02090185 CITYBILIIN DIVISIONNtI PERMIT ,CONTRACTORJNFORMATIONNN
BUT"49)8RENERRITT DR A PERFECT CLIMATE PF:RMIFT2090185
oWTHiFWCHIN DAVID WANG 10570 S DEANZA BLVD APPLIGATPP9�!RD/'Tf-2002
Ak
ZONE. 408 861-9545 SANITARY NO. CONTROL NO.
ARCI an-CrIENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MUCH
OOp LICENSED CONTRACTOR'S Ur:C1.ARAl'ION D O
rcuqr Ihereby affirm that l am licensed ender provisions of Chapter 9(commencing INSTALL NEW A�'�nl � FURNACE
�<6 with Scaian71MaB of Division 3 ofthe Business and ProbessionsCalc.and my licert¢is
in1.11Ronce and cifiI AND IAR PIPES . R �II�T
ion= Licenw Claes Lic.4 I=ON,�a�a'RJa+fid
F:— Date Comment, Y
@gkk ARCIIITECFS DECLARATION
. OyU I understand my plans shall bar used as public records OCT 2002
3 u. Licensed Prulessional llaa 1
=° OWNER-BUILDER DECLARKI']ON
ali q 1 hemby affirm that I in.cacmpt tram the Contract... License Law finite BUILDING
�'/ IVDA
®A fill^
E: billowing reason.Section 7031.5.Business and ProfessLions Gine:Any city or county if
>t$i� which requires a Pem,I,In construct,alley,improve,demolish,or repair any.strucmm $9800
w—'^ 'or m its issuance,also requires thea applicant linsuch Permit it)file a signed sateme0t
�'-'a hat he is lice used he pP RM1C Contractors Lice rise Law 9 S Ft. Floor Area Valuation
(commeSS P in Division p q
F° notben exempt
Section 7lakp nl basis for
M the Business sendon.Any Vi Coloof 31630024 . 00
y�� that he is exempt tcafrom and Ne hazes for the alleged exemption.Any violation of
SeCliun 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of APN Number Occupancy Type
nut mom man live bundled dollars($500). 301 - ROUGH PLUMBING
❑ 1,m owner of the pmperty,or my employees wit wages as Ihcir role compensation,
will Jo the work,and me structure is nm intended mOffered hostile(Site.71H4.Business gW�
and Professions Cookie The Conlmanr's License Law does not apply to an owner of 304 - ROUGH )_,a,,,1 ipons
property,who builds or improves thereon,and who does such work himself or trough his
employees.provided that such improvements arc not intended or offered for Pie.If. 505 — FINAL ELECTRICAL
however.to building or improvement is sold within one year of completion,to owner- 507 — FINAL PLUMBING
builder will have the burden of proving tat M did not Mild m improve for pugaae of
axle.). 508 - FINAL MECHANICAL
k as owner of the property.am exclusively contracting with licensed connaclnrs to
Comet the project(Sec.78W,Business and Professions Cede:)The Contractor's Li.
cense law Joes not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractons)licensed pursuant to tha Contractor s
License Law.
0 L am exempt under Sec. .B&P C for this reason
O� Dae OO
C I' IPEI AT ON D . AR
IhcrebyaRtrn nderpenallyofpedlosi net M following declarations:
I have and will maintain a Ccnifocate of Consent Io sell-insure for Worker's Compete
ion,az provided for by Section 3700 of the labor Code,for to performance of the
13700of
rk fur which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Secaon
sen
ion.
tit Labor Codethe,far pcff mance of the weak for which this permit is issued.
y Worker's Compensation Insurance caer and Policy number arerrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA'T'ION INSURANCE
(This section need not he completed if IM permit is for one hundred dollen(S FBI)
or less.)
I cenify the in the Per rmance of the work for which this permit is issued.I shall not
employ tiny person in any ndnera x Mr
eemhlecLtn the Wmkeri Compensation
Lawsof car f main,Dat t , 77,9Q
LGE 1 P1. .ANT:IL after making IT Cenilicate of Exemption,you should
Mcome subject to the Workei s Compensation a sol IM1c Labor CnJe,you mull
OO forthwith comply with such provisions or this permit shall he deemed revoked,
z CONSTRUCTION LENDING AGENCY
p4 I hereby affirm tat there is a construction lending agency lot he pcTfnumareCof
OY > the work for which this permit is issued(Sec.3197,Civ.C.)
W c Lents Name
C. Lender's Address
V O 1 cenify tat 1 have read this application and state that the above intimation is
D. F cortect.I agree to comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorise representatives of this city to enter upon the
r ab0vo-metnioncd properly ho inspection purposes.
6 (Wit)agree It,save,indemnify and keep harmless the City of Cupeninn against
F'h liabilities,judgment%,costs and expenses which may in any way accmc against said City y
U Z in sonegncnce of the grand ng of this Perm it.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SO E REGULATI NS.
�z iaoL Re-roofs
ognamm of
he
"On'
Type
Date
A]ARDOUS MATERI DISCLOSURE Type of Roof
Will me pplicant or future building occupant store or handle haocolous material
az MEuCd by the Cupertino Municipal Code.Chapter 9.12,and the Ilcallh and Safety
Code.Section 25532001 All roofs shall be inspected prior to any roofing material being installed.
p Yes d No
Will the applicant or furore building occupant use equipment or devices which If a roof is installed without thirst obtaining an inspection,I agree to remove
mit harvrduus air uomamioants as JcfineJ by the IUy Area Air Quality Management all new materials for inspection.
Disnict7
❑Yes '01No
I have real the hzmrmms materials rcquimments under CM1apter 6.95 of tM Cation
our Write&S:JmyGdc.Sections 25M)5.25533 00125514.1 undersand thm if IM Melding
Me,not currently have a Tenant tai it,,my reslamsihility to until tM or.am nl die
requirement%which mug Mmet labor unusint9enfaCertificate,ofOccupancy. SignalureofApplicant Date
° All roof coverings to be Class "B" or better
Owncr age ac