03090212 CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT CONTR'AGTnRINFORMATION
BUILDING ADDRESS: HSIANG TIEN YIE PERMIT N0.03090212
"5 NAME: PERMIT LSSUEDATE
PHONE: SANITARY NO. CONTROL NO.
ARCHITECfIENGI NEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+oa LICENSED CONIRACOPUS DECLARATION C] O O O
``u F 1 hereby affirm that I am licensed under provisions or chapter 9(commencing Job Description
`tawwith Section 7001 of Division 3 of Ne Business and Proressiunk Code.and my licens is
a« in fall
j�2License Class mrrmLic.q KITCHEN REMODEL/BEAM CHANGE
in mnfallm
Dam Contractor
ARCHITECTS DECLARATION -
E he U 1 underavnd mY plans shall M1e used as public rccmds (1
�u, Licensed Pnrfcssional
S OWNER-BUILDER DECLARATION
a 0 1 hereby reaso affirm that 11. exempt from @c Contractors License Law for the
00 following reason,scehan 7031.5.Business and improve.
ioli Cods;Any city Or county f7r/
<m which ryuimanpermit to requires the
nt forsudcmch rmilL fie atignodsuunum VF O
°iy pdonn its cervancc.also
antto the thovisiosOf for he Compactor's liamseLaw(Cha mem
—< (commthat he encingmdpSectiounthcpmvivision3 of the
ndProfesw(sCode) 9 Sq. Ft. Floor Area Valuation
eFo (commencing with Senior 70X)or Division3nf the Business and Professions QWe7 or
that he is exempt therefrom and Be basis for Ne alleged exemption.Any violation of 36924021 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number OType
_
not mom NOccupancy an five hundred dollars(S5o0). P Y yp —
❑I,as owner of the pO,,Oy,or my employees with wager av their sale compenulion,
will do the work.and the structure is not intended or offered for sale(Sec.7Me.Business
and Profusions Code:The Corrosion's License Law does nut apply man owner or d Inspections
property who bones or improves thefeon,and who dm
ad such work himself his 102 — PIERS
own employees provided that such improvements are not intended or offered for sale.If. 103 — UFER
however.Ne building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving that he did not build or improve for puryos,of 10 4 — REBAR
")`')' 105 — ANCHOR BOLTS
❑1,as owner ri the property,a Business44s and contemns with:)The C contractors m
construe doesntapply.nlanowmeandirtywhoWidsoriproConuromrsLi 106 — SEWER & WATER
cease contrcaanouh apply loan owner whobudesor ant to the Cemoa.orand 202 — UNDERFLOOR PLUMBING
wry contracts for such projects with a conronor(s)licensed pursuant the ContrazmrS
e ease law. 203 — UNDERFLOOR MECHANICAL
lam eae it under Sec. ,B&PC for notion204 — UNDERFLOOR FRAME
WO SCOMPENSA `C ATION 205 — UNDERFLOOR INSULATION
I herb affirm under B r 301 — ROUGH PLUMBING
y Penalty perj one of the fnllowin6 dmlaratiom: ,
❑ Ih.veand will maintains C.nifcmeof Coasenuo self--insure for Worker's Cumpen- 302 — TUB Se OR SHOWER
sari m.as provided for by Section 3700 of the labor Code.for Ne pnfommmen of me 303 — ROUGH MECHANICAL
work ter which this Namot is issued. 304 — ROUGH ELECTRICAL
f-1I have and will maintain Worker's Compensation Iuunnce,as myuird by Section
3700 of the Labor Code.for the performance of the work for which this perm it is issued. 305 — FRAME
My worker.Compensation msarancecarrier and Policy number am: 306 — HOLDOWNS
Carrier: Poli307 — INSULATION
CERTIFICATE OF EMPr1ONMOM FXM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
sir less.)This section need not W completed if Minor is or one hundred dollars(Sa10) 309 — EXTERIOR LATH
I ce tiny that in the perrm maria of the work for which this permit is island.I shall not 310 — INTERIOR LATH
employ any person in any manner sn as to become sobject to the Workers'Compensation 311 — SCRATCH COAT
Lawsof California.Dam
ens 313 — ROOF NAIL
Laws
NOTICE TO APPLICANT Ir,art,,maki ng this Ceni feats of Exert ptinn,you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker'a Comramation previsions of the tabor Code,you must
�z, mrNwith comply with such provisions orthis Permit shall xcounted mvokcd. 502 — FINAL PLUMBING ENERGY
?'C CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
I hereby affirm that there is a conswetion)eadingagency for Ba perfurmaeeo of 504 — FINAL BUILDING ENERGY
Y > Ne work for which this Permit isissued(See.3B9],Civ.C.)
F Lender's Name 505 — FINAL ELECTRICAL
rs
17
� LnaeAdd�
z 506 — GAS TEST
J p 1 trolly that 1 have rad this application and sura Nat Ne above information is 507 — FINAL PLUMBING
.icov1 agree to comply with all city and county ordinances and state laws relating to
0Uen.building consamuchor and hereby authorthe oPpoodurrives Of B115 city to enter upon Be — FIWC
AL
Lc ahovcmcn)inned property for inspection puyoses.
D. (We)agree m save.indemnify and keep harmless the City of Cupertino against 0 — FI
fA tiabiblies.judgments.costs and cxpcnsu which may in anyway among against said City
j Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH A N -POINT Issued by: 5ORKSDate
R E RRGULATIO
° Re-roofs
Si amrcof APPli omractor Da
AZARDOUS MATE qq LS DISCLOSURE Type of Roof
Will the applicant or future builJing d cupam score or handle hazardous maadal
dcfuad by the Cupertino Municipal Code.Chapter 9.11,and Nc Hit and Safety
sDyna zss3z(a)? /�/S[3\No All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or forum building«cupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
chair lus,so nus air c^numinants as defined by the Bay Area Air Quality Management all new materials for inspection.
District!
❑Yes No
I have rad One hara dons materials acquirements under Chapter 6.95 of the Califon.
nim Hit&Sdcty CMc,Scctiou 255115,35533 and 25534.1 understand daudRo budding
do.not cone By has a¢ amthm
n , at it is my rahanabiliry notify Be n_eupam of Ne
rqu' me nrtCmnalM 1 dpwissuana Tuaa9rOc p cy Signature of Applicant Date
Ow fauN9riacda
Cale
All roof coverings to be Class "B" or better