00060047 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGWI .s. PCRNOT N¢1006@047
)WNER'S: NG TAN - APPLICAI@SllY20@0
4 ,
PHONE. SANITARY NO. COW[ROL NO
o14-f Sr1
p z]. ARCIIIfECI71iNGINIiIi R: - , BUILDING FERMI l'IN[
C E.�O y�• RLI l4..Id ' PLUMB NI—IECII� IO 1l� �jy- 18Z 17 -I 1 i J
Ga
v LICENSED Ci,yriCmade, E .1ClION JOIT DCSCrIpllDn
S 5 1 hnmby ufdrm tlot I not on be l under full Poll,of Chamcr9(camm.ncing
—lnCIN wimsc.rmn7(Nro)aI n4..nm3onn.ImYiocsm,drromssmnsCode noamyE ns. PATIO ENCLOSURE
¢yy� Dt roll fo de t.
rc z c¢ Liccn,c ala v � Lic.N 30 �
3 N Uum I - Conwc /
Ao hiTECu a DECLARr l I(77rd Oil
f'a"4 I and l...hi mY plum shall be used a,public rccoN<
yas 3�
!O licensed Prom.wiowl '
c that l ant BUTeva fire IlIiCe ARAI Contractthe
or's
O
w=;t I hereby amour that 1 am.sump,from the ....C :My c Law,for ny I
F lollawing reusun.(Su:dnn]oils.Pu,inss and I'm@..call.CnJc,Any city ortvunty V
,M— which requires a permit it)convirrol.allat improve.demolish, p ry structure
i3^� prcal I nuc Iso memos,thre.,Iwardr h permit file a,,rudd.harriam
flit,c t t Lialoy L (Chaffer 9 Sy. Ft. Floor Area
eliminating with section 70f(I)of Di,inion 3 orae Hu.'res.and Pmf c,4.men u.k)
or than he is cumpt therefrom and the lot for the alleged exemption.Any violation
of Suction 7031.5 by in,.nppliatmt for a pooh,I,bjc,f,the applil I it,n civil fil lry
„ram marc nom eve hmdreJ dolwrs Os Imt AYMI lnTO}j. 00 OCCu panty Type
Cl 1,as owner of the pmpert'or my employees with wages as their.mle cnmpcns anion.
will du,he wmk.and it,sl o,utm Is nut In¢ndcd or.('foal for sale Sec.7044,
Busing,and Pmressions Code: lb,Conical Liam.Law does not apply to an 101 — - FOUN>gFMgeWnspections
r of property Who build.or improves them n.and who doe..mch work himul(
owner
his own nmploy..n.PI that such improvements toe not mended or 102 — PIERS
ollered for nude.If,howavcr,the h lilil or in inoveil is sold slain one year of
completion.the envner.buiMawill have the burden nfpmvingthat hedid nor build or 103 — UFER
Impels.mr Pnmos.or,dc). 1.04 — REBAR
01.un olacroflbc fusion,amexclumvclr contacting with licensed coommoiilu 105 — ANCHOR BOLTS
nnmm the project ISce,7(W4.Business and Pmfeoion,Code:)The Comeacmr's
license Lnw Jou not apply w an nwncr of prnpurty who builds or impavcs thcmnn,
and who contracts ae,uch ll with a conmaelodn) neuued pursuant in the 106 — SEWER & WATER
Commctxe exempt
Sec 202 — UNDERFLOOR PLUMBING
❑I ton coapt,oder tic.. .-0&P C for a4.,rcann
40 twner Dale 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION 204 — UNDERFLOOR FRAME
• I Ill altion Dale,lnnalty of perjury one of the mllowing deemmtmal cn =
05 UNDERFLOOR INSULATIONClm
I lie ural will o .lao in Ccrtircnuss„
te d Cot m seh [,it Workers 301 ROUGH PLUMBING
Comfit...I, us provided for by tiation 3701 or le Labor Code, to, the
pcrformanecofthewakfnrwhichmi,perril.<ued. 302 — TUB & OR SHOWER
❑Ihave art wwm:dmamWotker,Coml>eonarnolmumn.e.aso"m.JbySe.dou 303 — ROUGH MECHANICAL
PINI of the labor Gdc for the performance of the work for which,his permit is
issued.my Wo,kers ComPcal hournnee carrier and PnBcy numne,mr, 304 — ROUGH ELECTRICAL
Came, �ft�Flvt,rtva:At rNn: }.L?04'134 g 305 — FRAME
CC IpICAT1(IN OOf l4.%Can ION FROM WORKERS'
CONIII17NSAI'[ON INSURANCE - 306 — HOLDOWNS
(Thi,wetion need not be completed if the permit is for one bundled dollars 307 — INSULATION
OI(ximless.) 308 — SHEETROCK
1 tinily that in the prcommove of,he work for which this permit is icwed.1
shall not employ any person in any manner nn as to become subject to the workcri 309 — EXTERIOR LATH
Ca..l'sa a ot,l.a ,o(cal ,mia.nut. 310 — INTERIOR LATH
Applicant
NOTICE TO APPLICANT:If.after nuking this Certificate of aemwion,ou should 311 — SCRATCH COAT
hoanne subject ,the Worker,Cmnpensadopro
a ,kiu m of the Iamor Cod.,you moo
p zn
0 humwim comply with such provision,o,min armh,hall be d.sm,ed revoke.. 313 — ROOF NAIL
CONSTRUCTION LENDING AGENCY
wa.byarnnutjurcI,agar,mction(coding.,sprylinthevim —
sna:ti
e 501 FINAL ELECTRICAL ENERGY
fd,e work for which this perish is issued(Sec.307.Cm.C.) 502 — FINAL PLUMBING ENERGY
�^ landcr',N:nnc
iD z Lcod.rsA,(to-c,, 503 — FINAL MECHANICAL ENERGY
U O 1 cenify that I have mid this application und%lane that the above information is 5@4 — FINAL BUILDING ENERGY
4. F., correct,I agree to comply with all chy and connry ordinance,ad nate laws relating
O V e�h,tiMing canstm.non.and h.rcny aumanrc repses.nmdses it thi,city"'ct"cr't""" 505 — FINAL ELECTRICAL
the shave-mentioned pn,peny for im,,,tino plopoces.
a (We)ngreem ,msm
,live.indemnifyandkeephameCityofcupert.,.liost 506 — GAS TEST
IA liuhiliti.n,J:�Jgmcntn,cost,and. ,unw,which nn,y in any way cleric nguinrt stud
V Z chy in amseyun¢c nl'thc beaming ul this permit.
APPLICANTU UF.RSTANDgANUWILLCOMPLYWITHALL ON-P(BNT Issued by: Date
S<Wl!'GR .ATIONS �� ��O�OI)
Signature n—r ApplicanYContmcmr Ua,c Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE
WIN do apphcmo lir boom bullir,...Iran sem or ham he hantnlo,o Iralcrlal Type of Ro(507 — FINAL PLUMBING
as dcdned by the Cul,c lm.Municipal Code,Chapter 213.and the Health and Safety —
mlc.S vdod 255PLal^ 5 8 F1 AL MECHANII CAL
ov<s
El No All roofs sh•I inns for o mg material being installed.
;[p
,• W,Ilthe applicamor mum huildins,nc.Pantmcequipm.mmdevice,whilh If a roof is ed w 1 fst an nspection• I agree to remove
emit haredou,m,comamioanu m d.dned by the Bay Area Air Unal'uy Alanugcnmm p
Dixtnmo rat ❑Nn all new mat a : for i s L A a Maerstands and will comply with
all non-poi5."rcurc�t $Ikalu. P LIC WORKS
I have oad me Im/cuuus nuneriuB myai.mums under Chala,r 695 of,he
Cahfomiu I lemth&Safely Code.Sections 25505.25533 and 25534.1 ondersland Chill
fire building does not comity hast a temmntAbat it ie my responsibility to notify the
amymnt or the clout cmums which must he met prior m issuance of Ccnidente of
ii.eu ,icy. Signature of Applicant Date
•
4. All All roof coverings to be Class "B” or better
ownerma„t or aog.m um