02040143 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10422 COLBY AV 02040143
OWNER'S NAME APPLICATION SUB DATE
ANGELA S . CHEN 04/25/2002
j� HONE: SANITARY NO. CONTROL NO.
90 ZGARCHITECTIENGINEER: BUILDINGPERMITINFO
BLDG ELECT PLUMB MECH
�Z C_7 L-J LJ I_I
Z oy,,i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z- I hereby affirm Nat 1 am licensed under Provisions of Chapter 9(commencing
F`=twith Section 7000)of Division 3ofdo,Business and PmfessionxCode.and mylicense ADD 499 SQ. FT. & REMODEL
yI istafull toand taxes.
z at UcammCla,s - LicIt
O U Date s - DEC
ARCHITECTSDECfor
_;,ARCHITECTSDECLARATION ,
5od��rslme•my plains shall be use u public rcq unit �A/
6p�O Lfceh3Fd Prd'ek�mn �1 t n E- I - , I. a'�L
OWNER BUILDER DECLARATION "C
= 1 hereby.(Rein that 11. exempt from the fes ors Cu An, Law
forthe
...
t C following reason.(Section 7031.5.Business end Professions Code:Any city or county' $100000
ISG which requires a permit re'
e conxtron,stens.improve,eemolish,or repair any stmnurt
uwj 3 pdorto its issuantt,also requims Ne applicant for such permit m file esignd.:,:.ment.
Nat belslicert-o ymuen!tyythe preyisiom o(the Contrenofs Liccnm tali(Chapn9 Fpor Arra Valuation
mit_ eliring i- Secj)oh,7000)of Divixion3oRhe ltusinespaM Profgssions Cade) , '31%-VID�-S'.\U U:r+'�•yl "v`
or Nephe I!exenipfthereHoih olid Ne basis fns the ollepeE eKeniption,Any violation
--or'sufam7"1:5byntyapplicantforepetmitsubjccutheapplicmtmaeivilpetnity N�DT�yer p y�Yp
ofron .than five huMred datarS x5110). 101APN B 6ftATI ON f'L+"::1.a Occu ant e
❑Las mme,.fdat pmpeny,or my employees wish wagesm Neir sole compensation,
- t do2he worknnd Nrctmnure'ts not Intended or ofierc44,'e'fpr sale lSec:90 --' "--'- -PIERS -'- -'�- -- " ' '
Bottom and Professions Code.The Conuanor's License Law does fat apply to an 103 - UFER Required Insp'eetions 1
owner of property Who builds or improves thereon,and who does such work himself
or
completion.sa, of.however,
the
eg or improvementimprovements
old'vo Nd nolb Id or' -lOS ANCHOR BOLTS• ......
-i _..___. ..____._ ...__...._
that such 1.0.4__-- REBAR
[off spedion.the.'IChowuildethel ban rNi improvementisspat he did one ear of
P proving - '
improve for purpose of mle.). 106 - SEWER & WATER
of the I _
s rtes property. lus, lyconiruning wt[hlcensdcontrect to 202 -- UNDERFLOOR PLUMBING "'f '•'i'"` ' `
conitirtan Ne pJaxt(Sec'7004 Business s and Professions Codtar's
Code.)The Canna
License- lawdaxnotappyt fpmpenywho wudaartmproveaNrcon
e , 203 - UNDERFLOOR MECHANICAL- -
'I ,_end,who contracts for-Wel"PmloctywM a.controcmr(s) licensedTarsuou to Ne _.._ __...._-_. _._ -------
L
_--.-----
canvact LttnaeL _.�.. .._.2.0-4" -..UNDERFLOOR-,`F.RAME....-. .
❑lam pt nderse t'"• B PC farlhisreaT. 205 - UNDERFLOORS 'INSULATION
e L 301 - ROUGH PLUMBING
.r '�(, _r �N]RKE ' OM ygQyN DF. ARATN�
302 - TUB & OR SHOWER
1 barely a i Mer penalty of pep ry o e from fallowing declamation: 303 - ROUGH MECHANICAL
,..;, a. t
i O [Hove and will�mant Ceriifi a[< f Canxeel'td weltnnsure for Worker's 304 - ROUGH. .ELECTRICAL.'. , - -
" C mpcn anon(_es;provided for by Saton-3]W of the Lait Code, for the
peifohiia'ndero(the wart far Tv Nia perp.!,i,Issud. 305 - FRAME t
❑1 he a ard'w II mai t Wdrker,s Conakmation'linsurairice,as required by Section 306 - HOLDOWNS
37W of the Lalsor'Coam.for the performance of the work for which his permit in
issued My w rkri Compensation Insuranceand Policy number arca 307 - INSULATION
Ca
' , ', �' r;In 1. N ,,..308 .' :SHEETROCK ..,._,:• 'a
1 y";CERTIPICAIONOFEXEMPTIONPROMWORKERS i_ Z/t' I309 r1, 'E%TERIbi =" ATH '
COMPENSATION INSURANW?,RR ' "
r .,..,--.:..:.-...,.,, e---.........
0t
INTERIORliATH p
__
o:' i
.'(Thrse`ctiotideedtaot M completed i(the permt s or one hundred 'f
ii ( hdred dollars 311 - SCRATCH COAT . . .
Lansfy',!hn in th<perfomunce nE' h'for titch Nis Demur a issued l - `--3. . 13'- -ROOF NAIL.'....:- I l t ;'L C.
'en n
lom,employ any person y and aa,to beeame aabeot to New k<rf 501 - FINAL ELECTR I CAli ENERGY
z "
cmpenatataLawxarcrf D -502 - ' FINAL-PLUMBING ENERGY
O forth ihemply with such
oaktngNtsCenfnmofEemptonyoutwlst 503 - FINAL MECHANICAL ENERGY
APP ca t
NOTIcE TO APPLICANT If aftnm
becom ub) if theta me Compensationp v sof'he
h LabarCde you must
ao m peemn N_ be ettmdrcokd 504- -- FINAL. BUILDING ENERGY
z O P t CONSTRUCTION LENDING AGENCY '
=]'� a t I hereby.Rim Nst N eonsw tion lens g agency f Ne pe fmm nm 5 0 5 - FINAL ELECTRICAL . .
o(the work for
which this permit is issued 3W] Cv
iqc) , 5.06.- -...GAS TEST- - . _ - - . -. _..- .. .....
..Lender aNme� _
VW �(zr L.• nd r Add s
507 - FINAL PLUMBING
Ic nifY Nm l have mad Nt 508 - FINAL MECHANICAL L
pt 1gcomply all Jcouy ordinances and state laws relating
VM
509 - FINAL GRADE s
to bmlJng constmelion:ond hereby amhnna reprecenmtives ofth,s my to comattpon
tnl'above-mentioned property for inspection purposes., 510 - FINAL PLANNING
F. p. (W)apme to eat tad tnnify and keep harne,ldouCky d Cupenmo'against
.w'.f/J C.Y.l es'f dgmegD costs nd eapen., h ch y I,any way accrue agmn)said 514 - F I NAL U C WORKS
V Cy ulna of the gmni ng of ilii perms - ,s
com
&4 Pp AZARractor MAyyT//gER1A�DSC o17HA61.n N-Pgl`1D' - ` (Jv
S RC 10.P' _YAr Y/1 .y Issued by: Date
n Wdl(then nlj Omre.no Wilding oIALSDI DISCLOSURE
mare Re-roofs
OSURE t
,hoMlin hagada ardslmal _.Type Of Roof ._ _. -._.._... .-..,.. a.,..�.e ,.. •- ._.
us dened by the Cupen ao Municipal Cde Chapmr 9 12 and the H aIN and Safety ..
Code,!Section 259711e1 r _ k 7. Fit
rya r S k s I a .r
tJ ,' _ All roofs shall be inspected-prior_to.any roofing material being installed.
wiill0 pppl t 'Potarc �ldwg«cupauiuse'equtpmentordevices which If a roof is installed without first obtaining an inspection;I agree to'remove -
em t ha roods air co t is u defined by the Bay Arca All Quality Management
•D*met^ all new materials for inspection. Applicant understands and will comply with
QveNa all non= `nt source regulations: ., ;,; ) •, ,
.. ,
t 1 h rad the haze dos materials mcf.immentat'under Ch purr 6.95 of the r
.Io6 iiHcalN&Safety Coda,S pions 25505 25533 end 25530 1 understand that
-sf th Wdtlmg dues aim curteney havept ant Nm ins my re,nof,bi4.1ylon01ify the -
1 il nu which u t be m(prior w.asua c<of, Cenifume of - s - v
u 'of he re mreme
p Y-
- _ Signature of licant Date
o tacemisu onred,age .Data V All roof coverings to be Class `B" or better
11V
_l- '' OFFICE -. . .. .. .. . -. . - . . _ ..... _ - .__ ... _ . .