02030035 Y OF
F
DIIVIISSIIONNO CONTRACTOR INFORMATION:
PERMITS: PERMIT NO.
ARN AVE . HENRY YIP 02030035
APPLICATION SUB DATE
•HENRY YIP 03/11/2002
(I HONE: SANITARY NO. CONTROL NO.
WO 0 is ARCHIIECTIENGINEER: BUILDING PERMIT INFO
isu(y- BLDG ELECT PLUMB MECH
g u �J L:J U
so
Z n 0 LICI harts,afB mEthat I amli CONTRACTOR under p DECLARATIONChapter 9(commencing Job Description
;zoo provisions of e ADD SHED. ®
,_(_w wish sen ion]t100)of Division Jof the Business and Professions Cala and mylicense ��
ixin^ullf <Bcn, rlap�bt�e®
ee 6 Lice Lic.p rLr��
O d,O Date
Contractor
}3"so ARCHITECTS DECLARATION
a O a I understand on I hall he used as blip records S`C n .v
' ypan,a pa Cr 9 5 2002
i E o O
r_
Licensed Prdfic,innal
u�ca OWNER-BUILDER DECLARATION
='an 1 hereby affirm that I am exempt from the Cantracmr's License Law for the
(_ following reason.(Section]0315.Business and Professions Code:Any city or county
E F O which acquires 1 m construct.alter,improve. UILDI1tlG $
c pe prove,hPemitt or 2500
as. trial t polio 9 the o for such Permit Licenso File a e
Laand w(Cha statement V. _
that lie f itpuhul n IMprovisions of o theBusinesLcenseLaw(Chapter9 S r Valuation
or that a Is
'shS ci -t an !he ion3ofIea Business,add Professions Code) {„�.I.4 i !;3 / ft.�, �,: e[,•. t,l
or that io Is exempt thcrcfrom and the bars for the alleged cxemant to Any violation
of Section 7031.5 by any applicant for v Permit subjects the applicant m e civil Penehy ,
,ornot more than Rve nonartaaoBnm tssool. lOi PN -b'OU�DATION it Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation.
-will do'the work;and the-smcture-ix not intended or nReed for'sxle(Sec.]UW:' - - 102 IRRR -
"Business'anA P66ressrons CodeaTc Corrosion's License Law does not apply to an 103 - UFER Required Inspections^'
owner of prop .[erty Who builds or improves thereon,and who dtwsuch work himself
or mill his npl y.is,dividedthator
suchp ist: tintended or _ _. . .,.- _.104.._-=._REBAR. ....__-.__ ._ _ ._.._......_.__._. ._-.._. .._...._._ -_.__..
-.bore ple Tor Bald If,huwe4en the building nprovcmcni n sold within-atop nor of
completion.the owner-boilJer will have the burden of proving that he did not buil)or 105 - ANCHOR BOLTS
mproveforpurpo,eof,ale.). 106 - SEWER & WATER
1 rote pmpcnr44,Busini-vidyssa t g lCode)TheComcwn1O 202 UNDERFLOOR PLUMBING I: "t'
onabun the pmlccl(sec ]Oda Burnes ata Professions Codec me Contractor s I i :_•” .,',.'
License Law d«s not apply to an owner ofproperty who builds or improves thereon, 203 - UNDERFLOOR MECHANICAL:
_and,who.contncls foc.suchwith romma
P lee¢ or(sl.l'ttrsud ptionceara la the -.___ .
eo1. a an 204 -. UNDERFLOOR; FRAME — — — —
❑Iamexe ptaarspt ' .BA,PCr misde...o 205 — UNDERFLOOR' INSUDATION
owed Dote 3/!l�O
` ERS COMPENSATION DECLARATION 301 — ROUGH PLUMBING
� ': Ihandr afford d II r' 302 — TUB & OR SHOWER
sss r II r Pc!Jryn onner°n ga laationx 303 — ROUGH MECHANICAL
❑ 1 have and will"maintain a Ccnifc5m of Consent in self-insure for Worker's —
compen,at... ...provided for by Section 37W of be Labor Cade, for Ire 304 ROUGH ELECTRICAL
Performance of the work for.which this pcmit is ismeal 305 — FRAME
❑1have vad boltnainminramrod'r,Comairsagonmsumaec.as dgcited by.Secdm 306 - HOLDOWNS
37M of th 'Labor Cost for the pidilarmance of the work for which this pcmit is
,am MyWorkers Conp,arsationi <m�'a�P Tey namberare 307 - INSULATION _
,t,k a ...
ca:: r , CERTIFICATI POFFis PmterN ` 308.` SH$E:TROCK. -.
E%EMPTION FROM WORKERS } L l a
,AnoN INSURANCE_- t' 309' EXTERIOR LATH'
,•rt'.n nb ac ' nkd not x compinm tune permit i,for one hundred dollar, 310,i"=, `INTERIOR LATH '1 .... 3':-nr ,
al00Jor1"'l.h:, 311 — SCRATCH COAT
-' i Ic rl fYth itn the perfom- 'c of the kf hch lh pptn,l, - """ -313 'ROOF"NAIL. .i - - --
+• ued 1 - .. z ..
,hall ( .too Ya....an,. t e hl tI IncWA s "ltkds ss �+
Gomye tont elf ata D' nl 501 — FINAL ELECTRICAL ENERGY
App a t __ rte --502 --' FINAL—PLUMB'ING' ENERGY--
become
'NOTIC pgPjrJ.�C f aftermaking thisCertificate ofExemption,y u'sn Id' - '—
zy :bl rtothe, ok Compenant prooflnelzM Code you 503 — FINAL MECHANICAL ENERGY
Q forth th c ply ilh s h pro o or Ih ppm t shall be dee N rt okcd
CONSTRUCI'IONLENDINGAGENCY 504- --FINAL-BUILDING ENERGY- ---
or li th pee i ued f l a g g cY fo th pert a
505 - FINAL ELECTRICALOf ,
Address which thispc 1 -issued IS c 3097 C' C)
0 o LandeesName - - 506 -, TEST_. .. . — --
t a
o'z 507 — FINAL PLUMBING —
C? O 1 rtfYm to read this ,N!cra as t Inl�n b - r to�is 508 - FINAL MECHANICAL
k"ra"F coiretl g I,cirma 'th b city d Iy nt e. d state1a luting 509 — FINAL GRADE
lobuldmgconsto clonatidhh all
rtny,ortatvesofthistate locnmrupon
he abo t ed,Property fn inspection paryoa 510 — FINAL PLANNING
t'�.-L I We)ag io sae I de fy rM keep haml s the C ry of Cupertino ageinsl
-Z liabilities l dgme ts,cost. d expo which may n any way cane,g�nso said 514 — F I NA P C WORKS
2
U Z Cii. ty memo e9 eae of the gout ng fthisa t "-' v' U
APPCIgANT'UNDERSTANDS AND WILL COMPLY N'ITH ALL ON-POINT' �'
S URL E ULATIONS.:+ �I Issued by: Dat
ignaN �ticontmnnr ;� ' Date :'„I :. Re-roofs '
,HAZARDOUS MATERIALS DISCLOSURE -
W 11 thp'pvh<m f tare b Itl ns oc path stoic N die hazard°s m nal -_-Type of Roof. _
as defined by Ih Cupertino Municipal Cod Chapter 9.12. d the Health and Safety
Code Section 2553 (a)'
❑Ved s . s ONofrs iii ! 'sf
All.ro6fs shall be inspected prior to any
-roofing,materlal being Installed.
Will th int t f t building r comport e egmp I d s Management If a roof is installed without first obtainingan�:ins ection; Lagree to remove
iln Wad tiro t atlf db}thByA- A Q IryM 'gdmem
I0Y ON '” all new materials for inspection Applicant understands and will comply with
�t all no told source iegulanons - " _
" I hav<srtad sM h b 5 e¢nals gmremenu and Chapt '6.95 or the �' •t II''" '
C bfo a ve,m &heSafetyho Code,Seal ons 25505,25533 dna der C I undemand Thal
;thee -H doe Ic a h <atnatthtl y p bl rad Ifylhe -
6 Y
Occudied Ih qu' 9nt h h mu t h mel p t .ba ce of C n f am'of -
P d
fit / Sign re of Applicant _ Date _
"°^=ca gent jf I D'-�- All roof coverings ro be Class "B"or better
t. it
-- �:- OFFICE'