01060099 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18861 ARATA WAY EVEROWNED DEVELOPMENT CO P01060099
OWNER'S NAME: APPLICATION SUB DATE
ERIC W. YUEN 531 NORTHLAKE DR 06/18/2001
PHONE: SANITARY NO. CONTROL NO.
l„ (408) 725-8822
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U— BLDG ELECT PLUMB MECH
t;<i IE-i 1 - L_.J CI
LICENSED CONTRACTOR'S DECLARATION
5„- iamn Job Description
O Z—p 1 hereby(H of that I ore licensed sides p and
sof Chapter 9(commencing
FyFm with Section]fg10)ofDivision3oftheBmitrcssendPmfexsionsCade,andmylittnu DEMO 814 SQ. FT.
on m I is in full force nnJ effecJQ - —70
OU License Class_LJ Lia.,,
3 y Oats'-Jcnmraat
ARC ELTS DEC
I side nrnand on,plans shall h used as puldic mmNs
22
var
61 p O Licensed Professional
!S o OWNER-BUILDER DECLARATION
u� I hereby myrm that I am exempt from the Contractors License Law for the
?a following mason(Section 7071.5,Business and Profusions Code:Any city or county - - $1 O S O O
D which requires a permit to consul alien.improve,demolish,or repair any swcwrc
pr
n
tons c q t ppt
I
.
Ih1h1uliv,I core 11 n -I .1 'tc11 v . . p Valuation ...
a togwith SePfirainhltheb o�afmayasmt tlIb.An,ase tlej "37�.�lr
of thatfiea exempt therefrom area the basis for the subjects
the applicant
to Any violation t
�of Section903 LS by any applicant for a Pnmit subject the applicant m a civil Penalty
:ofnotmomthanrivehandledd°llanlasool. NO �:nlYnft INSPECT ONSvI '` OccupaneyType
O I,as mcamol the proper,,,a,my employee,,ith wages as the s le awn,al
will do due workc.and the tut s not-intended o ffered for sale'Sec,70,44 - - -
Posimicans Cade lContractor's Licenne Law does apply
Required Inspection lia
owner of property Who nmpm se thereon, J who dyes inch work himself
or through his
own
employees.provided that such improvements we notintended n
orae ed for saI If er,th
bWilding or"improvement Id withil year of -"
Ili a bu IJer all ha th brJe ofp gth ihedJ Wild Id or
Whave f
ImPm for p rpou of sale 1
O I nen (th P Pent I sivelY c t t gwith beemardeconturanamot _�
emotionst th p lea(S 7194 0 d Prof s ons Cad )Th C trct s
License Law Was not apply to an owner of prepery who Wilds imposell thereon. -
_nodh of h p leen 161h c t nips)1 nsW.P n m t the.
Cot t Li
Law.
°Irepam CUt maker See.
Ng,PCT tM1is
Owne, Data '.
'WORKER'S COMPENSATION DECLARATION
(� Ithereby affirm order Penalty of perjury 666 of the following declarations:
❑ 1 hav and'will maintaina Cenihicaid of'Consar td self-iosnre for Worker's
Compensation; as provided for by Section 370[l the Lalar Code, far the
pedormattce of the work for w�tich this permit is isucd.,,s,
- Cl I nave and will maintain Workers Compensation Insurance,as required by Section
77M of'the'LtWr Code,for the performance of the work'for which his Permit is
,.sued My Workers C rape t nnlnsd a artier rend Pal y' - ben are:"
,. `1 ., .. � .. _._..._.,_— .
Candor '-s Policy No.: 3 DD 1.liJ) t7oJ 3 3. _..__...."-. '- ....
CERTI ICATIONOFEXEMPT"'
COMPENSATION INSURANCE -_......, .._.. ,.___..... .1..._.. __..___L............,._........ ............__.. .
.,., ,.. ...._. ..... ...........
ahillUm ni need not be completed if the permit Is for one hundred dollars
(SI W)or less.)
` to Penan thispermittoteis kJl � - --
1 ten f than i the rfamr rt e of the k for which
1 '
shall not employ any of old r manner us to become subject to the Wankeis "
PP .
Compensation t on Lawa f Calitomia.Date
Pcnsa
NOTICE TOA time alkera It.Compenter sation
than Certificate the
Exem tion you should
becomeh em time Worker's Calm[,or tion provisions of the Luded Code,m,aik you mus
Q z fn Ili hh emmy with h pm .I ns a thispermit:hull h decided yoked
'ti!t .I CONSTRUCnONLENDING AGENCY ' ,
C"' 1 for affirm that there tis con traction lending agency for the perfonmarrte
ryrs�r oen work frwhrch thispc 1 .issued 15 309],Civ.C.1 ,
Led .Name-.e, n, t.. ..n.. ..._. .. , , .�, :... . .. ... , ....,,. .a... ._ ...._ ..._..., . _... ,._.. -_.. ... .
o Z Leal x Aildr s +
V,0 I certify that I have mad this application and state that Ire about information is
li [... 'corn r I greet comply with II city and county ordinances and tat I mlat ng
top Id' .t and herebya th cep se fe.t fth'.city to enter
y W IM1e - d J v c. a f. Pct p D:
F.,W sl agreet v de 'fyadk phamyintheCty fCPn against
V1 liabilities.judgments,costs and expenses wh ch may n any way azcrve ngaimt aid
C.1.,Z Cityy a eortequencn of dr graining of the pe m ^'
^' APPI I' NDERSTAND$AND WILL COMPLY WITH L"NON+P INT'
sou , 'v ;: 1�,. �' Q Q Issued by: Dale
O
Signam of Apphwnl/Cortcanan. : . . .!., .,ore Re-roofs
2 - ._ .n:'HAZARIOUS.fATERIAIS DISCLOSURE-"
sYll fhehpplicani at future 'ilding occupant than m handle'hLaMous material Type Of-Roof, - -- .. .. ...... ......._..._ ,.__.,...._..._.....___,..-
as defined by the Cup rt Ml'Code Chapter 9.12.and the Health and Safety
ewe s«rai, s-, - r . .r: ., , p .•' 'ip ' . . .. Yg g;,
°Y ' °N° _.AII roofs.shall be ins ected nor to an .roofin material.bein installed.—
Willilic applicant or future building occpant use equipment ordevicts which If a roof is installed:Without first obtaining an inspection;'Lagree':tti