
g
unJ dherrb Y an y nc g
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mr
trudinn
gwnti yspinanzcrepresenwtives ofthic city to cued upon
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e uhove propeit for inspection purposes.
-) dgmeed
( ") ugrcem serve, m unify and keep harmless the of Cupenino against
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liabilitie' judgmErc costs u d expenses which may in any way accrue vgalrot said
saw
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City
-City n sequ of the' muting tibia pernYir'
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I NI UL ERST DS U WILL COMPLY WITH ALL ONP T
SOU
Issued b "
Y� h Date:
Signature of ApplicanUCOmmcmr Date
Re -roofs - - -
HAZARDOUS MAIERIALS DISCLOSURE
Willy future building occupant sure tleh
Type Of'ROOf
as de, eC,pentor
thyme Cupertino Municipal Cale, Chapter 9.12. and NC'HOVllh mod Safety
2.und Health an Safety
_.
See
Cale, $colon 25532(u)7
re;
.o ',d'l� _
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All-roofs shall be' inspected prior to any roofing material being installed. '
Will the appli ... lvr future building occupant use eyripmcm or devices whim
hazardous defined by
is installed Wl OUt first obtaini❑ an inspection, Iagree to remove
g P g
emit air containments as the Buy Area Air Quality Management
Dictr ,in ��
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aterials to ection Apphcanf understands and will comply with
Yes
oint S cL
Calln-
re of Applicant Date
' ` All roof coverings to be Class "B" or better _
- owaermyamndrce agent Da,n,
OFFICE; '