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02020046as y Q Jy- YY� _CK „3 oc iO Mi �e HZ wt 3 1 CI uul o nc OF DIVIISSIIONNOPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 4 OWNER'S NAME: APPLICATION SUB DATE CHANG JENNIFER Y 02/13/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITF.CT/ENGINEER: BUILDING PERMIT INFO - BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I ]Ob Description P I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Senior ?000)ofDhmic.3oftheBusmersandProfession, Code.and mylicense to full force cola err«t. -ENCLOSED PATIO [is License Class Lic. p Date Commoro, �''`' It—'�p/� tr 9 9 �C _v ARCHITECT'S DECLARATION o'4 kin. 1>_ 1 underoand my plans shall be used as public records SEP 17 2002 5 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm, that 1 am exempt form the Contractor's License Law for the following reason (Semon 7031.5, Business and Professions Code: Any city or county whM1eq er[t teptllihor repo any structure a BUILDING $15000 III I.iiii,indstausni �,•1. Sq . Ft.,Floor-Area• vAI if Y�(�,`v j r. 'iZtkAt�� a`Cs: Valuation Nal he elcertvA inuistuarl allpro ', n lthe Commumer Licento La (Chapter 9 (co c g th Sort ],000) fDlvulon3 (th B e dPofe n Cnde) or that he Is exempt therefrom and the buss for the alki,11 ezemppoo Any ,volar on 3 619 1 2 5 : 0�0 t of Section 7031.5 by any applicant fora permit mhjeeu the opplicont m a avis penalty 'oInoomore manfile hundred dollars (s50o). APN Number I.r::. Occupancy Type property, 01. as owner of ,.ores Mees with woes as their sole [oro UI nn ywct Y 101 - FOUNDATION ; " 'wilt Orde k Ne :P o� intended or oRerte forsale 'IS c' ]Ula -Buse - - - - - - - - - ------ - __ d Profies,ions Code. The Contractor s License Law does not apply to an Who Required Inspections n - 103 - UFER owner of property bunds or Improves thereon and who does such work himself or m sn n- employees. p v i - t n p t t , yjar or ., nc r hiscideif, h sh b ul ng p e sold within )ear of -p1( ..__-10 4- - REBAR------- - -- ------ -- ------ -- -- cr m bolder ill have 'he burden riffraff.,mtn tee mild 105 - ANCHOR BOLTS •` - a" int o r v ris fm1e) /p _ _.... 106_.- SEWER...&..WATER_ pp 1 as f Ili propenK air exclusively contracting with licensed commercials to k t t theProject (Se[ roil Business and Professions Cm) The c t t . __ _. -"�_ 4 - --- 202 UNDERFLOOR PLUMBING - License Law docs not apply to an owner of pmpeny who Wild, or i ..proves memoq and who contracts for.such projects with a.co poicar(s) licensed pursuant to.Oe- 203 - UNDERFLOOR MECHANI CAL Can tm toe u[enxL ' ❑1 _ pt ury r B'&PCf tars reason 204 - UNDERFLOOR„ FRAME... _.... _..._ �221%�'� owne:' Date a�'=u_`� 205 - UNDERFLOOR INSUliATION ORNSATIOrt DECLA ATIO 301 ROUGH PLUMBING I thereb/yafical prr.".i of perjdrynaennhe fronowing deductions; 302 -.TUB & OR SHOWER O 1 have and will maintain a cenificam or Conant m self-insnro for Wake, v 3 03 - ROUGH MECHANICAL compensation, as provided for by section 3700 of the Labor code. for the 304 - ROUGH ELECTRICAL perromunee of the work for which this permit is issued. 111 naJa and lothmamain Worker's CompsmationInsurance. as required by Section 3 05 - FRAME 3700 of lhe'Glwr Code, fim 'he performance of thewalk far which this permit is 3 0 6' - HOEDOWNS Issued My Workers C.in,amouimn Insurance carrier and Policy number are _._ _._ 307 . INSULATION.. a",at C- v ''i 1 -t. f ) `, t Pol' y No.. : , - „r -r CERTTFICATION OF EXEMPTION FROM WORKERS _ ..... ......... ._- t!) }x.308 '; ; jSHEETRO,CKTIha t -LI ... .1; " �cOMPCNSAnONINSURANCE'" - "- 3,09_EXTERI.OR.,"LATH' - -- -,�-310 ._ t '. meed nm be completed if permit is r one hundred donors 'INTERIOR LATH _ 311 SCRATCH COAT many er pen nna work for which m permit s issued I t employ 6ha11 not emyloy onY person ;n any manner,w as to become subject to the Workers 313 - ROOF NAIL- •7r t..i'(, : •• n ( r t prcrr .D¢ Applicant 501 501 - FINAL ELECTRICAL ENERGY rNOTICE TO APPLICANT If, rt k. gmac rtr[m of _Ept onymadimlld -502 - FINALPLUMBING'-ENERGY become subject o the Workers Compensation pmvo.u.fm Lahr Cade you must forthwith comply with such provisions or this perms shat] be deemed revoked. " 503 - FINAL MECHANICAL ENERGY '••� v --''CONSTRUC[ION LEN DING AGENCY.' - "InrebY'frno - 504" =—FI"NAL BUILDING ENERGY• -'I.-: - that th isoconstructionl ding agencyr Onimpoimana of the work for which this pered,s Issued (Sec. 309], Civ. C(, 505 - FINAL ELECTRICAL) t c• - ..lindeeshhme �,s_„r:...;.:.., .a......_,,,•_. .._ ...,.•. ... .IL...__._ 506--- GAS "TEST -- ---- - n ci s Address .' 507 - FINAL PLUMB•INGI-''.t 1cenify thaj 1 have reed oris application ane state mat the above inrormation is cotieci. 1 agree m comply with all city and county ordinances and nate laws relating 5 0 8 - FINAL MECHANICAL m Wilding Construction, and hereby aumonm representatives ofthi, city to enter upon the 509 - FINAL GRADE above-mentioned property for inspection purposes. (We) agree to save: indemnify an keep hmmless'the City 5f Cupertino against 510 - FINAL PLANNING liabilities. judgmcnu, emu and expenses which may in any way ap[rue against said City quenceo g ntin8 bf thi pe t APPPI IS ST;,B,' 514 NVAZ WORKS k LY., LNO -POINT'` souRe E� ..///��5((( 1 Issued by: Date sIg a' our jr�rAPPI' C t cmr: �� le Re -roofs / HAYARDOU ATERIALS DISCLOSURE' Will the applicant flumebuilding occupant store or handlehauNous mammal ,_ Type,of Roof-,,,.. as d l d by the Cupen Municipal Cod Chapter9 13 arM th Health d Safety - Cod St 25532(x) - ❑r !iik a "�” l ,.; - t •roofs - W 11 Nc cam f t h Id g t a' n All shall be tlispectedfpnor ti any roofing.matenal being installed, _ p qu pment s'wn' .i r,o it ie card ave roam t u d f ed by the B yAre A Q al ty Manage Management If a roof is installed' without first obtaining an inspection, Pagree;to remove O9nC - - all new materials for inspection Applicant understands and will com 1 with P_, Y. - , t;,;" all non -point source re ulations'- " ---' g tI" 1 Woo read the h urs s atonal r lremDas under Chapter 695'of - 'v • q Ihe Celifomra Health & Safety Code Sections 25505:15533 and 25534. 1 understand that if the bm Ing does not cunendy have a tenant, mat it is my responsibility to notify the - -- - - - - me • ad, of me ie which mon bomn.pnw to i. uance f a Certificate of - ._ ,i. .. t i, .: .. .. Occup ., "'" of - .. Signature of Applicant g. -. .. -.._ Date All roof coverings to be Class "B" or -better' owne ream .c m-. ..e:,., ...., . _ ...... ..-.. .. OFFICE. _._.. .. .. _ . `i'