03080020 CI'T'Y OF CUPFICHNO "'?:: �J* `:• ' x aA'. ;
BUILDING DIVISION PERMIT CONTRAC rOR INF RMATLON�
B
U11DING ADDRESS: CHUNG YIN WONG PERMIT NO 03080020
.R'S NAME: 1049 SITKA TERRACE PERMIT ISSUE DATE
RY NO.
1;1c; q 200TI4111 2117D
NE` (408) 985-9289 SANITACONTROL NO.
ARCIRTLLTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
100 LICENSED CONTRACTOR'S DECLARATION
u C 1 hereby arum that I am licensed under provisions of Chapter 9(commencing Job Description
m with Sachs.7MBof Division3ofthe Busimseand Professions Codc.md my license is
' e in full fort a effect.
q= uanm r3/i/e ue..�� XOP9�/ KITCHEN REMODEL/RELOCATE FURNACE/STRUCTURE
IF,p Date Coal, r F'NALb®
ARCHITECTS DGCL TION
iO,a lampostandmypimsahall beumdaslmf ictccnrds
iau
°0 Lieenmdpmreaaiamel JAN 2 2 2004
S OWNERBUILDER DECLA0.ATION
q 1 hereby vffrm that I am exempt from Ne Contractor's License Law for In.
O o following mason.(Section 7W 1.5.Business and Prerrxsians Code:Any city or county
lm which requires a permit to consumer,alter,improv,demolish,or repair any structure
ey prior to its issuance,also requires the applicant for such permittu Elcasignedmaramm
SU"a mal he isBeensedpursuant to the pmvisionsof the Contraacnsc
nr'sLicLaw(Chapter9 Sq. FL Floor Area a RQit=—$ (commencing with Section 7")of Division 3 of lha B usiness and Professions Code)or
_
that he is uempl therefrom and the bazis for the alleged eamption.Any violation of 34246005 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more Nan Eve hundred dollars(SSW).
I,as owner Orth,pmpeny.a my employees with wages as ftir sole compensation,
will do lie work,and the structure is not intended or offered for sale(Sec. Business 101 _ OUND
and Professions Code:The Conanctor's License Law docs not apply to an owner or � d Inspections
pmpenywhobuilds or lmpmmathreamr.od who doesmehwurkhimselforthmugh his 102 — PIERS
Own employers.provided Nalsueh improvements tie not immadcloraRered formic.If. 103 — UFER
however,the building or impmvemenl is sold within ane year of completion,the owner-
builder will have the burden of proving thvl he did not wild or improve for purpnae of 104 — REBAR
sale.).
O 1,as owner of Ne property,am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS
compact am project(Sec 7044.Business and Pmressirns Code:)The Conuactor's Li. 106 — SEWER & WATER
cense Law does not apply to an owner of popery who wilds or improves Burned,dna, 202 — UNDERFLOOR PLUMBING
who commes for such p rjecas with a contractor(s)licensed pursuant to the Contractor's
Li,$ Law. 203 — UNDERFLOOR MECHANICAL
Psi am exempt under Sec. .B&P C for this reason
204 — UNDERFLOOR FRAME
ata
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
I hereby affirm under Penalty of perjury ere or the following declarations: 301 — ROUGH PLUMBING
0Ihave and will mountain a Cermcete of Consent to.seU-insure ror Weaker's Compca- 302 — TUB & OR SHOWER
sation,m provided for by Section 37W of the Labor Cndc,for the porrommnca of the 303 — ROUGH MECHANICAL
work for which this Permit is issued.
❑1 have and will maintain Wakcrs Compensation Insurance,as"Word by Section 304 — ROUGH ELECTRICAL
37W of the Labor Cade,for the performance or the work for which this permit is issued. 305 — FRAME
My Worker's Com pensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Carir. CE RTI FICATEOF EK EM ITI,Ircy Na. WORKERS' 307 — INSULATION
COMPENSATIONINS ANCC e 308 — SHEETROCK
m les.) his secomatured not bemmpleted if lair permit is fmonc hundred dallars(gIW) 309 — EXTERIOR LATH
1 canify thm in the performanec or the work for which this permit is issued.I shall not 310 — INTERIOR LATH
employ any Nount many memmersa asmbemmembjcct m me Workers'compensation 311 — SCRATCH COAT
Laws of Calirornia.Da n
APpEeam - �,—.-�+ 313 — ROOF NAIL
NOTICE TO APPLICANT:If,Iflef makirg this Certificate o pion,you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker's Compc nation provisions Of the Lahor Cndc,you must
)Z forthwith comply with such provisions orthis Permit shall xdeemed revoked. 502 — FINAL PLUMBING ENERGY
zDi CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
Ihereby amrmthat them isaconstruction lending agency lot the performanceor 504 — FINAL BUILDING ENERGY
]' 7 the work for which this pemoit is issued(Site3M7,Civ.C.)
Z) p mer'aName 505 — FINAL ELECTRICAL
enaerL :Addma
L Z 506 — GAS TEST
J O I canify that 1 have mad this appncatian and iodation the above information is 507 — FINAL PLUMBING
y orcu.I agree to comply with all city and county on inamoes and sure laws relating to
V
building conswtion,and herebyauthorize repmatonativesofdo;city toenter upon Ne WFIg&TNWG
AL
U abovomentionc l properly for inspection pugwsex
(we)agree m um,maemmur dna keen narmmm me cry or cupetdno.gaimat 0 9
^(a/1 Iiabililies.judgments.coma and expenses which may in anyway acerae agairn' !d City 5 JZ inconsequence of the graming of this permit.APPLICANT UNDERSTANDS AND WILL COMPLY WI H ALL NON-POINT Issued by:5 ORKS Date
j/
SOURCE REGULATIONS.—
4�24;' �O_ Re-roofs
atom 9r pla conlracmr am
HAZARDOUS MAT ALS DISCLOSURE Type of Roof
Will theapplicam or future building occupant store orhandle ha nous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Scadma25532(a)I All roofs shall be inspected prior to an roofing material being installed.❑Yea psea
Will the applicant or resre
building occupant use equipment or deices which If a roof is installed without first obtaining an inspection,I agree to remove
I
t hacardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
islricl? aa//
❑Ycs IONo
I have mad me hvaarduusmaterialt requirements under Chapter 6.95 of the Collor
ria HcalN&Smmy havlc Savomhatit i25533andnsibil 1 to coalftoxxwwiming
docs nm currently have.,te,um,that it a 55 3 And25ibllit I un ratify tie mdths,b of de
requirements Which Must be Met Prior 11)hadaine of a Ceroficarke Of occupancy. Signature of_A plleant Deter
etaraamar) ag - ,te All roof coverings to be Class "B" or better