03040010 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACIN
�TO,,R FORMATION s
,
BUILDING ADDRESS: KAI-KUNG KUANG """'03040010R'S NAME: PERMIT ISSUE DATE
E: SANITARY N0. CONTROL NO.
ARCHInC(ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Oo LICENSED CONURACTOR'S DECLARATION
4U 1hereby arf,mma1amriticBlicensed underprovisionsM Chapter,Code. 9(commencing Job Description
�W with Section ta3tgof Divixion3of NC Busin nand Professions Code.and myliceme is
in mu rrrte and effect. 'NAL E psp
i'q? ucerx ams ue.g ADD 2099 SQ. FT. /REMODEL 11�.dI9
°'io vete CUnDECL CHANGE CHK NO. 1026
'E',J' ARCHITECTS DECLARATION
v< 1 unticrsunJ my plans shall M used as public recnrM1s
�o� Licensed Professional NOV ZZ 1004
I OWNER-BUILDER DECLARATION
y 1 hereby affirm that I oro eacmpt from the Contractors License Law(.,,he
00 Following reason.(Section 7031.5.Business and Professions Code:Any city or county
4.� which reyuims it pmmit to construct,ahem improve,demolish,n,repair any nructme
31)11 DIN
°iy priorniuissuance,also requires the applicant for such permit to file a signed statement
gs0 that Im is licensed pauthe e pmvisiom Of the comment's Liecrla
m w(Chapm,9 Sq. Ft. Floor Area t 00 -
rt- (commencing with Section70rQ of Division 3 of the Business and Professions Code)at
y
that he is co mfu Nerefrom and On,basis for the alleged exemption.Any violation of
Section]031.5 by any tppl ent,for a permit subjects the applicam to a civil penalty of 3 2�Si(AIi3011�ier0 0 O
no,more man five hundred dollars($500). Occupancy Y Type
El 1,as mane,of the properly,or my employees with wages ad such salt compensation,
will do me work.and be swaure is not intended or offered for sale(SO.7044,Business RR
`da Pmfesn ons Code:T a Com icmrs License Law does not apply to an owner or 1 O 1 - FOUNDATe�i�ird Inspections
p i nyw m proves memon,and who does such work himselror Nrough his h N
own employcu,provided that such improvements one not intended or offered for sale.if. 102 - PIERS
however.the building or improvement is veld within one year of completion,the Owner-
builder will haw me burden of proving Nat he did not Wild or improve for purpose of 103 - UFER
mal`) 104 - REBAR
co 1,re owner of me Sec70property,.Business s and contractingfesss with(Itched contractors n _
comwct does joapplytoinOwnofprnd Professions Ca de i The Conmai lOS - ANCHOR BOLTS
wmetawduesnoupplytoan with
aofpropeny who
sedporimptoves,hcmrn.and, 106 - SEWER & WATER
who contracts for such projects aim a eontne,or(s)licensed pursuant to the Contractor '
LicenseLaw. _ 202 - UNDERFLOOR PLUMBING
0 anexemptundu a. ,BkPCfor this rtazon 203 - UNDERFLOOR MECHANICAL'
y� " .�o '�j 204 - UNDERFLOOR FRAME
a C - SCOM SATION DE^ TION
I hereby afE,m mntlerpeml f I jmy one or the following deelaatimni: 205 - UNDERFLOOR INSULATION
haw Certificate and will mainum a Cete ofConxto self-Nxum for Worker'sCoeren- 301 — ROUGH PLUMBING
tion.u prodded for by Section 37M of the uhor code.for me pertotmana of doe 3 02 — TUB & OR SHOWER
wok rat ahld Nis panto ix issued. 3 0 3 - ROUGH MECHANICAL
1 haw and will ode,fon Wmk,rS rm.Of the w rk for which
h required by Section
37M of the MyWorker,Cor Code,for mepcnmecarce Dad worm ro,wblenmix p„mi,isissued. � 304 — ROUGH ELECTRICAL
My workers Compensation taverna Drier and Policy nmmhcrma: 305 — FRAME
Cemcr. CERTIFICATE OF EXEMPf10NyFROM WORK ERS' 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(Or less.)(Thu section need not he completed if the Permit is for one hundred dollme ni l an 308 - SHEETROCK
1 cenify that in the perfomance of the work for which this Permit is issued,1 shall not3 09 - EXTERIOR LATH
employ any person in any roamer set as in become subjecaotln Workcrs'Compensation 310 - INTERIOR LATH
Laws
p.... 311 - SCRATCH COAT
Laws of im
NOTICE TO APPLICANT:if,after making this C,nificam Of Eacmptien.you should 313 - ROOF NAIL
laconic subject to the Worker's Compensation provisions or m,Labor Codc,you mut
Jzmnhwmmumreveled. 501 - FINAL ELECTRICAL ENERGY
0
? 53 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
F'a Ihcrebyarfrmmat mcaisaeonswnionlending agency rormepermrmanecor
C > due wurwhich this penmitisissued(SccJ(N9.Cis503 - FINAL MECHANICAL ENERGY
> C.) 504 - FINAL BUILDING ENERGY
Wnde,'s k Name
jz Und,rsAddmas 505 - FINAL ELECTRICAL
U C) 1 Ccnify Nat I have read this application and sum that the above information is 506 - GAS TEST
comet.1 agree to comply with all city and county ordinances and sum taws relating to
OU building consmuction,and hereby undborim,representatives Of this City to enter upon the FIN PLUM$( G
H 4 slave-mentioned prepcny for inspection purposes.
(We).,me to save,indcmni Fy and keep harmless the City or Cupeninm against O 8 F I L
h liahiics,judgments.costs and expenses which they in any way accrue against s4id City 5
[J'z int nxyucncc of me gaming of this permit.
AP (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by:5 NG Date
i�iT!
UL 1 5.
(a D 2
of nVcmnract Date a-roofs
HAZARD S MATERIALS DISCLOSURE Type of Roof
the applicant or Indn��mgtcupan,sn,corhandlchmmdousmax6al
Uthe Cuperlino Municip J Code.Chapter 9.12,and the Health and Safety
25532(a)?
�No All roofs shall be inspected prior to any roofing material being installed.
e applicant or future building occupant doe equipment of devices which If a roof is installed without first obtaining an inspection, I agree to remove
s air contaminants u dcimed by the Bay Area Air Quality ManagcmcntalI new materials for inspection.
❑yes �Np
1 have aaJ me hvudnus materials requirements under Chapter 6.95 of the
Califon-ria Hcalm 6 Safety Code,Section 25 )5,255JJand255J4.lunde.' dmmifmcnuilmng
does nm ermendy have a mnank Out pan"HY n noul'y de cumpan,name
quimmentswhich us in of aCertificate OrOCcupany. nature of Applicant Date
(o (�
s, Dam
carer ora ageAll roof coverings to be Class "B" or better