02050005 OF
CI BUILDI c DrnSIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
855 BROOKGROVE LA YU-HSIANG YANG y 02050005
1W >�JR-5{ ANG YANG AP8L7025/ 20r62
ppO� PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
>i LICENSED CONTRACTOR'S DECLARATION .tL Tia C p
R rw� 1
5zfl is Ihereby afErmthat lamlicensed under provisionsofChapter 9(commencing DOOR LACATIIIN
with Section]OW)of Division 3 of the Businessand Professions Code,and my liana j
i,din full Pone and efien.
M6 u 6 Limn.Class Lic.p
3 at Data S DECLARATION `-�
ARCHTfF.CT'S DECLARATION
'�> 1 undersm m my plans shall he used as public records
i O O Licensed Professional -- E-
I
D,
OWNER-BUILDER DECLARATION
0
u�=
1 i ons afOtm that 1 am exempt from the Contractor's License law fo
m y p r the
�C lollow ng res. n,(Sectmn]031 5 B siness and Profesatons Code Any c ty or county
wh h q 'rex a pem'no c ssmn alter,improve a Permit
e m t t file
repay any avuctum $3000
3$ . prim m mucc.*d Fore requite the .......for somehpncema License La (chapter t lu
that mincing with
itpSection 7me pr ismsof Ne the Business and
law(Chapter9 q hyi,� A�. Valuation
(comm he Is
(commencing Section7")and the
or t the Busmns end Professions Code) ] } ,'[ 1h3'Yt� 911^'Y .'LV i\. f .. ! i:.f 'a'
or that he Is 31.5b theie(roli end the have for the alleged exemptionAny it play ly "
of am mor,than iv any applicant fm a pemtit subjecu Ne applicmt Bem a civil penelry
of am more than eve nurtured aonars(sSBo). 101�PN qnDLIIPI'DATI ON Occupancy Type
El 1,as owner of the property,or my employees with wages as their sole compensation. 102 - PIERS
will do'me'wmk;and the structure isnot intended or offered for sale(Sec.7044, 1 O3 - UFER
Business and Professions Cade:The Contractor's License Law does not apply to an Required Inspections
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided than such improvements are tut intended in _ _
offered for sale.If,however,the building or improvement is sold within one year of "- ts,' _'"--' -
-completion the ow.a,-Wilde,will have the burden of proving that he did not Build or 1 -- -ANCHOR R T C ,�
improve for purpose of sale.). 106 - SEWER & WATER
[3 1.asowrierofdbepropeny;emexclusiklyannotation gwith licensed convacton Ia 202' =-UNDERFLOOR' PLUMBING -
- .. _ construct the protect(See.7o44,Business and Professions code:)The contractor. 203 — UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who builds or improves thereon,
.contracts form ro'een with a
. .
and who ch.P l mnwemr(s)Omnsed.porsam.ro.the ... _ .-204 — UNDERFLOORS-FRAME
Cornerstones License law.
-' Rklam amexe tunaer e. B&Pcfar fniaresaon 205 — UNDERFLOORINSULATION
at
�affimder
at` TION DE RATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
0� perjury one of the following declarations: . 303 - ROUGH MECHANICAL
0 1 have and will calf main'a Cenificam of Coon,to self-insure for Workers 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the labor Code, for Ne
rfo
_ -
Compensation,
of Ne work for which mix permit is issued. 305 - FRAME
❑1 have and will maintain Worker's Compensation Insurance,us required by Section 306 - HOLDOWNS _
3700 of the'Labor Code,for Ne Performance of the work for which this Permit is
island.ss307 - INSULATION
iued My W rkera Coope ton Immarso c cater enPolicy number arc:
. : comer ...-... .. HE TR K..-
PM cy No.: '1' t, r"s h' t 3OJf 1 EXTErF1tIORrLATH•
it;
CERTIFICAEXEMPTION WORKERS
COMPENSATION INSURANCEy : 1 '
_
(This section aced not be completed if the permit is for one hundred dollars 311" - SCRATCH COAT
(5100)or less.)
,hall
sw at the peA mmnce bi dr orkfar which thispleadis iuued.l -.. -313 " -. ..ROOF NAIL .:.-. .- ..
y parsbn in any ko me FFublmt the worker 501 - FINAL ELECTRICAL"IENERGY'
e(C doom.D? (27 7�n9Z•.
Apphoopgnnyy Ji �i— �. - 5.02 _= FINAL PLUMBING ,ENERGY -
NITfICPPOAT: .afteran at this Cambium of Exemption,you should _
becddm sublet,to the Worker.Compensation provisions of the labor Code,you must
503 FINAL MECHANICAL-ENERGY
O fo;mbwimeomplywnnsuchprovisionsormixpemthmeRxammed.veked. 504 - FINAL BUILDING ENERGY
., _ .. - t. _...
hereby
CONSen is a construction
LENDING AGENCY' "' 505 - FINAL ELECTRICAL
1 hereby wRrm that tticre is s conswction lending agency for the performance 5 0 6 - GAS TEST "
�i or the work for which Nix permit is issued(Sec.J097,Civ.CJ -
Lender'sAame'-__.:..- , ... . 507 FINAL' PLUMBING '"_.
Lender's Address
U.O "' ` " ' ' 508 - FINAL MECHANICAL
1 la nify that I lave toad this end state that the above it
iv
o tEy 'correct.l agree to roan,a with ell city and county mdatives s and sum laws relating 509 - FINAL GRADE / Q
O:v the Wilding construction, spNoriri.ptesenutives of Ns city mcnmr upon 510 - FINAL PLANNING
a. the eba(We)agree
1.1..,ny,for inspection purpose.
��•.tt GA (We)lionmroscosts demnlfy and which
mayintheCity Bottpertin'ost aid 514 - FINAL PUBLIC WORKS
G•r y City in co judgments,costs and experts which may in any way aurae against said
V:.Za City in consequence of the granting D this permit
SOURCE
U�'DERSTytDS AND WILL COMPLY WITH ALL NON POINT Issued by: r Date
SOURCE RfAOA V94 Tlpl .
ApP. HAZARDOUS
ct CL{ ....'��pp Re-roofs '
HAZARDOUS MATERIALS DISCLOS RE m
" Will the a Cupatn m none,Muni wilding occupant store m handle os rrea eat Type of Roof _ ... . .
mdefined
Yes the 32m), Municipal Code Chirpier 9.12, ad the Health and Safety - '• -
Code:Section 259321e) " v N "';a s I ;., - a r� r 1 ( ' Vie 1 k r y 1• ; ^, •.t - .' s'• sf,
;
r Al] roofs shall be inspected prior to any roofing material being installed.
Will me applicaut or f to w ngmeape-tuseegapmentordeviceswhich If a roof is installed without first obtaining an inspection, I agree to remove
.;t h d rr cont m
into
a efined by the Bay Area A Quality Management
Darn all new materials for inspection. Applicant understands and will comply with
F °9 °N°. .` all non-poo[source regulations. '
l4 1 have mad Ne heaallouvremenals requirement under Chapter 6.95 of the
California Health&Safety Code;$cations 25505,25533 and 25534.1 undersmnd thm
if the wilding does not currently have a mount.that it is my responsibility to madly the
mempam of the requirements which mum be mm prim m issuance of a Cimific m of "Each
un`' _ J Signature of Applicant Date
autnonaed aunt „-' Dam All roof coverings to be Class "B"or better
. ,r •,:( .._ _ _ .. OFFICE
eN 6' -
-2/'q �oZ
CUPERTINO
CITY ILDING DIVISION PER* CONTRACTOR INFO ON:
BUILDING ADDRESS: PERMIT NO.
855 BROOKGROVE LA YU-HSIANG YANG 02050005
W1�—'si iMG YANG �OLS��02g/'20x02
op� PHONE: SANITARY NO, CONTROL NO.
k O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
i L i = = L -)
LICENSED CONTRACTOR'S CONTRACTOR'S DECLARATION
Z vS 1 herebyaffirm that l em licensed under provisions of Chapter 9(commencingJob Description
Cyt. with Section 700)of Division 3oftheBusinessmdProfessionsCode,and mylicensDOOR RELACATION p
is in full force end effect.
o < Licm.c Class Llc.0 In
i a c Dare Convector
ARCHITECT'S DECLARATION
i�y I undeuimd my plena shall be used as public records
Y
l o Li<enud Profession]
OWNER-BUILDERDECLARATION
w 1 hereby affirm that I am exempt from the Contractor's License Law for the $3000 Z< following reran.(Section 7031.5,Business end Professions Code:Any city s county EX IR =hD'
$3 0 0 0
O which requires a,a],.re tonstrun,after,,plic improve,demolish,fi repair any sumtom -"
- pdmmiubumce,aosarrquires pmOWOO,o for C.mcemdnoice.Lawdstammem
(Mt he is licensed pwiveos m Np provisions of Ne Contractors Liccnte law(Chapter 9
(Commencing with Secrefromand the basis 3 of theBusinessesandiol.RoamsAny
Code) s •s_3'Y,� 9.1%,'Y�..1H� , Valuation
or that he Is exempt therefrom roti w buffs for the cue Demerit .Any violation '
of not.7031.5 iv any applicant rs a penNt subjau Nx epplicmt to a civil petWry
of not mart tbm me hundred atnera,sacci. 10 Y�pN NVITIINIMAT I ON Occupancy Type
0I,as owner of the property,m my employees with wages as their sole compensation, 102 PIERS
will do the work.and the structure is not intended or offend for sale(Sec.7044, 103 - LIFER
Business and Pmfesaiom Code:The Cantracmr a License law does not apply tom Required Inspections
owner of property Who builds or improves thereon,and who does such work himself 10 4 — REBAR
or through his own employees.provided that such improvements an not intended m
offend for sale.IC however,the Wilding or improvement is sold witbir tine year of 105 — ANCHOR BOLTS -
complcdon,the owner-imider will hew Ne Wrden of proving Net be,did not build m
improve rest PuryewOfsala.). 106 - SEWER & WATER
Dl,as owner of the property,am exclusively contracting with licensed convectors to 202 - UNDERFLOOR PLUMBING -'
construct the project(Sec.70 ,Business and Professions Coded The Contractors 2 0 3 - UNDERFLOOR MECHANICAL
License Law does not apply to en owner of property who build.or ime provthereon,
and who contracts for mch projects with.connectors)be u d ptorm.m N= .204 — UNDERFLOOR FRAME _
Contractors License law.
P5l un exemptender ,B&PCfo%is reawn 205 - UNDERFLOOR INSULATION
er tram Oz P-7- 301 - ROUGH PLUMBING
R• COMP1i�AT10NDE RATION 302 — TUB & OR SHOWER
,hereby aPorm unserpemhy1f perjury ane onhc following declerstimec 303 — ROUGH MECHANICAL
++ ❑ 1 have and will maintain a Certifinu of Conant to se Labor for worker's 304 - ROUGH ELECTRICAL
.V` Compensation, h. provide, for by Section 3]00 1. the Labor Code, for the
perlonvnce of Ne work for which this permit is issued. 305 - FRAME
❑1 Mire and will mountain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
3700 of the Labor Code.for the performance of the work for which this permit is 3�7 - INSULATION
iuued.My Workers Compensation Insurance cerric,and Policy number are:
308 .- SHEETROCK
'Policy N.
.
CERTIFICATION oFMEMPIONFROM WOR—�— 309 ''EkTERIOR , LATH
COMPENSATION INSURANCE
-- ---- -310 — -INTERIOR-LATH _. .
Tilde union raced not be completed if Ne permit is for one hundred dollars 311 SCRATCH COAT '
(51001 m less.)
I c=itify Net in Ne performance of the work for which this permit is issued,I
313' - ROOF NAIL •
khsll not employ any person in any er ao come b'ec,to the workers' 501 — FINAL ELECTRICAL'�ENERGY
Compena.u..laws fC ifarnot 71_'L
Applis�op �'f z� ��� 502 - FINAL PLUMBING ENERGY
NOT( AR �^.R,aftermetol,thisCertifieseofExemption,youshould 503 — FINAL MECHANICAL ENERGY
O Cbecome mbjecuo the Workers Compensation provisions of the IaWr Code,ym must
forthwith c. Ply with veers provisions or rows penrOn shill x seemed revoked. 504 — FINAL BUILDING ENERGY.
T�
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL l+
� y I hereby off.Nat cede is a construction lending agency for the performence
'. of the work for which this permit is iuued(Sec.309].Civ.C.) 506 - GAS TEST
� q Lender'sW& dme` 507 - FINAL' PLUMBING "
"�z Lenders Address •
VO 508 — FINAL MECHANICAL
I comfy Nm 1 lute reed this city
and
ma nam ane the above laws Nan is /a
ITi' V coned I.pee m comply with all city �ri county Ordinances end cute lows misting 509 - FINAL GRADE / g/
O. toabowgmnsonedpraradhertbyeuthoowrepreunutivesofOscitymmtesupon 510 - FINAL PLANNING
�y W the ebo(we)agme to property for inspection puryoue.
{„s In eWe)egmetoseve,indemwpensesfy and whep ichless;
myhe ay acme agmust said 514 - FINAL PUB IC WORKS
F.i p] liabilities,judgmenu,coati and expenses which may in my way acme ega'vut said
V City in consequence of the granting of Nis pemtie
APPLICANT ERST ]DS AND WILL COMPLY WITH ALL NON- INT
SOURCE a�° /P0 Issued by: Date
TIAAPPhcAnWp nes rAq/rE to Re-roofs
k/ HAZARDOUS MATERIALS DISCLOSORE
WiB Nc epplirant or(Unna Wilding ouvpmt pore m Wardle menial Type of Roof
as defines by the Cupertino Municipal Code,Chapter 9.12,and the Heald and Safety
Code;Section 25532(aj] s '
oY=e lG?la All.roofs shall be-inspected prior,to any,roofing material being installed.
em
Will the applicor f(umrc W' ng 4cuparayse equipment or deviceswhich If a roof is installed without fust obtaining an inspection,I agree to remove
emit hsaardous encmmtdnmu efined by Ne Bey Are Au Quality Menagemenl
Ubtrin] all new materials for inspection. Applicant understands and will comply with
°Yes ON. all non-point source regulations.
9 1 haw read the Inactions.-me.requir msmus under Chapter 6.95 of Ne
California Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that
if Ne Wilding does not covemly have atenant,that it is my responsibility to notify the -
mcuparit of the requvemenu which must be met prior to issuance of a Certificate of
Occupancy.
Signature of Applicant Date
summons Date- All roof coverings to be Class"B"or better
...... ._ OFFICE