05080256 CITY OF CUPERTINO 7>nZ --777" —77
BUILDING DIVISION PERMIT gkCONTRACTOR INFORMATION �'
BUILDING ADDRESS: MARVIN DAVIS CONSTRUCTION PERMIT N0.05080256
.109.77 rmn T4ARRnR All
OWNER'S NAME: PERMIT ISSUE DATE
YUNG & JENN
NE: SANITARY NO. CONTROL NO.
408) 975-0200
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
v00 LICENSED CON`RACTOR'S DECLARATION
U r I hcmby ef0,m than I am limned under pmvisians of Chapter 9(commencing Job Desai ipdon'�
_Zrn with Senior]000)of Division 3 of the Business and Professions Cole,and my license is �� It
in urn Tara ane trc TEMP POWER POLE Illlllll u V i':I as
j ? License Class Lic,isWN Z2
i r Dow�lr�/n CenOuer
CHDEGTS DEC RATI N (aN/r 200[
ya�-I ,. I understand my plans shall be used as public meet& j/ sJ
I
"
o Licensed Professional rr a,
.� S OWNER-BUILDER DECLARATION Iq��JT(IIIIfIV'I'plf
<y 1 hereby affirm that 1 am exempt from Nc Conuamoh License Law for tbe
act following mason.(Section 7031.5,Business and Professions Code:Any city or county
UNG
HE'
which requires a permit a consaam,alter,improve.demolish,or repair my structure
ami prion,,is issuance.als.requires docii,licantfar such permit to Bleasigncdsulemem
s
< that heislicensed pursuanttothepevisionsofNeContractor''sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
�t-� (commencing with Section 7")of Division lefthe Business and Pmfessiav Carat)or $
i
that he is exempt timmfmm and the basis far the Jlcgcd exemption.Any violation of Y 250
Section 7031.5 by any applicant for a permit objects the applicant o a civil penalty of APN Number Occupancy Type
not mom than Bw hundred dollars($500).
❑ L as owner M Ne property,or my employcu with wages as Nei,sole compensation.
will do the work,and the structure is not initiated a,orcemd for sal.(Sec.7044,Business 36910003 . 00
and Professions Code:The ConuacmYs License law docs not appy to an owner of Required Inspections
property who builds or improve Neuron,and who does such work himself or through his
Own employees,provided that such imparvementa am not intended or offered for sale.if.
however,the building or improvement is said within one year of completion.the owner.
builder will have the burden of proving the he did not build or improve(a,purpose of
sale.).
0 I,as Owner of the property,am uclusively contracting with licensed contramors m
construct the project(Sec.7014.Business and Professions Cade:)The Conuacwr's U.
cense Law does not apply to an owner of property who builds or improves themon,and,
who contracts for such projecta with a canmmortie licensed pursuanua the Communes
Liked.Law,
0 1 am exempt under Sec. B&P C for this maven
Owner Dem
WORKER'S COMPENSATION DECLARATION
1 hereby unions under penalty of perjury our of the following declarations:
I haw and will maintain a Ccnifcate of Conant m self-inane for WorketsCompen-
7370)
ian,as provided for by Section 3700 of the Labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Imunna,as required by Section
of Ne labor Code,for Ne performance of Ne work for which Nis permitis issue .
Wer ri �pertaation Inu^nce celri.,.ad Policy numkrare:rtier. __ ITT__CCIIJJ.. /nf VV 1/✓l Policy Na..
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if be Permit is far one hundred dollars(SIM)
or Icss.)
I certify that in the performance of an,work for which Nix Permit is issued.1 shall not
employ any person in any manner an as e become subjm to unit Workers'Compemadon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccralleate of Exemption,you should
became subject to the Walker'Compensation provisions of Nc Later Condit.you..in
.JO foMwidl comply with such provision or this permit she]be deemed revoked.
Z(7 CONSTRUCTION LENDING AGENCY
'r+ Ihereby a(Erm that Nem is a convection lending agency for Ne performance of
C? dte work per which this permit is issued(Sec.3097,Civ.C.)
WA Lender's Net.
W Under's Address
D
U(] 1 certify that 1 have mad this application and tete that the above informauun is
W F' COmm.1 agree to comply with all city and county ordinances and sum laws muting to
0U building convection,and hereby&uthome repmsenutives of this city to enter upon the
,r W atove-mentioned emptily fm impaction purpaus
C (we)agree atame,indemnify and keep hamdcss Nc City of Cupertino against
F'rA liabilities, enu,cossandexpe s which may in anyway&come against mid City
U in cove rte of Ne ting of permit
^ APPLI A UND TANG ND W L COMP I ALL NON-POINT Issued by: Date
SOU E GUL /y,J
d"( Re-roofs
i tore of Applican mmmor D
RDOUS MATERIALS DISCLOSURE Type of Roof
Will Ura c Cupam of future building occupant sere or handle anomalous material
m k.Sa by tic Cupertino Mum ipel Code.Chapter 9.17.and the,Health and Safety
code. 0Yes zsslz(a7 All roofs shall be inspected prior to an roofing material bei,, installed.
❑Yea � Na' P P Y g g
Will the applicant or Tut m building OCOO m use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
istria7
O Yes No
I vc sed the beard/&121ul'
enu under Chapter 6.95ofnceCalifar-
niaHca &S myCodc 8534. dcrsund Nat it&Wilding
dam tau relyha a mvihil' duly no accupam fthc
myutmehich ra -r sea Signature of Applicant Date
rte mauthorindagt rte All roof coverings to be Class"B" or better
� Community Development
��� 4' 10300 Torre Avenue
Ear r' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: /� PERMIT #
0 -2 (J V' V� Ci C2S-!;ZSSG
OWNER'S NAME: yUNQ Cjne*J PHONE # kJOS C(7S- 020
GENERAL CONTRACTOR: gY } FAX # p Cl S- CeOn
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical O
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
_,Tile
e4,4 zzz g 2
OwneoContractor Signature Date
CITY OF CUPERTINO b SD 1--o Z,f
TEMP POWER
2 UPERTINO PERMIT APPLICATION FORM
MOFAPN # �O 9 I D �te29 CS
Buildin _A�ddre 0co G \V
yc,�Owner's Name: Phone #:
C nt�� 'N 0� - 20o t PhLice1 }I-�>�-I 2-0
Contact: Phone: Cupertino Business License,0 C2C4 QV #:
co I qDS C1�J -o2a a2
Building Permit Info:
Elect
Job Description:
NWO,
Residential Y Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
3 7s
2c-" Z , y7