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05100009 • CITY OF CUPERTINO BUILDING DIVISION PERMIT ,CONT,RACT('iR INFORrMATIQN r; BUILDING ADDRESS: PERMIT NO.Q 51 Q Q Q Q 9 ,e 9415 ('RF. NraC)C)n I)R OWNER'S NAME: PEItMrf ISSUE DATE LORETTA JEW 10/03 /2005 )NE_ SANITARY NO. CONTROL NO. ARCHITE=NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o 0'z LICENSED CONTRACTOR'S DECLARATION Job Description G I hereby affirm that 1 am licenxd under previsions of Chapter 9(commencing P U with Scetim.7 M))nf Division Wife,Businessind Professions Codc.end my license is nmllto- and Off« GAS METER (4 UNITS) . Licenu Class Lic.s /eA P.017 c-o Dam cc^ comamt rna rkM oL waa� CONTRACTOR: MR. CHA PLUMBING & ROOTER t-F ARCHITECTS DECLARATION p;< I undersand my plans shall he used as public records JiU s G G Licensed Pmfessianal 5 OWNER-BUILDER DECLARATION iy I hereby affirm that I am exempt from the Comrenors License Law for the 00 following mason.(Section 713 L5,Business and Prercssions Code:Any city or county i m E which nu,irn a Permit to emmarvn,alter,improve,demolish.or repair any suumure °i< 'min.,ts issuances alw require Oc applicant for such Permit to file a signed comment that be is licensed pursuant to the previsions of the Connector's License Low(Chapter 9 Sq. Ft. Floor Area VaIDa[i$15000 xr0 (commencing with Section 7")of Division J ofthe Businessand Prufeaions Code)ur i Nat he is exempt tlarefrem and the baso for for alleged exemption.Any violation of section 7031.5 by any appficantfor.pmm,mbj.ctsthe.,ficantto.civil Penalty of APN Number Occupancy Type not more than five hundred dollars(6500). 37504030 . 00 ❑1,as owner ofttie property,or my cmPloyceswith wages u their sole compenution, will clothe work.and the awaom is not intended orofremd rot sale(Sm.vas.Basins Required Inspections and Professions Code:The Conuacm's Liana Law mixed not apply m e an Owner of q P propeny who buildsor improves thereon,and who doessuch work himself or through his Own employees,provided that such improvements arc net intended or.Rand for sal..If, however,the building or improvement is sold within one year of completion,Ne owner- builder will have the burden of proving that he did not build to improve for purpose or sae.). ❑1,as owner of the property,am exclusively convecting with licensed convenors m construct the project(Sec.7W,Business and Protections Cade:)The Contractor's Li cane law does not apply to an Owncr of property who builds or improve thereon,arm. who contracts for such proXets with a conuacier(s)licensed pursuant to the Contractors License law. ❑T am nempt under Sec. .B k P C for this..on w r Dam WORKERS COMPENSATION DECLARATION 1 hereby aRfm under penalty of pe jury one of the following declarations: T have and will maintain a Certificate of consent to self-hour,for Workers compen- don.as provided for by Seeaon moo of the Labor code.for the Performance of Oreork for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,az required by Section 7100 of the Labor Code.for mm performance of the work for which this permit's issued. My Workers Compensation Insurance canicf and Policy number art: Cmdr,': Eli MQy�� Policy No.: CERTIFICATE OF EXEMPT ION FROM WORKERS' COMPENSATION INSURANCE rlTu section need not becompleted if the Permit is forem hundred dollars($10)(1) or mss.) 1 certify Nat in the performance or the work for which this Permit is issued.I moral not employ any person in any manner an as to become s rbjen to Or Workers'Compensation Laws of Califemia.Dam Applicant NOTICE TO APPLICANT:IL after making this Cti ificate of Exemption.you should become subject in the Workers Compco tion previsions of the Labor Cadc.you mum .J O foMwith comply with such provisions or this permitsha t be Oriented revoked. 'Z'C CONSraUCTION LENDING AGENCY fY P .M•. I hereby atrrm that Nem is a construction lending agency f or the performance of � the work for which this .it is asted(Sec.3W?.Civ.C.) U] ESLemicr's Name Lender's Address V 0 1 certify that 1 have read this application and sum that the above information is U. P correct.I agree to comply with all city and county ondnanms and sum laws relating to DU building convection,and hereby audiono,representatives of Nis city to cnar upno the res above-mentioned proper for inspection purposes. (We)agree to save,indemnify and keep harmless the City Of Clepcnino against Iiabilitiu,judgmenR eats and expenes which yin any w.yaceoe against said City U Z in consequence of the granting of this pertn' APPLICANT UNDERSTAND ND ILL PLY WITH ALL N N-POINT Issued by: Date 116--?- 0 a— SOURCE REGULATIONS. i d o a �= e-roofs .cul Siyuwrc Of Applicant/ n r or HAZARDOUS MATERIAE. DISCLO RE Type of Roof Willdue yfive Cli,amor fume,buildinge.Chanlstom .handle Health usmamrial az defined by de Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cade, - Q No SectionYes 25572( All roofs shall be inspected prior to any roofing material being installed. ❑ Will thea licarm or future building Occupant use. t or devices which If a roof is installed without first obtaining an inspection,I agree to remove nn s v equipment silt havmnus air contaminants as,donned by the Bay Area Air Quality Management all new materials for inspection. is. 0Y.s ❑No resam I have el Ne hardnus amrimsrcd.imni under Chapter 6.95 of the Cali foo- ria Health@ SafelyCoce.Scedas 25585.35533 and 255th.l undcrsvW does ifdle Wilding does not currently hart a soon,Nat it is my miliumbil ity to awly the meupant of the requirements whichmomlometpoortoiasamceofaCenNcateofOmdparrY Signature of Applicant Date Owner Of auNomed agent pare All roof coverings to be Class"B" or better U L r ci J-e 2 > f � �oS- ( �1 �(� �r 2 Q� Gv�o d� �U Cu /�-�r•-fi l2� .,�. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 OCITY OF Fax(408) 777-3333 UPEkTINO Building De artment JOB ADDRESS: PERMIT # lcl-to 2c6 Q S% 0660 OWNER'S NAME: Lo2CSTA gw PHONE # Lig 5to GENERAL CONTRACTOR: u>J Co i FAX # I am not using any subcontractors: 1 0 1 3 1U S ignature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing 1 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO REPIPE/SE'WERS/MAIN SERVICE OCUPIEkT NO PERMIT APPLICATION FORM APN # .- 7SOK03c� IIv�3/G5 Building Address: z1f 1 q#2 m'115 aF(:rJ vioov 0sz 14 ,105 - ter Owner's Name: Phone#: L o P-C-CTA Contractor: Phone: License#: Out.jv . Ilii CNa ( Noy 2iS- e7bF) (o BflS17 Contact: Phone: Cupertino Business License#: JwN& CHI), Caw. 2r Building Permit Info: / Bldg ElElect ElPlumb Q Job Description: Residential Commercial ❑ Cost of Project: fj U 00 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING 3 Wy