01050194 CITY BU or curr
uml.mCONTRACTOR INFORMATION:
rvc DIVISION su)" PERMIT
IID I LDING ADDRESS: PERMIT NO,
JUST 6MTER
X1-94
OWNER'SNAME10141 BILICH 1,1 ATION SI Ii DA'Ili
�pON1'' CHOU KUO W AND CH. AVESANITARYNO o.
O c z ARCHITECDENGINEER: BUILDING PERMIT INFO
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BLDG IiLECI' 1'LUM1IB blliCH
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LICENSED
ante RACTOR'S DE'non,
Job Description
O 2 O hereby aflimt that I ntn of Ill,
under cad iron,of Chapter H(atutme..too
EyC� i inSectinn701q]nflJivi,innlnl the lin,ineax tmA l'rvfm,iun,Cuda and myllmnna
It Iidl Inrtc unit elite,.
f {°l�en.a Ela„ Al,« REPLACE 50 GALLON GAS NATER HEATER
.
��a
3 d. Irtm CDECLAr
AIo,hall Ibe'.S DECLARATION
nndersntnd 0)Y Plv r shall be coed as PuM1lie mcurJs
wew p O Licen...i ProteNimml
e a G\\:NER-BUILDER DECLARATION
^,n I hereby alErm the I an,caea,p,from the Commit v Liecnnc Lnw'to,the
.�.3< sono ling reason.(Section 7031.5.Moines,uad Prafesinn.Cute:Any e,,y or ennmy
OM xl q pert t t , h alt p e I ,uI 1 ny vo Imre
cap t t sal oppl tf hl rn tl llell amcownt
tlix lic isyer,odpar - i ludill, tat l the c tem I' law(Cban",) Sq. Ft. Floor Area Valuation
(,oOngwithSeed
al ..7000)olDlvwloalEO 3ofIn..lnand e,
er. V... oon,COJ,)
nr thin ho 1,aaempt Inerehnm and the has,for trio tdlegwl u.utuptloa.Any vVlaioa
ill Seminc 7031.5 by any uppllcun fora nnil o bjccl,the a,,licant la civil penalty
of tett tm,aa than rise htmarad dollar,(s500). APN Number OCCLI panty Type
❑I,m nwaer of the pn,pany,or my en,pl,r ec o ah wages as their sole compensation.
will do the work,and the,tructum is not intended or catered for.sale(Sec.I(M-k
nn,ine„and Profit,ioa,Cod,Ill,Com,alo Id,an.e 1.aw doc,not apply m an Required Inspections
urr of Property Who build,or intpooe,thereon.and who docs num,work himself
Om,ugh his own employeesprodded that,acn imp...cmenn arc not Inmnded or
o fic of In,hale.If. It,heading or improsetnent is old n;l is one year of 31621071. 00
itnplelion.,he owner.hadder, will haw Oto hi nlen of pnw'Ing ma he did not hand or
0,,Los am aor of dale.).
oLndowneronheProperly,nate.els,ismy11ali'hngwill,liaan,,.Icollaactolslo 502 — FINAL PLUMBING ENERGY
L,romtct the projrot(See.vans maria—and Pnne.aion.Cale:)The commeror,
icense Low doe,not apply m on owner 01 pmpeny who hnild,or imprnvec doused, 506 — GAS TEST
tad who calumet,for roan prnjaep with a eortmnodrl licensed pm,aaa,m the 507 — FINAL PLUMBING
Cn1 an r h urease Law'.
❑1 an emmpt unites Soc. .E&I'C for his reseed
Ox Her Dam
WORKER'S COMPENSATION DECLARAI ON
Iliceb5aflir ImofPIjc,,ore Ilhcf ll n,d1clanodiOn,. FUMALED
1 10,,and oil t C ......in of ClOolaft 1.1 11IF-11111111t N ke,',
Compensation, tie I I' by $ ( 3700 of tl L Ie, I , ntn
penonnance or the work for w hint this pernil 1.issue`f JUN 2 7 2001
❑I have and x'ill maiondn Workers Conmen,ntion Insurance,it,remmiccl by Section
3700 of,he Labor Calc,for the perforniance of the work for which,his Permit is
isoird.My Workers Canisnsation Imtmtnnecomerand Policy numberare: �' ®���
Carrier: POliey No.:
CER'r119CATION Oh EXEMPTION FROM WORKERS'
COMPIiNSATION INSURANCE
(This talion used ail be. m..O'd it on par oil Is Ina nuc It ho tl dNhe,
18100)or les)
I marry that in die Iwdunmmtt Of the wad,fnr which mi,panni,is issued,1
shall rill employ any Flanon al any mamter,o as ro become rabbet to the Workers
.ComiNnsatinn Laws of California,Dole
Applicant
NOTICE TO APPLICANT:IL alter making this Clar dicac of Iixc""non,y,,a should
hcnnnc.wbjea to the W,akcrs,Compos lion pm,i,iom of the Ln1a,r Cotte,Sou taro,
O fnnhwilh comply all udr pro,kiod—,this Permit Rhill be deemed tevukeJ.
r
CONS'1'RHCIION L coon cG AGENCY
hereby ulBmh Ohm Ohetu I,.a closwSo,, land'ntg' C.) Iia'the perliantunm
W of the work for which this pc...dt Ir iaaial(Sec 31P)7,cis.CJ
6( A L.Olor'I Naas
z57 Lemmrd ndere,„
V 1 conify that 1 have sad this application mrd x,am,hal the above information is
E., correct.1 agree to comply with all city and county ordinance%unit state laws relating
C) C.7 ,building cnnaruction.and herehv rahmiie repremnnaive,of this city,,enter upon
it,mi,c-mronati l Pollan, or Inspection pared,,,,.
F, S (We,)agree to save.union...ity and keep Inmates,the City of Cupertino against
Z) hahilric.,jadgmenk,mstc and oa Fanuc'which may in ani wap'accrue agniva.said
U Z City In oa,,a,n c of mi,gntnt ins of Otis permit.
APPLICANT UNDERS'IANUS AND WILT.COMPLY WII'If At.[.NON-POINT Issued Date
SOURCE REGULATsslle
IONS,
Si6naomol ApplicantlContmua1' [)are Re-roofs
HAZAEDOUS MATERIALS DISCLOSURE
Will the rEdwindormauuhoddhag„napoo toryornaomnhavooda,,ttataaal Type of Roof
o dclined by the Cnpemmn Municipal Cole,Chapter 9.12,maybe Health and Safely
Cale.Sermon 25532(0):'
°'C9 ONa All roofs shall be inspected prior to any roofing material being installed.
Wit l,heapphca.tor Latin,bwldiag,Keapanttoca,Iodon,nto,desice.wmeh ]fit roof is installed without first obtaining an inspection, 1 agree to remove
mit hanodnas air man maria;is detined by the Buy Arca Ait(Bal try Maag
nement
)'Imm1a all new materials for inspection. Applicant understands and will comply Willi
°ly, °Nn all non-point source 1Cg1Ilati0ns.
1 rill read the tannin.....slot tats aaPntetnatls ttmlaa Chapter 6.95 nt ntn
C,d'tfomia Henlm&Safety Cud,,S,,Ii 25505,25533std25534.I add edaad arta
it the bottom,doe,Inn Ideally latvc a tenant,that it is n,y responsibility to notify the
occupant at be re,ducmb enwhich tnmt be met prior m isvmnce of a Certificate at
occupant
Signature of Applicant Date
Do per,"onmornadagcnt Dole All roof Coverings to be Class `B" or belter
OFFICE