02030046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORINFORMATION:
BUILDING ADDRESS: PERMIT NO.
10576 JOHANSEN DR. CHRL HSIEH 02030046
OWNER'S NAME: APPLICgqTION 5 B D T
CHRL HSIEH 03M72 62
•HONE: SANITARY NO. CONTROL NO.
p+v0�0F ARCHITECTIENGINEER: BUILDING PERMIT INFO
E< c� BLDG ELECT PLUMB MECH
� E I I CJ L:1 IJ
zZ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am lic t under provisions of Chapter 9(mmmencing Job Description
ori with Station 7M)of Division 3 oftheBusinessoad Professions Coda and my license ADDITION
is in full forte end effect. r„ i ,� J
z s a License Class Li,x r,%,
41 Ck
0 n u Data fomrecmr
u 0 ARCHITECT'S DECLARATION
y 1 understand my plans shall be used as public rcmrtls /� t Ile "�I
}
ao o Licensed Professional OWNER
e� BUILDER DECLARATION
1 hereby affirm that 1 1. exempt from the Contractor's License Low for the 11,205 I0
C?< following requires
a permit
in
]031.3.Business and Professions Cade:Any city or county
as Ilio h licensed a perms m con wv sloe improve,demobsh a repair any structure
which q res two oleo rcqums the applicant for such permwo fl sigmd statement
n3_ (Commencing sed pdnunnt to ihp Orb isions of the Contractor License Law(Chapter 9 r Valuation
(Comening with Sco 7000)pf On iion 3 of the BusinessgrM ProfnsstonsCde) i ',' '„t3 �' �r;V"S'tl .'lY :s 1' ',_”
nr t Itis
or
he
empl therefrom and the basis for the alleged alempuoa Any violation -
of Section 7031.3 by any applicont for a Permit subjects the applicant to a civil penalty
,of
nm mmterhei,five hundred dollars($500). 101APN kft DATION • ^- Occupancy Type
1owner of the property,or my employees with wages us their sole compensation, 102 — PIERS
eo the work.and the structure is riot itheaded or offered for sale(Sec: 10 3 - UFER Required Inspections'"
'Busihess'mid-Professions Code:The Contractor's License Law does not apply to an --
owner of progeny Who builds or improves thereon,and who does such work himself 1 0 4 — REBAR
nr throe h his ow employees provided that h improvements arc not intended or _
m eyed o isle If,w ow a herwill
building or Improve nt n sold w this one year of 1 O 5 — -ANCHOR--BOLTS
`improv tion,the owner-builder will have the burden of proving that he did not bold or
improve roc pamose or sate.). 106 - SEWER & WATER '
Dl as awnv otthe pro gny ern exduslvel ycan trading with hcensed convonomto - '2 0'2—" UNDERFL R -PliUMB" ' .ii��
construct the projecl bee.7(44.Business and Professions code:)The Comtroetore 2 03 - UNDERFLOOR MECHANICAL-..:, I;
Licence Law does not apply to an owner of property who builds or improve thereon, -
._and.who.conteaev..for.uch.projets whh.a.conmutorfa)liceoutal,pursuant.to.the. ._._,.2.04._.—.._UNDERFLOOR FRAME-.-
Contractor,ons tors License Lew .,
❑Isis scop Dila Se _ Be P C to this recon 205 - UNDERFLOOR'; ,INSU'LATION
301 - ROUGH PLUMBING
Der W RKERS� at Ohl DECLARATION SO2 — TUB Sc OR SHOWER
�i I hereby affirm uMer penalty ofperjury',mne of the following declarations: 303 — ROUGH MECHANICAL
LD I have'nod!will meinuin'a'Certificetc of Consent to sclifinsure for Worker's 304 - ROUGH ELECTRICAL
/ Cmmpc....itnir cs provided-for by Section 37W Of the Labor Code:for the
Performance of the work for which this Permit it issued.. 305 — FRAME
O l Woeand will maintain Worker's Coppeussiduilns...a,as mal6ired by Section 306 - HOLDOWNS
37M of the Labor Code;for the performance of the work for which this Permit is 307 - INSULATION
ksued M Workefa Compensation lnsuOn a mess u
My a 1 g 'dPamyn mberarep 308; SHEETROCK-' '"_"
_.
e�.
caner cont No. i- -
ExEMPnoN FROM WOR - '309 ' EkTtRfOR LATH'
SATION INSURANCES r
coMPEn 310--.; INTER30R--LATH---
(This section need not becoppleted it the permit is far one hundrM dollars 311'`- SCRATCH COAT
($100)or las )
eAhP 11orsalon employ an :. s. .. . , .. ._.,.....,,.502. ^ �FOINALNPLL _.._. __ .__ ...... -
1 eemfy thatin the gdo ace o(the wok(r which tht 4I
nh such s Ctmoms or thn permit shall bed t is t sued t
n pevona ay nater to become sbjecto this Winters 501 FINAL ELECTRICAL'IENERGY'
ffellfbmla
UMBING .ENERGY..
0 ,IAN f Re,mali n eNBc�L me.fEuZinin Y.0thoold 503 - FINAL MECHANICAL ''ENERGY
0 lmrthwit coo 1 w a stO:h ps Compensation provmone lithe Labor Code.you mus
m n a ton w
OTIC A
Demme sub em to
CONSTRUCTION LENDING 504. _- _F_I,NAL BUILDING ENERGY,
P Y P _ pe deemed rewkea
p 505 - FINAL ELECTRICAL
thereby affirm this there s e issued
(Sec Irndtn eyency for the gr(orinaace —
w _ c) 506_ GAS TEST
0 rndvi N acidly that Ibha a ad this applicationS cendmm the '—_..... _.
Z
r, 507 - FINAL PLUMBING .I
L d acidly V
v 508 - FINAL MECHANICAL '
t the above informer n rs
fL=U token.ng cree m cotnpl.with eby autsoil county ordinances and stere Iowa enter
upon 509 - FINAL GRADE
O;rW theaboe-mensudedpropndhercinspecLnre4epreunmuvesofNiscitytoenmrupon 510 - FINAL PLANNING
? �y the above-mentioned meaironed property for inspection purpou
tr` Y 1We)egmeiosave, and
keep harmlesihe City of Cupentno against 514 - FINAL PUB IC WORKS
Fa'fq cliabilities,tyon judgments,corse e d gases huh may m any way ac roe ageinIt.uid
V y City c sequence of rhe grant B otW pl '' n
ysPPGCANT NDER$TP1D$ WtL[ PLY WtTH ALL ONPOINT' 1
So Ree L'AT o� �` Z Z-O Issued by: Date Z
atuJey APPB, can r mr . nage, Re-roofs
(/ HA7ARDOUS MAr6UALSDIsCCOSURE `
¢unto Pooue building accu nl StorciorhuWle hAAvadu mem al Type of Roof: p•...__ p _ ., . . yroofing
_ g ati ---
.. Will the I g FSafety .. r .... ... ..
bF B W
defined by the Cupertino Mum t _ode Chapter 912 and the Health and
Cede Semron ZS 324U7kt fit t J s'r - 'i
❑Y<s ro oonta mann u a b this e, A aAm cart M.en All.roofs shall be ms ected nor to an roofin material being installed-
nh)Wjl map N r4r 5 G
i
,wul tae. 6nn*onus as d la'.gbyoctopturat use Bay'Aegmpmenality M cel which If a roof 1s metalled without first obtaining ant inspection,I agree.tolrerriove
nci7 A all new materials for inspection Applicant understands and will comply,with
' Quality gement
Ceb(o I hHe W d the(ou.,d.,O 6,umesn2334timm F3 all non-point source regulations ,:, '
!tic huemaus !oriels re .25533 a
oc a ant of re'ore a which rnu met riot m ssuAnee df a Cemfic!the
Y / d that
Y j responsibility ronotify the.. . ... . . .. - . ... .. _ _. ..
-if Ili rob ncd eaq fey f P Id 233361undenunete,of
� under Chapter 6 93
_ Signature of Applicant Date
_. roof be
o a rat rhorrzede am .1,-, �^ a All roof coverings to be Class `B"or Better
- Y Dat
.� -OFFICE.. .. - .- _.. . .. .._... _ ..._ ,:._.._... ._._..._.