01010034 CITY OF-CUPERTINO -
BUILDING DIVISION ! PERMIT '- ' CONTRACTOR INFORMATION t
.BUILDING ADDRESS ' PERMITNO.
11137 CLARKSTON 01010034 '
OWNER'S NAME APPLICATION SUB'DA'I'P. '
TOMMY ,&•' CHIN SHWE 01/08/2001
Y110N'li. SANITARY NO. CONTROL NO.- -
Mm Q ZO ARCHITECT/ENGINEER, - BU14DING PER IT INFO
U - ' " • BLDG. ELECT' '• PLUMB MECH
so
C ' 1=1.
LICENSED CONTRAC IOR S DECLARATION
o c Inrebr n athm licensed I p fCh,pter9¢none ,g Job Description
w w,th5 I 7W01 rD ln9nfthe Bn dPrfsam1n Cada'mi I ,
a `� ,i hE1 < n re REPLACE WATER HEATER
a/a License Ids' " �_ Lia.
k f ,
kr' .
ARCHITECT'S DECLARATION _ r -
I unden and my pl ,hull be used a,Eaddid victims
w y O O Licensed Professional
OWNER I hereby affirm that I amexempt ER DECLARATION
6 following mason.(Section 711315 Businessand P f.. ,Code Aycityand r re
which to o y P t t , It , d I',h p y structure ✓
p, ir I,_ pro , I I. y h fpr tl hIt hl 6 d Renin• - - -
is.3 mat n it p , m p nn c to t License Law(cM1 peer 9
' - ' p ally
'Sq.,F'tT.Fl-oorJ,Area alba1tion
o a with Section t . l if do BusinessndI dl
orh PI th fomad heh 1 ,M1almost pt Anyviolation
o1Secf lSy tfopermit subjects the appy ammaev1
Orn t more than five hundred dollars($soo) `APNNumber OccupancyT
ype
❑Ia,await,
-
'
nr the id the,y.rrdu en,ployecswith wagesasodfor cai(Sed.7 4T
35651'022. 00
Bus d m k tr me,tmemrc it ,at intended i r nrrLaw does
,no (Sed.7oa4, - 'Required Inspections'.
Bus I e f: . Code:The Contractor's I L d , mat -
igh piny e l ee i ,n e I I :e� tended 502;.—. FINAL' PLUMBING ENERGY '
owner a gh hat own employees.Pr ui dolt o prof nprovw t nal raw year nr - _
alfemdfor
T.If,nn men building improvement pont Id linin raw year or 5Q;6' — GAS TEST -
, improve
la "one- h 'Id :II have the burden of pmving That h did not hu'IJ or �.� '-
mprnerrprnprue'aremGl. 507 —`FINAL' PLUMBING ,
❑1, a.,do,o f(tie p P rty In meditatively Contracting vith licensed contractors to -
enmoRt the pmjai(Sec 7044 Bus nes and Profession Code)The Commcmr's
License Law doer not ripply to an owner of prnprny who builds or improve,thereon. ".
and who contracts for such projects with a contractors)liecmal punmrm In the r
Caul I ,Laccuse Law 4
❑I pt d S 11&PGI ,1': c.
ton
Owner D'1
WORKER S C01111 NSAI'ION ULCLARAIION
Ilarrehyriffroutarde,penall,ofps) y bit,ofh 11 nge F r
s-
1 have it evill a firm a Cediffirobe ofCement 1. If' : f Wrker's
Compeumt o, a ptauded fn- by Station 3700 of the Lebtir Code, far the '•a
perfannnnce of the work Cur whaT 1ue permit is issued. ,
111 have andwill nwimoin Worker's Compunsalinn Inr" ra
un ,namounted by Section • n
3703 or the Lunar Cade,for the performance of the"suwork for which this permit is - e
sated.,My Work,,',Confloarsmion Insumade currier and Policy mtmbef Ire:' ��q
Carrico l7 v•r k/_�.F miry No.:/UUU W�QIoSa 2—CJ� r` -
CERTIPICATION OF F.XEMP PION FROM WORKERS'
• COMPENSATION INSURANCE
(This sectionneJ [b'completed f the permit i,for one hundred dollars
($1(10) '1:t' •
.I cerry that in the performance of the wank for which this permh Is issued,I
xhall net airplay my person in any manner so as,o becarav olo sot w the Workers'
Conmanontlon Lnw,of Gdifomia.Date a �'
Applicant r P
NOrICETO APPLICANT II R 'k' btl C nl r o[E nil , ym should •^ -
bec . l 11 Ih W ke,,Compensation precision,oftl Lab Code,You must t -
s ZQ. forthwith readily with such provisions artls pima shall la,d niod mroked. -
VI .. CONSrRUCT1ONLENDINCAGLNCY - r 1• F
• F' �"' I beach y effrn,tM1 t them a construction leadim,agency far h perfnrnunce P,
`of*dho workf Much lhis fromts issued(Sea3097,CIV.C)- -
Q Lend N
Lenders Arco,.
01 terrifytl I I have madths ppl air d!'bus,that tbove maturation is _
corn I.1.,me t nply mid,III city' T ty mrfintrace,a d ,am IS - refining '
Op tob 'Id' g Ansloadiloonadh by moronicpt . tt l(hs c'l,m emcur,or ' _
:y Gy the ab f laid prPnyf :Pt pp ':. 4
r�,l CL OW)agree to save,andermanft' I k the City f Cupertino mar"
h liablC . l I p by' may. y cne.ga at aid
V CiIY m luau grant,g of N p ,ml -
AYP A ERSTANDS AN IL P).YWITHALLNONPOINT O
s �cu IDNs. C `1 Issued by 111 Date' /
f Signtmre of Applcan/Conracter - _ Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - ,
Will the applicant or n haildin,attrp+nt„erear handle hanamtirs material Type of Roof - ,
as defined by the Captain.Mrm pal Code,Chafer 9 12 and the Health and Safety -
Code,Section 25532(a)"
P '
El yes ❑N ` ' - r
' .. All roofs shall be inspected prior to any roofing material being installed;. ,
-
Will the applicant Or future building accimain use apartment devices which If a roof is installed without first obtainin an ins action;I agree to'remove
• mi,tr 1 ram lmc deflated by tl By Arco Air Quality Munagenmen g -p• g
District^ - - f , - all new materials for inspection. Applicant understands and will eomply'with,
°Yes °N all non-point source regulations
• "
1 h T the•htr dregm .unJ Chapter 6.95 f'he
'
Calif - Healthk Sef,on de Sea s255 ,25591 nd25534d tndiht
fNebuldn 0%one tI I , Ih, , y p n.thltry, ffythe ' _ s _
the ra� Is which mus t ' rmuso ce rfn(enifeut d e '
oCC1pan`y
Signature'ofApplicant_ Date
owner o; theaa,aT agent - . ala, All roof coverings to be Class"B" or.better -
:'1 OFFICE 5 -