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01040009 CITY OF CUPERTINO - ' BUILDING DIVISION PERMIT CONTRACTOR,INFORMATION: BUILDINGADDRESS: PERMIT NO. 21103 LAVINA CT. 01040009 OWNER'S NAME: APPLICATION SUB DATE DENNIS WONG 04/03/2001 PHONE: SANITARY NO. CONTROL NO. ZO ARCHITEC'/ENGINEER: BUILDING PERMIT INTO ee u E BLDG ELECT PLUMB MECH waoa CJ LJ I-1 L._I Z 5 N Z LICENSED CONTRACTOR'S DECLARATION Job Description O Z so 8 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing F=- with Section 7")of Division 3 of the Business and Professions Cod and my license axe is in fail force ad erregl� .6 t 7 SFDWL, 4185 SQ.FT. LIVING SPACE, ca O i License Sic.p w 3¢,h Data c°"tm`1Of 2y��" 489 SQ. FT. GARAGE . } RCHITECreDECLAR 1 o 1 understand my plans shall be used as public records 1)Q �' �® w p O Licensed Pr°re,sionid .2 p Q 2 00 2 OWNER-BUILDER DECLARATION 1 hereby ulBrm that 1 am exempt from the Contractor's License Law for the F Z< following reason.(Section 7031_5,Business and Professions Code:Any city or county JUN C L et which ey 5 a perm,m construct.alter,improve,demolish or repair any sura m e pliellis illIs reditilecl the applicant Tnrsoch pennit to file asigred tteric)t h he 14 Int5flVitid111111L.ral , Ne la .moor the G,nlracl,r, La,,(Chapin9 SC.I1- EIOUT-Alea n�p, uation-. a 'sums t 7WO) fD'.an 3ofheU-meS dr rs,on,Code) i-.43'b1=^.� : .l a, 4..�.7'r.sx-�_�9.'.i'it 4{5I3, or that h Empi th f m d th empuon basis for the alleged exAny violation i Y}/ 2 of Section 7031.5 by any applicant for a Permit subjects the applicanuo a civil penalty l or not more than five hundred dollars(S500). APN Number - 1, it Occupancy Type ❑1,as owner or me property,or my employees with wages as their sole compensation, -w111do the'wblk,,-and'the armhole not intended.1 Ifirred for sale(see.lou; Required Inspections'" 'Business andprofessionsCode:The Contractor's License Law does not apply to an •' ` - owner of property Who Wilds or impmves thereon,and who does such work himself s °r through his own employees.provided Nm such improvements are not intended or 1 1 - FOUNDATION --oReied for..E.IC fiowevcr,the building - ...._.__ or improvemem n sold within ons Wild of -_---I -- - --completion,theoserifsuild'r will have the burden of pmvmg that the aid not buJd of 102 - PIERS mprovemrPupo orale.). _10.3. . LIFER.._ c _ Oas --- .._.._.._ - - - - ---4----- - -- -- -- Las ownerofthe property,amusinessland Professions CWensThe Commuter's omcmrsto 104 - REBAR ,; _ -- consumer theLaw rowan(Sec.]to a.owner o and properly w io b Code:)The les them n, E.l ,. License law does not apply m an owner of property won buds,or improves thereon, 105 - ANCHOR BOLTS _and who.contmcu s.wima for such prejectcontracams).licensed pursuant-to.de- _.. _ -_ _ .. _. . .— c°""a °`aL"`"m106 - SEWER & WATER„dt ;,,, ❑lam exempt under Seca' ,B&PC,(or this mason (1 oma « phti . 202 - UNDERFLOOR PLUMBING WORKERSCOMPENSATION DECLARATION 203 - UNDERFLOOR MECHANICAL I herebyafrm d_ pnaltyifpLrluynnGofmglznowmgaeemrattnn,: 204 - UNDERFLOOR FRAME >, """ and w,irmaintnin a'c Adleme of Consent to self.msom for Worker's 2 05 - UNDERFLOOR INSULATION Compensation:-as provided for by-section 37W of the Labor Code. for me performance of the work,to which dtisge,mitis i„a'd.l 301 - ROUGH PLUMBING ❑In mJ did t Wo rk Crat,broillim . ecoiled bySbflma 302 - TUB & OR SHOWER 3700 f the"Ihcr'C& f Ili perfo' f the work f which this'red,i 'is MY WorkjjPaCn d Icon n naP1y brare: 30.3. ROUGH MECHANICAL...-...... __._... _ _._._ .__. _ .... Ca eSfiA.TR!,C(.�lvl e.Pu cY _... O s• �}.,.pF'� _ - /0-0S'304 -ROUGHi;ELECTRICAL rt;iiIM N OF.EXEMPTION FROM WORKERS tt- + - .y.. .. COMPENSATION INSURANCE- .;.„-. FRAME_-. ' s' •' '”, mis saaiitin Aced not be completed if the permit is for one hundred do_Ilars 3 0 6 5,1-" HOLDOWNS '''- " `' "`'''t'"' . . '(8100)mlusd .3&7 - INSULATION-..._..:i._. i,� I c ndY,that in the pert mance of the work foi wM1 ch di-pe,mit is issued,l Iv, {,� shall not employ any,person in any manner so as to become subject m me'WorkeK 3 08 - SHEETROCK Com ,.ah Laws of Califomla:Date.' -' APPIa'r-°" . _.EXTERIOR_LATH' ...-.--- - z ^ ;NOTICE TOAPPLICANT;If,after makin this Certificate ofExemtion,youshould RCOAT --- .I- , necomesub3ecn theta rke! C penvg provisions of thLabor Cod,you must 310 - INTERIOR ' O form th reply ithsuch p ism ns or the Pmol hall be deemed tea. ....311._- SCRATCH _ 5 CONSTRUCTION LENDING AGENCY i - 7 1 h reby affim that'he.is.construction lending ag cy far the perfmamme 313 - ROOF NAIL , W of the for which mxp mil is issued(s3ro7 em.c) Lendeders Name _ _ __..,501: - . F.INAL_ ELECTRICAL -ENERGY. N • -.. (See _. ... - e. - Q-Z lad Add"` 502 - FINAL PLUMBINGnENERGY V-0 1 rectify that I hao,leadthis applicationd site that me above information is - 503 - FINAL MECHANICAL ENERGY Tar-F.t correcting o ct 1 grt to comply. th It city and county ordinances and state laws belong O_V tobuilJingmns,rection:hndherebyawhrdizeiepresenmtivesnnniicirymeme upon 504 - FINAL BUILDING ENERGY the above-memlomJ proPeny for,inspection purp°,es. ,_ Imnu (We)agmeinsave.mdamniryaadkeepharmlesstheCity ufCupertiv, gam, 505 - FINAL ELECTRICAL j udl ems mv5 d ncpense which y in any way accrue again,,said V Ccome o q -earth . Rhe gr,tng Of th mit 506 - S T T _ PLICANT,UNDERSfAM1DSAN1) OMP WITH AL -POINT Issued Date S URCLREGULA71(3NS 'l` 2 .Sign ur btAppicant)Cont st Q - ,pate-, Re-roAO - FINAL MECHANICAL Will theapplicant HAZA us fv1AlFR1Als DISCLOSURE " .d .I Type o6 A�3f- FINAL GRADE " o I m b Idi,g ,pantshandle ... _ _ °i 'h rd° _ as re'n'd by the Cupertino Municipal Code,Chapter 9,12.and the Health and Safety cos seahon253 u I t r f F� , X510°I'=: FINRli�;PLANNING ❑vet.- , No , , d+1 � " eta - _Atl rocggis4al!_belt11 RT.9d.POBlpjoy Woftgnaterial being installed.-,__---_ Will the applicant future bddmant use equipment or devices which ! emit mocardims air conta to'defined by the Day Arca Air Quality ManagementIf a rod'knsalRl *optfy.%gb i Uspection, Iagree to remove Distrct all ne%T ijerLiIs*6&pp � . Micant understands and will complywnh ovaIP all non- Tt sou p�1 n. n` I hova read',th haaaN us materials requirements under Chapter6.95 of the 4 - ��P' N-PROGRESS' •tl' ' CaliforniaHealth&Safety Carde.Sections 25505.25533 and M534I understand tear if the all Iding Jas not cnrre have S tebhni:tea ius my msponsibiliry to notify Ne - anpam of the require is r ich must h t met prior.,issvnace of a Certificate of Occupancy., .r. / . . Signature of Applicant _. —._. ._ .._. _ . Date_ .. . . Gwne,orp n xe 'm All roof coverings to be Class"B" or better . , ._ '-.�;. .. . ,: ._._ ....... ..--- • -'- -._ r -- OFFICE t ..