02040142 CITY OF CUPERTINO'. -
ttutiotnc nrnsto d PERMIT CONTRACTOR INFORMATION: '
BUILDING ADDRESS* PERMIT NO.
18661 ',BARNHART AVE 02040142
OWNER'S NAME: APPLIC4TION SVB DATE
HENRY YIP. 04/ 25/2002
HOPE: - SANITARY NO. CONTROL NO.
ARCHITER/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICE\SED CONTRACTORS DECLARATION
Ihertbyaffrh
. Job Description
EDws<mELECTRICAL 'OUTLET FOR SH
eism ptga
-
full
0 L u Liccnx'Clas Ga.
3_U Date _ Cmtranvr ... - .. -
ARCHITECT'S DECLARATION - -
n O j I understand my plans shall b used as public maurds
E o O LicensedProfessional -
_(_ OWNER-BUILDER DECLARATION 1 '
•'•` 1 hertby nmrm that I um ncmpt from the Contromr's License Laos,for the
h?¢a following reasons .(Section 7031.5.Bulinus and Professions Code:Any city or county -
I F C which requirea permit to construct.alter.improse,dem2 0 0(]olish:or repair my structure ••
Hsa 'vn req PP a B
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«tot swntt Iso u nth lsa tf uch muuofleaurcdwremem-
Nithetnlcrrbdlau. amtathcp,o, ftheCmtrxtw'sLttseW IChaper9 t_.Y�s .. f �s,srAA„„�� a , . Valuation
(Com
oco cog A Section)000) fD' sionJof th B finbssa dProf so sCMe) . 3 g' V.S7.."V®
or th t h mpl the from and the basic for the alleged<i- alb.Any violmion - "' -.' ..
of5 t )031 5 ny any aPPlicant for a pe
subknx the vppl m'm o civilpsnalry-
' -dr net mosto fivehII.urLadollarsfssw) 304ApN E H ELECTRI AL'" • o Occupancy Type
❑I,vsown«nr the p�anv.or my employees with wages as their sole compensation, Ol —' FINAL ELECTRICAL ENERGY..
w•iioei":+�oikanmtheodr:TreConttmoMLcenseI-Awdoes.,offered for metsplyloaa; 505 — FINAL EI&l: gT,n�an
!', Owner of property Who b CMe:The Contractor's,and w o d docs not apply to an
owner ii progeny Who builds or improve s such,end who does such work himself
r tem�gh his own employees pro_d d dos such p mems t nt dcd /
1Ie df la Ir now then a rimprovement :Sola- to- - r y r .. _ __ -_ . ._. __ .. _.
nal t then e b Ida willhave the bud fp gth th dtl tbuild.,
-improve -
for purpose of sale.).
z ec I. f the progeny am
c mto fc d tractors t - - / �
conswn th al l T
t app 06
11 Business M Psrofafeniod )CThco
Con
License W docs not apply to an owner of progeny who builds or improves thereon,
aM ho'contracts.forsuch:proLsrc a cm ouno fs)b..sAd.pmsuam tothe. .
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C mmenc s License W
❑I < mPtuM Sx f �' '�'Br&PCf this rtasov
a serp� ZJ D2 4J ;:
'I' {l W RKFR S[OM�ENSATION'DE' TION
I hereby affirm AMer pcwhyrrof pe f ry-I of the following declvxuons:-- _
❑ I have and'will'maintain'!!a Cbnifica< f 1 Consent"io self nsum for Worker's
Comps scows-as pro d d f by:Sect o 3)00 of the.Labor CMA, f« the
_- _ perfamunce of Ne work f«which tlds pennit,ix
❑1 ha x M 11 r Oodat Worker om ori a work
or tt required bj Section
3100 of the Loon C for the Performance of Inc work'fc "which this permit is
1e 1 1.:My Workers Compenwiion Iniuronce Omer alnd Policy number ercy -'
t ;. - . ..
Cam r 5Jar r I I ...::T PolicYn '7. _r - ----
s, r 'CERTIPTCATIONOFE EMMONFROMWORKERS
'• ..h:;. r;_COMPENSATION LNSURANOE,' ,
fms sccunn need cot ne completed if pemat is for o«hundred aenart -'t'.. . - ,_. ,r. s.>•;rnei^c�:a v�tc.
15100)«kssJ •
of the work fo hch this ,cotsissudl - " -•,"._._•• .... ..•_•.._..-.
1 .,Ity ninmApinana Compensation
omnot small y any person,n any One'
so ns to become subkct to the Worker% - •- .11,%
:- Comp< a o rands of 'California.ltDatil '
NOTICE TO APPLICANT
' aft kCamper"Of mpm You should
Z es the Workers Co ulOnp' it usbftheWbCoca,youmuni
for camely with such Previsions OrhipA t shall bdeemed revoker.
Z O _ ..-
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y+CONSTRUCTION.LENDING AGENCY.- - i l.. '1 o D
LY, 7 'r;t Ihertby Kirin that th rtrsGEonswaon l-d'ng agency f«the perf nc2 f- t
•i i
W Aof the o k me Nish th s perm t s Issued(Sec 309) C v.C.) 1 ;;
Larders Name" '•` ''•a"" -_
-U 1 - ^ f
V sen fy th i 1 ha a kaQ th app(m and State that the above information is
comical 11 agree t comply Isth all ry aril county ordinances d tai 1 relating (`
C7:L) m bu ldmg construct on.ana heresy euthone<oeprexntames a Nn city to enter upon
the above-mantimed m a
tiW s . 'hial ramify and
purposes..
(..,.¢ NO 42114 costs
aM keephama in the wayaCop'enino against
liabilities.Judgmctns,co is and xpenyes wh d, y any way true g inst said
V City n e nsequcntt of th g ng f this perm t
APPLIGA\7 UNDER57AN A`:OKfLL OMPLY tfITH ALL\O\pp` T 1
SOURCE REGULATION Issued by: Date
mone of AppLryw,U�Hsure
AZARDOUSMATERIA DISCLOSURE r, / Re-roofs
-Wil Ne appllrant«Fula 'building compact store or hmdl hazaNa material]
4 defned by theCupertino Mun c pal Cod Chapter 9.12.ana a,e Health and Safety .Type.of Roof _, :,_,
'. ❑Y .. 4 1 ICI N1 1o. '� f - '
er, t „ ,All roofs shall be mspected,pnor.to any_'roofing Ratans(being installed..........
'
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-a 1 Will the it,cmiantorf t budding occupant use cquipm t«Eo,cAs wnt`n If a roof is installed without first obtaining an inspection;I'agree to,reinove
emit halardous a r cnnummants es defined b1 the Bay q Ai Quality Management
°i" all new materials.for inspection-Applicant understands and will comply with
Nn .
all non-point source regulations
have reed the;haze dons mat rials egmaments mdc Chapter t5.95 of
r�forn a He-lN&Safety Cade Saucns 25505.•25533« Z536-I elereund that
C li
e buildingdoa AN currentlyh eatmo t that t us spmabthty to nodfy th
a ape t f
he I, Ix nls h h mu Fc ct p t Is5 a ce ora A ate of -
r 0e uPancy ..: .: ..
` 1 - f v, Signature.of Applicant Date
. - -- .._.
«< n oho aapagan, . All roof coverings to be Class"B"or better
Is
.- -. .-.._... ..-OFFICE
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