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04110019 CITY OF CUPERTINO ('� BUILDING DIVISION - PERMIT00NT •'" our ., BUILDING ADDRESS:. RAYO HOME IMPROVEMENT PERMIT Ncb 4 110 0 19 21328 METEOR DR OWNER'S NAME: PERMIT ISSUE DATE LARRY & JANEY LIEN 20649 CELESTE CIRCLE E: - SANITARY NO. CONTROL NO. (650) 218-3228 ARCHITEC iENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Piz Ppp LICENSED CONTRACTOR'S DECLARATION - Job Description - hcmby effil met 1 am limned un r pmvisions of Chapter 9(commencing, u with Sects 7IXN 1of Divlaion3ofthe Bwi �mfcaiona Cod,andm liana is pry, in full force I �"aa� ¢� .� KITCHEN REMODEL 5 Z Licence s Lie.At Z;: Dam Contrectnr z� ARCHITECTS DEfy9R z a 1 n&nJ my plans shall Inc used as public molds D�U f t ;0� Licensed Professional '- z OWNER-BUILDER DECLARATION y 1 hereby affirm that 1 am exempt from be Contracmes License Law for the 00 following mason.(Section 7031.5,Business and Professions Code:Any city or County x$� which requites a permit to construct,alter,improv,demnluh,or repair any sumo m 44tl44tl1j /' r ,Z,o prior m its issuance.else requires be applicant forsuch permit to file a signed statement v - ., F that he is licensed pamount mthe prentowofteCmaractoisLicense law(Chapter 9 Sq.Ft.Floor Area "� //.. Valuation a $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he k exempt therefrom and the bwie for be alleged exemption.Any violation of `- Section 7031.5 by airy applicant for a permit subjects the Applicants m a civil penalty of a `W=Occupancy Type oat more Nan five hundred dollars($500). 0'1,as owner of the property,or my employees with wages ss their sok compensation, will do the wer"rol Ute suuetue is cotintended oroffarnd fo...1.(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply m an owner of Required Inspections property who buildsorimproves thereon,and whodoessuchwork himalfor through his own employees,provided thmsuch imprewormla are notinended aroReed for sale.IL however,me building or imp no.nonot is said width.one year of completion.be owner .- .. builder will have be burden of proving that he did not Wild or improve for purpose of - sale.). ❑1,as Owner of be pmpeny,am exclusively contracting with licensed contractors m construct the project(See.7044,Business and pretensions Cache)The Common's Li- cavae law does not apply to an owner of property who Wilds or improves brown,and who contracts for such projects with a contracmr(a)licensed pursuant Or Use Contractors Lim.law. ❑1 am exempt under Sec. .B&P C for this moon 137M er Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: have and will maintain a CeNBcam of Conant mself-imsum for Walkers Compm- .. n,w provided for by Section 37011 of be labor Code,for the performance of the for which this permit is issued. '- have and will.maintain Workers Compensation Insurance.w required by Section of me Labor Code,for IW performance of be work for which this permit is issued. Wnrkcsry�rojensation Wurance carrier and Policy number ampi .s `^(A's'f0✓I Paltry o.: �C 'Z Oo CE RTIFICATEOEEXEMMON MWORKERS' COMPENSATION INSURAACE (Thu section need not be completed if tk permit is intone hundmd doilm(E I W) or TCaa) 1 certify mat in be performance of the work for which thin permit is issued,I shall not employ any person in any manner so as At become subject m the Workers'Compensaian Laws of California,Date Applicant NOTICE TO APPLICANT:If,after making this Ccniftcate of Exemption.you should become subject m be Worker's Compensation provisions of be Labor Code,you must Oforthwith comply wide such gown. .ser this permit shall be deemed evoked. z h CONSTRUCTION LENDING AGENCY [-t I hereby affirm that them is a construction lending agency for tW performance of a 7 the.,it for which this permit is issued(Sec.7097,Civ.Cd W Lender's Nam. z Londe.Addraa V Q 1 certify met 1 have read this application and state that the aWve information is W.F comet.I ager m comply with all city and county oNiusnca and sum laws elating to 0 building construction,and hereby aunnim epresenmums of this city to enter upon me W akve-(We)agree 1.trysaw for i indemnify an purposes. !F^+ (We)agree to ave,indemnify and keep harmless me City of Cupertino against W liabilities,judgmems,costs end expenses which may in any way accmc against aid City U Z me......enof me grommil of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGULA Re-roofs gwtumof Ap U t r te f Will beapplican�RDOrebuldingocjALS cupatsmCreorhandlehsAousmateriai Type of Roof w defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety Code,Section zss3z(an �--- All roofs shall be inspected prior to any roofing material being installed. ❑Yes �No Will the applicant or future building occupant use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air comem rmous as dolood by the Bay Area Air Quality Management all new materials for inspection. District? r ❑Yes �(No 1 have read be haardous materialssequiroments underCkpter 6.95of me Califor- nia Health&SafctyCodc,Suctions 25505,25533 and 25534.1 understand motif Ute Wilding docs not currently ham s tenant,mat It is my responsihility at no mcupant of the requirements which must mmpnor m issuance of niflCpin0 cupeacy. Signature of Applicant Date Owner 6 as ml agent /> Dam All roof coverings to be Class"B" or better (/ Auk CITY OF CUPERTINO BUILDING DIVISION PER CON=Cl2AC'�trFOR INFORM, SON ; �A.,.�3. OUILDING ADDRESS: RAYO HOME IMPROVEMENT PERMITNcb 4110019 21328 METEOR DR PERMIT ISSUE DATE OWNER'S NAME: LARRY & JANEY LIEN 20649 CELESTE CI SANITARY NO. CONTROL NO. 7appliwt NE: (650) 218-3228 BUILDING PERMIT INFO CHITECT/ENGINEER: BLDG ELECT PLUMB MECH (_� 0 . LICENSED CONTRACTOR'S DECLARATION Job DBSCrIpUOn Wrcby affirm Nat I am liccaed under pro_vi9ne of Chapith Sccu ]IXNl).f Divisi.n3eftW Busine3eod ProfcssiC�andliccnscis ren sere;t� n Cd�YYI� KITCHENREMODEL � ccnm a S a _4ale Cum actor a ARCHITECTS DE6l,AR T30N1 mlo, d my plans shall he coed as puhlicrccemde iccnxd Pmfcssi.nel /OWNERBUILDER DECLARATION1 hcrchy.('firm on I em rump(from the Centns Co :Anyc Law for thellowing moron. er it t IDorals Business and vex,de sea Calc:Any city es county hich rcquire a Pcrtnit m cnatmm,elmq improve,JcmnlL h,m rtpair any suucmre , QQQ ar d or m its issuance,also Mquires the applicant far such Permit m file a signedsu¢memm�c is licensed pursuant to the pmvism.sof the Contractor's License Law chapter 9 Sq.Ft. Floor Area aluation ommencing with section]000)n1 Division 3nf 00 Business and Profesimu Cousinhet he u eumpt thcreffum and the basis for tW alleged eaemptim.Any violate.of ection]031.5 by any applicant for a permit subjects the applicant to acivil Penalty ofE Occupancy Type not more Nan Ove hundred dollars(5500). 1,a owner of the pmpmty,or my employers with wages a their sole rompenudon, will do the wmk,rod Ne structure is not intended or offered formic(Scc.7W,Business Required Inspections and Professions Code:The Connecmes rs License Law donot apply to an owner of q P Property who Wilda orimprove derem.and whodocssuch work himeelforthrough his own employee,provided Na(such improvemrnts are not intended or offered fors de.If. however,to building or improvement is sold within one yes,of completion,the owner- builder will have the burden of proving that he did not Wild or improve for purpose of sale.). - ❑h as owner of the property,am exclusively connecting with licensed convectors to construct the pmjecl(Sec-7(a44,Business and Professions Code:)The Comracmrs Li, cc=law does not apply to an owner.(prepare who builds or improws thereon,and. who contracts for such pmjecu with a ronuacmrcs)licensed pursuant to she Cennecsor's Liccnw L. ❑1 vn exempt undm Scc. B 9 P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby afford under penalty of perjury one of de following declarations: t]I have and will maintain a Ccnlficate of Consent to self-insure for Worker'sCompen- aatian,as provided for by Sane.37W of the LOW,Cade,for the performm en of Ne work for which this permit is issued. ❑1 have and will maintain Workers Campeau nn Insunncc,an required by Section ' 3700 of the IaWf Code.for the performance of the work for which this permit is issued. My Warkc' ompeaauon Inmemmen,caner and Policy morthe -. am foti Pency ..:rte/9�oY-Z 08 CERTIFICATE OF EXEMPTIOAM WORKERS COMPENSATION INSURAACE ('Ibis section need not W completed if the permit is!.Tone hundred d.11ina(SII10) or Icss.) I cenifv Nm in the perfotmanm of th,work for which this permit is issued.I shell nos employ any person in any manner so as to become subject m thewakeras Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenificate of Exemption.you should become suhjccuo Ne Worker's OnnOmsutien provisions of the Lab.,Code,you must .J'Z f.nhwith comply with such provisions or this permit shall x deemed revoked. z� rN. CONSTRUCfiON LENDING lmdm,AGENCY �-r ( to,which hi Nat then is a construction(Son. W7,ding agency for the perfurmena of D:> the work Tor whir.this permit u issued(Son.3097.Civ.C.) W�Q Lenders Name a z Lender:Aaarea U O 1 ccnify that 1 have read this ap,Iic.i.M and sure shad On six.information is IL P conecL I agree to comply with all city and county oNirwa<s and stat,laws relating to 0 U building consmictian,and hereby authorim opmsenlativcs or his city to enter upon the r tLl .hove-mentioned properly for inaPced..purposes. 6. (We)agree in save,indemnify and keep harmless the City of Cupertino against 611 Vt liabilities.judgment.costs and expenses which may in any way.cane against said CityUZ in consequence of the granting of this permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA Re-roofs guaturcef Apel i/ ctr te I �It�=DOUSMATERIALS DISCLOSURE __ Type of Roof Will the applicant Or future Wilding Occupant store or handle W Rous manna] a dcfncd by be Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Sccuon 25532(.)? 1 All roofs shall be inspected prior to any roofing material being installed. ❑Yrs RHO Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove • emit havard.us air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disuict' ❑Yes �Ne 1 have coed the hmardous mvenalseyvirements under Cnapu:r6.Y5 efthe Califor- niaHnMhJaSafetyCode,Sections 25505.25533 and 25534.1 undersuM did irOc Wilding does not a meetly have a anon.that it is my resp...hility to nnfty .ccupam.r Nc require mcnu which mus sect pdortuisemnceef Gcrdf C:%;. cepancy. Signature of Applicant Date _ � .�� - � n„ All roof coverings to be Class"B" or better 1 f � I 1 I 1 II WL it rj L c _ rp T t i m 1- rt�NLsw q m `o _ h LL rA 0 1 = sa arc C 3 a Q OCD 2 y� QO ♦--j1��.EZ � -BY G mit � g sw o all , t 1 / *CITY OF CUPERTINOP CITY OF PERMIT APPLICATION FORM CUPEkTINO APN# -3Z / G Date: Building Address: /2 1-1�2� K C+GQ VJD v Mailing Address tif diff ent from building adgess): Owner's Name:40 t I vP7 Lievt Phone#: — Contractor: qQl1 License#: 84¢-0/6 Contact: C,11 a 0 Phone:qce-g:�6-.36o Cupertino Business License#: Fax: Building Permit Info: Bldg P$( Elect ® Plum Mec Job Description: k tfcucNr.Bnoze;L-,uG lv , NEL.) coati - Residential M QC'' ��f( tl�NcsS Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: �j�r- rr-5� Occupancy Group:f I( Type of Construction: Please check this bok if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other A liances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3