02040035CITY OF CUPERTINO
,-�
O
Q
Z
O
I:.
f,
m
L
Za
-
- - - -
BUILDING DIVISION PERMIT
-CONTRACTORINF.ORMATION:
BUILDING ADDRESS:
PERMIT NO.
20091 FOREST AV
NGUYEN
HAI T ET AL
02040035
OWNER'S NAME:
APPLICATION SUB DATE
NGUYEN HAI T ET AL
04/08/2002
PHONE:
SANITARY NO. CONTROL NO.
zo ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
F.
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
1 hereby offum that I am licensed under provisions of Chapter 9 (commencing
Job Description
p
w with Section7")ofDlsiston3nnheBarmessandProfessionsCode.andmyE«nse
j Is In full force orad effect.
� NEW
SUBPANEL FOR KITCHEN.
U License Class Lic.p
Data Contracmr
ARCHITECT S DECLARATION
g I understand my plans shall be used as public eecards
II— B�YI
/i�[F.CO
p Lensed Professional
OWNER
us 1 hr M. exemptBUILDER m the CoATION
License Law for the
1 am exempt from the Cantos
MAY 1 4 2002
aso on 7031.5. Business and Professions Cmc: Any, city or county
o
a following rcama permit
t
O which requirts a permit to conarva, ober, improve. demolish, or repair any structures
$800
m . prior to its issuance. atm requires,he applicant for such period to file a signed statement
- that hats licemed pursuant to the provisions of the Contractors License Law (Chipmr9
(cbmmencing with Seetion]00o)of DivisionJof,he Bsyiness end P.rpf<ssions Code)
SQ, - ��I� A•�•
t,
- - -
Valuation
or that he is exempt therefrom and, ,he basis far ,he alldgcd ea onslumm Any violation
,.I. 31tl-TiT'7�-QC
.'
'
of Swim 703 IS by tiny applica sufma permit subjects the: to a civil pcwhy
of not Five
•app
10Y"a'�P
DATION
Occupancy Type
Lidernnthad
Ofthehundrcedmlyeeplovir.
or my employees wages their sole compensation.
h as owner of the and
'°vittdo the
the is intended d
a,
swaure not endM1
a
e offered for sale apply to
nessa Professions License now apply to an
Cme: The Coes
103
- UFER Required Inspections
ownBuser of pro erty Who theins who s such
owner of property Who builds or improves thereon, and who encs such work intended
°r,heo°gn own employees, or
,or mpb improvements are no, onendm °r
104
REBAR
sol t building improsreardne a sold within one year of
.oRem1 for sole. If, a, -Wil r. the tibase the
compinion, the mwner-Wilder will hovc,he burden of proving that he did not build or
-
105
.-..
" '
- ANCHOR BOLTS
improve for purpose of sale.).
- ... . ..
106
- SEWER & WATER
I, es owner hophe property, am exclmenadPromlag
diha with iiprnsea pnn,;adors m
ionswct ,he project (Sec. ],10.1, Business and Professions CmcO The Contractor
.. ..... . _
� 202
.. _- ...... - _
- UNDERFLOOR PLUMBING '
ima.Lawit=notapplytoanownerofpropertywhoWildsorimprovestheted,
. and who contracts for such projmu with a eonuaemefs) licenscd.pursuem ed the'2
203
- UNDERFLOOR MECHANICAL "
Conuactor's License Luw.
O4
-.. _... _.. .. ...._.... ... .-.
-'-UNDERFLOOR 'FRAME ""
❑lame an peg. B@P C for this
205
- UNDERFLOOR' INSULATION
}(¢/y''pI
``rr..�{{ .. 9ole779�
Owner-✓^ WO R'S�C0 PENSATIO DEC RATION
301
- ROUGH PLUMBING
Ithereby alremaMet Penalty orp<1jmymennhefau°wingdppl.ra,mns:
302
- TUB & OR SHOWER
I have and will a Cay If Coastal ,t Ifinsurefor Worker*a
303
- ROUGH MECHANICAL
Compensation. roiled Septi
for by Section 3700 of the Ismr Code, for ,h<
304
- ROUGH ELECTRICAL
Performancehe .Afair
.1 he work for which ,his permit is issuN.
305
- FRAME .
❑ 1 have and will minimum Worker's Compensation Insuream es requirtd by Section
metier,helaWrcme.rnr,Wperrnrmanpear,newodso%whichthispermitis
3 06
- HOEDOWNS
issued. My Workers Compensation Insurance [artier end Policy number art:
307
- INSULATION
Carrier.. � t � � .. Policy No.:
"'
308,=;.SHEETROCK
• CERTIFlCATION OF EXEMMONTEOMSURANC WORKER. i -
.... -, ... mMPENsnnoNwsuaANCE �. ., '
a
309 '
- EXTERIOR LATH
.
'(This xaion need Turd W completed if the permit is far one hunerm dollars
.INTERIOR...LATH
51001°''`rs')
311
- SCRATCH COAT
1 Certify that In ,he perfnrtnance Of the work for which this permit is issaed. I
, . ... 313
- ROOF NAIL - .. ... - .
shall not employ any person in any mender to an m became subject to the Worked'
Compensationof Cala. Due
`LX:.
501
- FINAL ELECTRICAL ENERGY
Applicant t
"502
- FINAL PLUMBING ENERGY-'
NOTICE TO APP ICANT. . after making ,hrs Le ¢mc of Eaem , should
NOTICsubjauo,hd
terrEtabort
lancome Workers Compensation provisions youmuo
forthwith comply with such pm%kions or permit shall te deemed mvoked.
503
- FINAL MECHANICAL ENERGY
504
- FINAL BUILDING ENERGY
CONSemUCnoNLENDwn AGENCY
I hereby this Chert mss construction(Sc.lending agency for the perfomiantt
505
- FINAL ELECTRICAL
which
oldie work for which Nip permit is issued (stip. 3097. Civ. C.)
Lender's Name
.. 5 0 6
- GAS TEST
LendcrsAdder..506
507
- FINAL PLUMBING
1purifythisIhave readalthis rndlainancesaabove ilaw'mi°ng
508
- FINAL MECHANICAL
ityandapplication
to
,o building cons,rvnion, and hereby authorize rtprtsrnarives of this city to corer upon
ildct I conter tocomply d hhencityartaere or nmatims and state law'missingI'd
509
- FINAL GRADE` --
he above-mentimmilPINdy far inspection mrpos
(We)"me m save. indemnify and keep hamdessme City of Cupedino'againsi
510
- FINAL PLANNING
liabilities. j illons s, ensu .ad exp ns« which may in any way accrve agamic said
City in consequence of the granting of dims
514
- FINAL PU I C WORKS
lamina.
APPLICA L:C�RSTA.\'pp4or- hC
SOURCE U ATIO
LCO.ILY
r
Issued by:
akeI\'ITHALLM1'pN.pO1
%/�/
�'/J{((/V'(a/./
Date
Stgnamrc AppbcHAZARDOU '—�- tp
" HAZARDOUS MATERIALS DISCLOSURE'
Re -roofs
pa
WIbyte Cupertino
tenure Municipal
Cgocc hapt mortwhad the Health and
ss defined by ,he Cupertino Municipal Cme. chapter 9.12, and the Hca1N and Safely
Type of Roof
Coro. Semon 25532(a)' '.
oyes oN°'r
Will fumesbuildingbytheBayAeaAirQualityment
All roofs, shall
be inspected prior to any roofing material being installed.
us airoiintmecasurn
emit hazardous air conuminan¢ u defined by Bay Area Air Quality Manegemem
onagees tint
If a roof is installed
without first obtaining an inspection, I agree to remove
istn`t?
❑Yea 0No
all new materials for inspection. Applicant understands and will comply with
all non-p❑Ppint source regulations.
1 have read the hazardous mamrials requirements under Chapter of the
California Health 3 Safety Cme, Sections 25505. 25533 and 2553a.luna 6.95 othat
standtify
if,he Wilding docs not cunemly have a ¢mart,, drat iris
my responsibility1untie
no @e
u xhich tax, be met prior m issuance of/a Cenif ate
G/Tq
y✓a Y
of
--v
Aculanm,.1dui
�_/— V
Signature of Applicant
Dateo
All roof coverings to be Class "B" or better
agrn, /� D —
OFFICE
•
•
•
APR -08-2002 .1 ; 03 AM 510.8, 8. 6. 7. 5. 9, 54P)
SUBMITTAL
1
fOOA 60A
M4i470retkP/1_
� r
rr
, t
w/3
r
' r
4P,A .Z dA 16
AYS 15108867595
•
r�i s
P, 02
-5"
OA
;ORDANCE WITH THt l.{I + 0�, a
I(Nr OL'.Q AND JDL: AN',.S
.his sel aa', cations MUST
be kep, r 1t1 yes and it is on
lwlui to is : or alterations
n some :e mission from
e to, d n; ';upertino.
rm n
no specifications
Pe mir .r to be an
S�6 ny provisions
�o,S/�a.CeS /,� G'ircui7.S
RPP l�'
U S C
on I y
III APR 0 8 2002