01110110 CITY
ovsoNO
itNPERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO, -
1103 KENTWOOD AV 01110110
OWNER'S NAME: APPLICATION SUB DATE.
KHANH NGUYEN 11/27/2001
PHONE: SANITARY NO. CONTROL NO.
COO ARCHITECDENGINEER: BUILDING PERMIT INFO
c U- BLDGELECT/ PLUMB MECH
GJ ->
�y= LICENSED CONTRACTOR'S DECLARATION lob Description
i Z 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
,iia, withSection7")ofDivisim3oftheBusinessaadPrefelme,Coca,aadmyIisms, ADDITION OF SUN ROOM
is in lull to.and affect.
Data Glma Lie.. PINALED
Data SDECContractor
!'v�s�0 rn ARCHITECT'S DECLARATION
i 6 p O I inderss ada1y plans shall be used as public records
License
FEB 14 2002
s�= OWNER-BUILDER DECLARATION
1 hereby affirm that I nm exempt from the Contractor's Licence L,Por the
N
t g a following reason.(Section]meat,Business and vet demolish,
Code:An,pai city or county $22234
Fd AC whichrequires opermit tocnnnmeLpplicit for suh Permit. fi repair anytatemet BUILDING
prior 1.a, that heioissuamaaho«16thert,the visions of for comeacmWoniforle m gaed w(Cnnmrnt
- that heir.littngdpuisuant3btfipprovid.nxonheContrazmtsLittnscLwiChepnr9 1, Valuation
Division 3 anne Business and Profession ewe) CO.
(commencing be isewiNSa0efrom 01ofDas
or that be if ezcmpt therefrom and the basis for the ellegrd uemp,iov.Any violation
of Smion]03 P.tby any applicant/or a permit mbjccs the epplicam m e civil pennlry
ofnm marcthan five hundred dollars($500). 101"PNDATION '' I , Occupancy Type
❑1,vs owner of the pnspeny,unny employees with wages vs N<ir sale contpcnmtinn,
"will do he work.and the'etrro.wis no,intended or offered for ma(Sec.](44,' -
•Businas'and Po fessiuns Code:The Comm,tor'.Licame Law does nut apply n an 103 - UFER Required Inspections -
owner of property Who builds or impvom,themon,and who does such work himself 10 4 - REBAR
or through his own employees,provided that such improvements are not intended or
.offered for sale.ICliovi nna buildhi - —.
g or improvement n sold within one year or 10 5 - ANCHOR BOLTS '
completion,the ownervbuilder will have the burden of proving that he did not Wild or
imp...efimputposeof:ale.). _ 106 - SEWER & WATER
- - _. _._..._. . , ......
_...
wnerbnhe rn leY.mn exdustvelp ronwycµn with licens Paoo cvanors to - ;,.•:�tlq ,ss,;
p e r r Bw, 202 -= -UNDERFLOOR the project(Sec.](144,Business and Profeninns Code:)The Commcmr's 2 O 3 UNDERFLOOR MECHANICAL'• ' of I if ""
If
License Law does at,a 10 an bwnerof o en ho builds nr int thereon,
' ..und,who,contracts Ba.such projecte,with a contrvicerms)licensed purmaut to the .. _. .. . -2 04 " UNDERFLOOR "FRAME... .__.._..._-... __.....
i Commaors License law. .. - ---- - -- ---
_. ❑Inmexe ,unite Sec. ,B&PCforthisr....a205 - UNDERFLOOR -INSULATION
ar' n sI�iT0/' 301 - ROUGH PLUMBING
WORKE S MPENSAnONDECLARATION 302 - TUB & OR SHOWER
Ihereby.ffml under penalty or perjaty one of the mnnwmg declarations: 303 - ROUGH MECHANICAL
❑ 1 have and will'maintuin a Certificate of Consent to self-insum for Worker's 3 04 - ROUGH ELECTRICAL
`gtL,y Compeniaram, as provided for by Section 3100 of the Labor Code, for the
perfent bone work f..which oris permit is issued,, 3 05 - FRAME '
" - 0 have and will maintain Worker aCompenurinnInsurance,umeatball bySection 306 - HOLDOWNS
; 3700 of the Labor Code,for the performance of,he workfor which this permit Is
- L issued.MyworkcesCompeasatlonInsurance carrierand Policy number am.
3O7 - INSULATION
G , '
30, : ;SHEgT11 ROCKarner it t : Pol Policy No. '` 191 C', : • ,
j t CGRTIFICATION OFE%EMPTION FROMWORKERSEXILRIOR
T-H'
COMPENSATION INSURANCEL.
„ -';, „-_-, .-.-3 107 310' "INTERIOR'liATH —__
(This sermon need not be rm mmplend if the pet is for one hundred ars doll ' •i 1-
sloB)ori s.) 311 - SCRATCH COAT ,
`` 1 c Wiry that in,h pert nnance'of,he work int which this partial is ismaj 1 ~.•3.13......ROOF NA -L"__.....:... ..... ._.,...�,.. .....__t. _
'ihall not employ any petro to any manner m as to become subject to the workcrrs 5 O 1 - FINAL NAL EhECTR I CAL'�ENERGY^
comicant onLawanrCalromtaDae, INAL PLUMBING ENERGY- .
NOTICE TO subjAPPLICANTIfshepeek. CisionsofofLaboron ,youmshould FINAL MECHANICAL"ENERGY -
Z becom subjecttothel such
Compensation ons.1pn provisions Code your n
p0 forthwithcomply Nn such prosmnsoth Permit shall bedeened ked. FINAL .BUILDING..ENERGX_.._
'CONSTRUCTION LENDING AGENCY "
t."13 505 - FINAL ELECTRICAL
.E 1 hereby t(mt that them is s const , n lending agency f the peefommnc< .. ,
�.,., nnn nkr piano IK t .isa1,- esea, - civ cd 506 - GAS TEST
Lender Name j_ ... __� _. . _ ._.. .. _ ._. . ..._ -... -. __-. .. . ._._
6t: , Leod AdErcs, 507' - FINAL PLUMBING. .
- VO - _. t • 508 - FINAL MECHANICAL
•
I certify tna,1 hese read ths application end month.,the above mformanion is
mmeci.1 agree n comply with ail.city and mcounty,nordinances and state laws relating 509 - FINAL GRADE
O'V to building cos, inion:and hereby authorize mpren,a,ives of this city to enter upon
:W the above-mentioned pro, 1,no"mi,amionpurposes., 510 - FINAL PLANNING
- ;Ont (We)ago.to sdre,indemnify and keep hornless the City of Cupertino against
fw liabilities,judgments,cons and esp -
enses which may in any way accrue.,.ins,said 514 FINAL PUB IC W RKS
UCityin2onsequenceofthegmniingonnispemnit.',
APPEICANT 'NDERST DSAND WILLCOMPLY R'mfAV HON DINT'
s Rcl :r n o. (1 l Issued by: Date
i,a.mofApplican nRe-roofs
HAZM RALSDISCLOSURE '
RDO
r W11 the applicant or Name building beepant more or handle hevarddus mncdal .Type.of Roof .. .._. ..: :. ....-_ - _.._....a,_, ._ ....
as defined by,he Cupen nn Municipal Code:Ch pt 9,12,end the Health and Safety
Cod OYes'25532(e)°at1 ,d,N t 1 ,,L {e, S (. '„'{�s^F,f, `l, atr s 'I.lt i,�'' '.,r ;'ts,y s,rat 1. ...._
_All roofs shall be inspected prior,to any.roofing,material being installed._led__. ._,
t411Wn11 Ne vpphca t rfuture Wildiag oceupml ass equpmrnt or davices when' If a roof is installed'without first obtaining an'inspectioti;I agree'to remove
a ii,ihci? d s' Ar Quality Management
D"oat all new materials for inspection. Applicant understands and will comply with
cont minan¢ns a the Ba A
n ❑Ys ono , t T all non-point source regulations;;.,,; 1- _
1 he e read the lassuolotc.'materials requlrcmcnts under Chapter 6.95 of the
California Hciah&Safety Code;Sections 25505,25533 end 25534.1 understand that
ifbuildin dcexnot cvncntl havemm�am,that it ismB
to nntify,he '-
cccu ant of the rc uirc nt which must be m t to issuance of a Cem(am of '
P 9 P.
_.-Signature of-Applicant--- Date
up or
.Z O 1 - ..
`• own r r.umorizeda,n, I Data All roof coverings to be Class "B"or better ,
OFFICE