05020134 iARC1HRLkGINZEkR:E
Y OF CUPERTINO rye
BUILDING DIVISION PERMIT CO1 �ACTOR TNpACTaN .;
ING ADDRESS: STEVEN CHU & HOSANNA HO PERMIT N005020134
615 JOHN WY
R'S NAME: PERMIT ISSUE DATE
STEVEN CHU & HOSANNA HO 08/10/2005
E: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
S U BLDG Mql PLUM MECH
o(, t�
app LICENSED CONTRACTOR'S DECLARATION Job Description
1 Wrathy ME.that 1 am Reamed order pmvisions of Chapter 9(Commcming P
with Section 7W))of Division 3 alone Business and Professions Co to and my licenW i3
in full fame Leeand ( F2� ADD 1300 ' -FAMILY_$M� - 2 BATHRMS
s Date clan �_comr PARTIAL REMODEL/WINDOWS
3 D.m Contractor
e ARCHITECTS DECLARATION
j I undewnJ my plain MVI be used u public recortls
' �f2es
s0
Licensed Pmksaional S
OWNEm exempt
I DECLARATION
I hemby.(Sem that 11. exempt form the Gaainclor.License Law for the ! '
o o
which
re reason. (Smit u 7fy3 L3,Business and Professions Code:Any em as county "'✓ /t�.'C.���
which reyuiaa a permit o cnnalmcL alcor.Improv,dPermit art 2 sig any mucture
Zsn
prior msliceenatip.. Acquiree the applicant for m.hractartmicens,Law
alaimerl
ggFFG Nommen lkmwit pursuant 70th)pavisionsn or Comaereand Prulaw(ChaPlcr9 Sq.Ft. res titin
SIL th(commencingaisxempt Section 700d the
basis n 3far n( al Business ecad m t en.My
Cone)or $16 0 0 0 0
Wt he ts exempt therefrom and Ue basis far the alleged ucmpa..My violation of
Section
e inns Nen feby nndartdhdon frs rSSW) h subjects the applicant o a civil Family of APN Number Occupancy TI pe
❑1.uownuoftnepmpmy,ormyemployeawiAhwaguutheirmleeampenntian,
will do the work.andukurumunit.mmundedorolferwmtaake(Sec.7Bea.BAwACM Required Inspections
Ad Pmfoulona Cade:The Commences License naw dues nut apply m an owner or 9 P
prepeny who builds or i mprowa thermn,and who does such work himself w shrough his
Own employees,provided thatmch impmvemeno meet landed aroRerad found.If,
however,the building or Improvement is mid within o«year of eemplco0e,the Most-
builder
woerbuilder will have the burden of proving Nat he did not build or improve fa puquse of
nk .
1,as Owner of the properly,am exclusively contracting wish Ikensed contractors m
construct the pmlem(Sec.7044,Business and Profession Coda)The Contractors U.
cense law dans not apply m m owoer of property who builds or impmw derma.rod,
who contnar for such pmjeN with a eonuacor(O li«rand pursuant o the Contnetors
License AW.
I am exempt under
Sm.
,B h P C for this won
r Data a or
ORKFRS CO ENSATION DECLARATION
1 hereby aflimt under penalty of perjury ane of the follmving decimations:
1 Mw sad wnl maintain a Caronam of Consent to ulfduune for WaM1er.Compem
noon,as pmvlded for by Secdon 3700 of the tabor Code,for the pcdomtance of one
work for which this Permit 0 issued.
❑1 haw and will maintain Warders Compensation Wurm«.as required by Section
3700 of she labor Code,for she perfomunec of be wart rot which this permit is Actual.
My Workers Campeueti.Inman«canna and Pull,number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMP 70N FROM WORKERS'
COMPENSATION INSURANCE
(Dissection need nmbecamphned Ifthe pensh Isfmombandad dallus(5100)
At less)
I certify the,in the perfmmaecc of the work for which this permit Is Issue d,l shall nor
employ any person In my manoerm m e n to N)worken'Compeuaaon
Laws of California.Dau
Applicant G
NOTICE TO APPLICANT.If,after making this Ccaiffom of Exemption,you should
become subject An one Worker's Compensation provisions of she Labor Cade,you muss
O O forthwith Comply with such pmviamu or Nu permit shall be dd rev
«m) oked.
.N~. CONSTRUCTION LENDING AGENCY
t—e I botany alarm Wt thea iso conswcdW lending agency fn tie performance of
fdi dk work for which this permit is ladled(So,.3097,Glv.G.)
�W G Lender.Nam.
7 Z Leaders Address
U O 1 certify that I haw read this application and sum Nn the.bow Infomulun is
1••� comtt I qme An comply with all city and county on inameas and sues laws mlating to
Q SV' nulldlagCa0aWC1i0n.and hereby mtharim mpmkmatlw of this city m mist upon am
W ahavrmenaonalpmp)oray far inspection Purports.
(We)agree saw,indemnify and keep Mahatma;As,City of Cupertino against S40
y Iiabilides judgments.cats and expenses which may in my way Monte against said City 6
U 7 in conseq.me of the{Hung of this permit.
A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 8-//V
O
SOURCE U TION
Re-roofs f
Signa rt of Applican✓Contracor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.factum Wilding occupant alma a hadlc hand...maneaal
caned by the Cupenim Municipal Code.Chapter 9.13.and de lha A and Safety
Seca.25532(a)? � All roofs shall be inspected prior to any roofing material being installed.
❑Yu g]NO
Will ate applicant of future building a«u m.k If a roof is installed without firs[obtaining an inspection,I agree to remove
Pp g pa equipment m devices which
it havardeu air c.andoe u u defined by the Bay Area Air Quality Management all new materials for inspection.
t Dimict7
❑Yes MNo
1 haw mad the huzdmsmamriabrequimmenu under Chaper6.95of de Califon
nu Hultha'SofNy Cade.Satiou75303.2S533a 25534.lmdem4MNulfNe Wilding
dm M.,.d
ew a Conant,shat It u my responsibility m nndfy dw ace.Pant Of one
myuim"b)mmpdatotstu.:ceofaccmnc.mafoccupmcy. Signature of Applicant Date
.gem Data All roof coverings to be Class"B"or better C/