02080144 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
10530 MIRA VISTA AV 020y}801€
v�Flr44
Gs29�NG & MEI YAN APPLICA08/26/2002
PHONE: SANITARY NO, CONTROL NO,
1
WOO ARCHRECLIENGINEER: t BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
<� f_ 1 1 1 I_1 L_J
oNi 2 LICENSED CONTRACTOR'S DECLARATION Job e$CrIPIIOn
Z. _ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing WINDOW I N GARAGE (SLIDING
P<41---; with Section 7000)ofDivmion 3 ofthe Business and Professlorw Code.and my license t�n ��+®
Cra, is in full force and effect. Imo'
z6 Licenx Class Lic.0 11 G'r
n O Date Contractor '
oS 3 a G ARCHITECT'S DECLARATION
��
1 understand my plans shall he used as public records SEp 2 4 2002
6 p Licensed Professional
OWNER-BUILDER DECLARATION
g 1 hereby affirm on 11. exempt from the Contractor's is Licenx Law for the
H
G i a follow g (Section 903 15 Businessd Professions s Code Any city or county
Be 0 wK<M1 ts e.Permit t construct, h P demolish.or repair ed ndermrc
Be o pout t ' 1requiresprapplicantf m nnofilean in,(Cummcm - ,�s,,,,�a - ----- -- -
mmheslasediSiniins Chep rthe c t CommunesLicensePrlawonsCas ) r,t 1 yy33aMl/'at iiA.....r-g(ga -t'� A's° Valuation
(mom angim Salonoin and
vat l fth alleged mess agdkth Any vi Code) ss \)aAi ] t i—l/"t1Jas - t ,81.E).:7f 'S;
or that he is exempt lhemfrom and the basis for the ctstheapplicant
to Any violation
of Section than
iv any hundred
nom for a meteor subjects the applicam to o civil penalty
of not team lnannve nnndrod dagam oslrol. 10 lAp-I`I NJPJNDAT I ON ' ' Occupancy Type
❑I,as owner of the Property.or my employees with wages as their sole compcnution, 102 — PIERS
--war do me work,and the structure is ria,intended or offered far.[.(sec:mu, 10 3 - UFER Required Inspections
Business and Professions Calc The Cmumcnn's License Law does not apply to an Cl p
owner of property Who builds or improves thereon,and who does such work himself 104 — REBAR
or through his own employeesprovided that such improvements are not intended or
-offered for sale:If,however.the wilding or improvement is sold within die year of " 105 - ANCHOR BOLTS' _ . .... .. _..._...------......._--.-._.
nmpletion.the owner-Wilda will have the when
of moving that he dm not wild or . .
improve for purpose of sale.). 106 - SEWER & WATER
_ _ _202 "="UNDERFLOOR-PLUMBING -
of the En Pent m clusiv ly c nt et g with I d tractors 10
gn:wt the project(Sim 704tin Business and Promotions Cade:)rentractors 203 - UNDERFLOOR MECHANICAL-
License law does not apply to an owner of property who wilds or improves thereon.
_and who-cmura�s.mrsuch Projeds.wilt aanmallooll.licensed pursurbut°.the .. ...__._ 204. .__.UNDERFLOOR FRAME --- --- --- -• - '
Contractors Lcepse Law.
❑ x 1 am to pt oder Sec. &P C for this reason 205 - UNDEUNDERFLOOR'-- INSULATIONUNDERFLOOR'-- INSULATIONLATION
DDa'tet 1iPle301 - ROUGH PLUMBING
COMPbWwTIONDECLA ATION 302 - TUB & OR SHOWER
! Yo Penalty Perjury g 303 - ROUGH MECHANICAL
' 1 hereby rrm,ander ❑ f r me following declarations:
0 1 have aha will maintain a Certificate of consent to selr.msure far workers 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by section 3700 of the Labor Code, for the 305 - FRAME
'performance of the work for which this parmlt is issued.
- ❑1 have and will maintain Worker's Compcation Insurance,as required by Section 306 - HOEDOWNS
oo
3Ya)of the Labor Code.for the perfarmanee of the work for which this Permit is 3 07 - INSULATION
sod My Worker's Compen ati Into on
308 SH'EETROCK -
cite e. 'f 's I Y i " Policy No
and Pol y a rte am: f s P". 4 7 .. , it .... )
CERTIFICATION OFEKEMPTION FROM WORKERS) 309 ) EXTERIOR- LATH
.. COMPENSArIONiNSURXNCE. -- - 310 - INTERIOR--LATH - - - - '- —"---
Cru,wet on need not W co nt pleted if the peon is for one hundred dollars 3 11 — SCRATCH COAT
(sim)aness,t ._ 313 ROOF. NAI-L-. ._. .. .. . "... . _ -
1 certify mat in the performance o the work for which this permit is issued.I
,hall not employ any permn iany ma crm r ) t he workers' 501 - FINAL ELECTRItAL'`ENERGY
psmlprnsmion Lryi� f w�hm ��`G`i 1i�e ° _ 502 - FINAL. PLUMBING...ENERGY .." _.
p,P_t-9}_. is Ceniticamm Exem ron.ynushould "--
'Na�eiii�((Y�Octmine ':I,u to rponveg 371 503 - FINAL MECHANICAL ENERGY
bac esubjen mthc N'orkcrs Compcnwtion pmvisinns of the Libor Code you must
O f°nhwithcomply withsuch novisimixor hisperdm
mshallbedeeodmvaked. 504 - FINAL BUILDING.,ENERGY_
^ V] ' "-CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
- I hereby affirm that there is a construction lending-agency for the perfmmuno,
a'>
Of the work for which this permit is issued(Sec.3097.Civ.C.) - 5 0 6 - GAS TEST :
y-p -Leaden Name- :. - -- --._.... . .. - -.. .i- - -' --507 FINAL PLUMBING .. .-- --
O,z Lenders Address _
Iartir mailhave read this a eaaeanandstmematmeanavemrormaeonis 50 FINAL MECHANICAL
'ks O correct.1 agree m comply with all city <oumy oNinanccx end stare laxs relating 5 9 - INAL GRADE
O ,toWilding conswction.and hereby amhorirzneumax nnivesofthiscitytocoerupon 5 0 - INAL ANN NG
r� the above-mentioned property for inspection putpoms.
(ham agree tosavc:indemnify and keep harmless the City mf Capenina against 5 - INAL RKS
A liab'dides,judgments,coots and expenses which may In any way accme against said
!„)'^ City in eirsequetme of the granting of this permit. '
APPLICANT UNDERSTANDS'AND WILL COMPLY WITH ALL S N- IpT Issued bDate
_ /7
�Ignmure of ApplicautcontmctorType
Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE,/
Will the applicant future Wilding occupant mom or handle transitions mammal -
: as definedbylinnithe CupanmoM cipal Cad Chpt 91_,and th Health and Safety
• '- 1 i','. ;Pisces.- i)�°s, nV2 �tA -]ivP"'a;
Code,OcYcs 23532(gl
. All-roofs shall be inspected pnorto any-roofing.material being installed. --------
w B thapplicanto f t wading...,open,use x,mproem or devicev which If a roof is installed without first obtaining an inspection; l agree to'remove
emit hazandons,air coni t. Acord by the Bay Arca Air Quality Management
Dist t .` ,.a all new materials for inspection. Applicant understands,and will comply with. ,
❑res dv" - all" on-point source regulations. '
I have read the harardoso materials mquiremems under Chapter 6.95 of the
California Health&Safety Code.Sections 25505.5533 and 25534.1 understand that .. _ ..
,lif the building dues not cnncntly have a mnnm,that it is my responsibility nt unify the -
re pate of the requimmenu which mint he.met prior m issuance of a Ceniticam of
a�r�Ztc Q��I� Z Signature of Applicant _ Date
neratanmarisedagcnt t All roof coverings to be Class "B'•or better ,
OFFICE