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02110101 CITY OF CUPEWI'INO wa;' rr� "• max• --'�. • "'� s' BUILDING DIVISION PERMIT 4 CONTRACTOR INFORMATION s^ so Bl11LDING ADDRESS: PERMIT NO. 21672 GRANADA AV 02110101 NPR'S NAME: APPLICATION SUB DATE , CHRISTINE HOANG/MICHAEL SHIM 11/14/2002 PHONE SANITARY NO. CONTROL NO. ARCHUITCT/ENGINEER: BUILDING PERMIT INFO OLDG ELECT U MECH w00 LICENSED CONTRACTOR'S DECLARATION WOO p 1 hereby¢roan that 1 am licensed under proviciofa of chapter 9(Commencing Job Description Z�W with Section 7(11f1)of Division 3 cribs,Business and Prn&ssimuCcon ,and my license is t_`n4 bib@nhrmeand er@=t. NEW SINGLE FAMILY DWELLING �� 0ogn License Lic.N LIVING SPACE 1044 SQ. FT. °m F Date Contractor F-- ARCHITECI'SDECLARAI'[ON GARAGE 483 SQ. FT. I understand my plans shall M food as public records ow� u,�; Licensed Prnfcssinnal SEP 2 4 2003 0, OWNER-BUILDER DECLARATION K <7 1 hereby affirm that 1 am cxcmpt form the Contracmr's License Law f the ��'�� i S 0° following reason.(Section 7131.5,Business and Professinm Cook:Any city or county w g which requires a permit to construct,alter,improve.demolish,or repair any strvctum I—.ZY prior to its issuance.also requires the applicant for such permit it)Glc a signed statement im`o that lu,is licensed puratuant to he provisions of due Contractor's License Law(Chapmr 9 Sq. FL Floor Area Valuation rcF$ (commencing with Section700(yof Division 3 of the Business and Prnfcinns Cadc)or y$— that he 1s exempt heretical and the basis for the alleged exemption Any violation Of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of er APN Numb not more than five hundred dollars($500). Cy Type ❑ 1,as owner of be property,Or my employees with wages as then sole compensation. will dome work,and the structure is not intended or offered or sale(Sec.7094.Business and Professions Codc:The Comment's License Law does not apply to an Owner of Required Inspections peapeny who builds or improves thereon,and who doessuch work himselfor through his Man employees reasoned that such improvements are not intended or offered for sale.If. 101 — FOUNDATION howeveu the building or improvement is sold within one year of completion,the owner, builder will has,do,burden of proving mat he did not build or improve for purpose of 10 2 - PIERS "le 103 - UFER I,as owner of the pruriency.am exclusively convecting with licensed commission,to 104 - REBAR c smart Ne project(Sec.7144,Business and Professions Com:)The Contractor's Lt cense Law loco nm apply to an awncr,of property who builds or Improves thereon,and 10 5 — ANCHOR BOLTS who contracts for such projects with a comourcoodid licensed pursuam le the Convenor's License Law. 106 — SEWER & WATER of"m exem Stt B&PC fur this moon not lyf�i� 202 — UNDERFLOOR PLUMBING C.G/d Dam WORKER'SCOMPENSATIONDECLARATION� 203 - UNDERFLOOR MECHANICAL I hemby alum under penalty of perjury one of the following declarations: 204 — UNDERFLOOR FRAME p l ham and will maintain a Certificate of Cormentto self-insure for Workers Crimper- 205 — UNDERFLOOR INSULATION satim,c provide)for by Section 3700of the labor CWc,Me Rhe Nommaance of the 3 01 - ROUGH PLUMBING workforwhichthirpermitisissued. 302 - TUB & OR SHOWER ❑I has=and will maintain Worker's Compensation Insurance,as required by section 303 — ROUGH MECHANICAL 3710of theLim al Iar Code,for be perfom use,of the work for which this permit is issued. My Workers CompensationlasuincecarrierandPolicynumberam: 304 - ROUGH ELECTRICAL Careiel: Policy No.: 3 05 - FRAME CERTIFICATECOMPENSATIONINSURANCE WORKERS' INS RAANE306 — HOLDOWNS (Thioxaction need not he completed it[be permit is lire one hundred dollars($I Oth 307 — INSULATION Iemil.) 308 — SHEETROCK employ any in mn performance Of tM work far which this permit is issued.1 shall not 309 — EXTERIOR LATH employanyijima inany manner m asm Mmmc subject mthe Workers Compcnxation Lavercant rmia.Da" 310 — INTERIOR LATH npNleam NOTICE TO APPLICANT,11,aper making this CediGcac of Exemption,you should 311 — SCRATCH COAT become subject to the Worker's Compensation provisions of the Labor Code,you must OZ formwim comply with such provisions Or this permit shad he deemed revoked. 313 - ROOF NAIL zCONTRUCfIONLENDINGAG[NCY 501 — FINAL ELECTRICAL ENERGY F Ihereby allirmbar thntsamnnmchouleading agentyfor meN,formanceof 502 — FINAL PLUMBING ENERGY C > he work rtwhichthis pcmaitisissued(sec.3()J7,Civ.CJ ndersNamc 503 — FINAL MECHANICAL ENERGY Y]0 �DZ Icnaer'aA°e " 504 — FINAL BUILDING ENERGY U O 1 certify that 1 have read this application and state that the above information is 505 — FINAL ELECTRICAL lT. F+ comts.el agree to comply with all city and county ordinances and state laws relating in O U building construction.and muchyamhorlmmp2serandoesefthis citytocnt=rupno be 5 — GAS TEST FW aMrve-menGonedpmperyfor inrreehoupf r 507 — FIN BI G C4 (We)agree to save,indemnify and kap harm less the City or curator no against h liabilitis,s,judgments costs and expenses which may in any way warms against said City 5 N U Z in comosucnce of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued b 0 S UR I.A�JONS. Date f� O ��" �� '�f (7� Re-roofs 514 - NAL PUBLIC WORKS sog—fi aloin TApphcandcontranor Date HAZARDOUS MATERIALS DISCLOSURE Type of l�9Q — ROOF PLYWOOD NAIL Will the applscamor(.'am huildingweupem smrcor handle hvardfus material 603 — ROOF BATTENS defined by the C.Nn)no Municipal Code,Chapter 9.12,and the Health and Safety le,Section 255321¢1! All roofs 616LW bt m Pte"t� GRdH OY°r den, � &jfrnalerial being installed. Will the applicant or furore building occupant use equipment or devices which If a roof is installed without first obtaining an ins Ion, I agree to remove emit hxrmdu t, or contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection. Di.arin! ' ❑Yes I have mad the havaNnusmumrials requirements under Chaper6.95 of the Califor- nia lMahh&Sarety Curio Sections 2550.5,25533 and 25534.1 und:rstund that ifthc building does not currently have a tenant mat it is my rcsponsiMlity m runty the occupant of the qui h t met pdy o tirf a cenmeme fit Oeupaney. Signature Date of Ap nt Date / �q Yi owncrnrauthnrmedagcm / / �'L All roof coverings to be Class "B"or better CITY OF CUPEW11NOr- ,, "'•' BUILDING DIVISION PERMIT CONTRACT•OWINF.ORMATION — ! BCLDINGADDRESS: SOUTH BAY CONSTRUCTION CO N&ITNO, 21672 GRANADA AV 02120101 ER'S NAMI7: 511 DIVISION STREET APPLICATION SUB DATE MIKE SHIM 12/30/2002 PHONE (408) 379-0400 SANITARY NO. CONTROL NO. ARCHnIiC MNGINEFR: BUILDING PERMIT INFO OLDG ELECT' PLUMB MECII wOo LICENSED CONTRACTOR'S DE LARATION z U F I hereby affirm that I am licenced under provisions of Chapm,9(commencing Job Description �Od with Section oxxq of Division 3 of me Bus and Pmfoaaions Goland my llcenais �� intallfneca e! ` 3� DEMO EXISTING HOUSE License LIc.N ca Date cr ARCHITECT'S ,CLA ATION n OwU enured my plansshall W used as public records uviLLo� Licensed Professional IL OWNER-BUDER DECLARATION C,uvii q 1 hereby affirm that 1 am exempt form the Contractors Liecuse Law forme a a OO following reason.(Section 1831.5.Business and Professions Code:Any city no enunly I which requires a permit In ennstrvct,alter,improve,demolish,or repair any structure t°-'^ oionn its ismanccalsrre mma thea lican,Rusoch .it file a signeds,mcmenl I-Z• p 4 pp pc z< thmhicn With S FL Floor Area s o 9� $7404Ltion C,f- (Commencingatheisempth hum o m and th basison 3 r e allcpinexemptand Promason.Any vi Grdc)of y $ that he is 31.5 b tang applicant li and the basis for the alleged applicant to Any violation of Section 7t1han by any applicant fo,a permit subjects the applicant m a civil penalty of not more than live hundred druara(ss1IB). Occupancy Type ❑I,as owner of the pmpeny,lir my employees with wages u their sole compensation. will do me work,and the structure is not intended or offered for sale(See 7(44.Business and Poofcasionx Code:The Cunuannr's License law does not apply to an owner of egmre nspe-abons property who builds or improm thereon,and who docs such work himself or mmugh his Own employees,provided that such improvements arc not intended or offered for sale.If, however,Be building or improvement is sold within one year of completion.be owner- builder will base the burden of proving that he did not build or improve for propose of sF O�C9 n /jk�A LE ale.). 0 ❑h axr of me property,am exclusively contracting with licensed contractors to cormottthe project(See7(),14,Basin.aoil Professions CWC:)The ConVac,orl se Li- AN O 2UU3 cenlaw does not apply m an owner of property who Wilds or improves thereonJ ,and A L who contracts for such projects with a contractor(s)licensed pursuant to me Contractor's License Law. ❑I am exempt under Sec. ,B&PC for this reason BUILDING r Dat WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of thr following declarations: ❑ I have and will maintain a Certificate of Conscnt lose][insure for Wurker'sCompen- .had.as provided for by Section 37(1(1 of me labor Code,far me pcmmnd.of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insman s,as required by Section 390)of the Labor Code,for the performance of the work for which this permit its issued. My Worker's Compensation Insumnce carrier d P lily rol am: Comolli. -Q. �C�p .fo: 031 Z'1-Z-0$ CERTIFICATE OF EXEMPTION FROM WORKERS' s7� COMPENSATION INSURANCE (thissection need no,becompleted if,he permitisforone hundreddollars(Siff) car Ices.) I certify that in me performance of the work for which this permit is issued,1 shall not employ any person in any manner m aur become al l to the WorkersCompensation Lwsof California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should Wammc subject to the Worker's Compcnation provisions of the tabu Cnk,you must Oz rormwith comply with such provisions or this permit shall W deemed mvoked. 'Zuj CONSTRUCTION LENDING AGENCY F I hereby affirm that mere is a construction lending agency lin the performance or cLthe work for which this permit is issued(Sec.MAI,Co,C.) 1 0 Lender's Name z Under's Address U C I certify that I have need this application and sure that the above information is IL r. correct,l agree to comply with all city and county ordinances and.seam laws relating to O U building corstmction,and hereby authrrive representatives of mos city to enter utter the W aliovom,judgm pmpcny for inspection purposes. H a (We)agree to save,indemnify and keep harmless the City of Cupertino against lin incoities,judgmcnu.costa and eapeoves h'h may in any way attrve againn aid Cily U z income{ reel of the gramin (this pc ti. APPL A UNDERSTA AND LL CO PLY ITH N N-P Nr Issued by: Date SOU CER ULATIONS. �.,_ R14 e-roofs ayyrw r sec tar D m HAZARDOUS MATE RIALS DISCLOSURE Type of Roof Will meapplicantor m,Immobuilding Occupant Chapter sure or handle Ihallousmateriel c JC.Ste io the Cupertino Municipal Code,Chapter 9.12,and the Ileal,h and Safely C.Scnion 25532(x)'! / E]W., ,Ip'INo All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant Use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mil hazardous air Commit minis as dc6mcd by the Bay Area Air Quality Management Districl9 all new materials for inspection. ❑Yes No I have dead the hasaNnus materials requirements under Chapter fi 95 of the Califor- rslical S ryCalc.&r1mxv255O5,2M1J md25534,1undcrsundmulifmc Wilding Coaxial torte t neve a tenant it is�I�f,espnuibil' In not IM t'upon of me 7drTem. hthmuvWmm nn is cenfaC .fie of ey' Signature of Applicant Date 0 owne nfaam All roof coverings to be Class "B" or better