01110126 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BJjH1DINCyTREINDY PL PERMIT NO. 01110126
YttlWE:& LINDA TONG Cp
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PHONE: SANITARY NO. l U U CONTROL NO.
BUILDING PERMIT INFO
0,-,.FARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
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z
nZ LICENSED CONTRACTOR'S DECLARATION Job Description
J z C I hereby offrin that 1 um licensed under provisions of Chapter 9(commencing KITCHEN REMODEL.
with Section 70000.1'Division 3 of the Business end Pmfcssions Code,and my license
r Y is in full force and effe o O
OU License Claw Lic.p J
Date �^7�
Cion or
IRE,
a0 ret ARCFrITER'S DECLAR
g 1 iu demand my plans shall be used as public ors a
Y
u O O Licensed Professional
'n,a nor I..BUILDER DECLARATION
1 hereby aRrm thm I am exempt from the Ca'stor's a An law for the 5 1
t z a fon g reason (Seco my 5 Ba:neva and Pares,onto Code
os A y c ty aoanty t t 1000Dwh h 9 rcsape"Iso c .t naPireli' tirtictnobb P 7r�,4
R ,. .....�
3� pnmi 1 ce.ebom9m m ppbcam for such perm.. fl g d txmem
h• PoorI ish_,dpuj Tin a' provisionsof the Commcmr License
¢n Ia IChapmr9 a ,,3 cGn2�g r'.g ,� 3 s' Valuation
(mono.., gwrth Satbn](NNI)of DivistonJof th<Busin. red profess
rro"
or that be o exempt therefmm'un'"a .,i,for the alleged asfmpsion.Any violation
of Station]03.5 by any'appliaant for rt permit subjects the app recon, a civil penalty-
otnotmorethan five hundred dollars($50o), 101AP-NE41IRMIDATION Occupancy Type
01.as owner of the property,or my employees with wages as their sole compensation, 102 - PIERS
:will do the work.andthesbuclure is not intended or offered for sale(Sm.7044, 10 3 - UFER �
Business end Professions Cade:The Contractor's License Law does not apply to en Required Inspections'
awns of property who builds or immasea maman,and who does..all work himself 104 - REBAR _
or through his own employees,provided that such improvements are not intended or _ _ _
offered for sale.If,howevec the huilaing or improvement is sold within one year of 1 Q 5 - AN BOLTS
completion,the owhic,builder will have the burden of proving that he did not build or 106 - SEWER & WATER
improve for pmposeofmle.),
.s . -202' UNDERFLOOR--PLUMBING
❑has owner of she progeny,oto exclusively a d Professions
with licensedecant Con tractur m '
-.- aonswnthe ons (sec, toa Business dna Professionscode.)Thecontractor's 203 - UNDERFLOOR MECHANICAL
Licensenwho
law does oat apply man owner of progeny who builds or improves Merton.
- and who contrasts for such projects with a complainant)licensed pursuant to me. . __ __.. .204 - UNDERFLOORFRAME - --- - -- -- - -- -- ----- "
c° exemp uSm.License
1anoSm.
damps under B&P C for this 205 - UNDERFLOOR:INSULATION
❑1 am � reason
owner nam 301 - ROUGH PLUMBING
_ - WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
_ IherebyaffirmunderpenoltyofPerjuryoneofthefollowingdeclaretions: 303 - ROUGH MECHANICAL
O 1 have and will maintain a Certificate of Consent to self-insure for Worker's 304 - ROUGH ELECTRICAL
Compensation, as provided far by Sem. 3700 of the Labor Code, for me 305 - FRAME
perfori of the,work fm which this permit is issued.
_ ❑I have and will mainuin Worker's Compensation Imunnce,as required by Smion 306 - HOEDOWNS
3700 of the tabor Cote,for me Performance of die work for whim this Permit is 307 - INSULATION
- island.Mr es Compensation Insurance carrier and Policy number are. -308 :SHEETROCK' .. -..-
cariier:- t MCAT' � 1)(EMPTIO: l 5.�' 063 -•2m N�'. to: ; ',3 09� 1'=%tXTF:RIOR/iliATH..' , ....t'..
- FEKEMPTION OM WOR'R
.. cEunFTcnCOMPENSATIONINSURANCE .. ...._.. 3-10-t-; INTERIOR--LATH --..__.-..
COMPENSATION
(Tho union need not h completed if the perm t is for one hundred dollars 311 I SCRATCH COAT
(jlp0 or IessJ
313 .- ROOF..NAIL . . .
r I certify that in Ne pettormonce or the work for which ri this .issued,I t
shell not employ any pean
rson in y mannm er as to become subject to the Workers' 5 01 - FINAL ELECTR I CAL'''ENERGY
Compensation taws of California.Dam
Applicant 502 _FINAL PLUMBING ENERGY
A - -: _. - .. _ _
NOTICE TO APPLICANT:ILafnr making this Certificate afExemption,you should 503 - FINAL MECHANICAL 'ENERGY
O Cbecome the Worker's Compensation provisions of she Labor Code,you must
fonhwimcom I with such provimmnmorthis permit still beaeamedrevoked. 504 - FINAL BUILDING ENERGY
., - _
a � Iherebys(firmCibNthercUe6cOntnon'enaAgagCcyfomeperr°m,an« 506 GASATESTECTRICAL l _,
of Ne ora for h¢h Nu pert"t s issued(S 309] Civ.C)
�y q LneeraName 507 FINAL"PLUMBING _. .. .. ....
v O508 FINAL MECHANICAL'
1 cont Nat I have read this application and state that the above information is
IT. ootreat.1 agree to comply with all city and county ordinances and cute laws relating 5 0 9 - FINAL GRADE
O 1.Wildingconswcdaaandherebysuttioriurcpresentativesofthiscitytoenterupon 510 - FINAL PLANNING
gy the above-mentioned property for inspection purposes.
L (We)agrcemsave,indemnify and keep hannlexs the City of Cupertino ageinv 514 - FINAL PUB C WORKS
0 liabilroca pallonams,costs and esframa,which may in any way acerae again"acid
6> City in consequence of the jointing of this:permit. "' "
APPLIC. NT UNDERSTANDS AN 'SILL COMPLY WITH'ALL NON�POINT Issued by: Date
Olt REGULAT'DYL y'
MRof ApplicanUComnnm Date Re-roofs 1 + - Z 4"�Q /
HAZARDOUS MATyY PIS DISCLOSURE'
III dx appliant m furore hudajng'o:upaul time m handle hazvdous maerial Type of Roof --- -- - -- -. ..
es Rted bythe Cupenino M°Ncipel,�tymd Chapter 9.12,arta the Hea1N end Safety
Coic.Satiad P2(a)]- 1 s . .,� .•,y �a .l ' ... - ,.,,.�
Quem o o' ? . All roofs shall be inspected prior to.any,roofingmaterial being.installed.-.._._._ -
_� Will the applicant or future Wilding circulation use equipment or devices which If a roof is installed without first obtaining an inspection; I�agree'tc;remove
amit hazard -s air contaminants as defined by the Bay Arca Air Quality Management
District? all new materials for inspection,,Applicant understands and will comply with
- ❑Yes 0N all non-point source regulations:
�1 I linve'read the heaardous materials requirements under Chapter fi 93 of dive
California Health&Safety Code,Sections 25505:25533 and 25534.1 understand that
'
if Ne building does not currently have a mount,that is is my nmponsibility,to notify the
cupnt of N mqulrements which most he'met prior to issuance of a Certificate of
`y' Signature of Applicant Date
d a ages t
Date All roof coverings to be Class "B"or better
..,. .,.._ .,.. .,,.�,.. OFFICE... .. . ..... .. .