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CITY
DPERONo
NPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
APPLICATION SUB DATE
KUO HUEI P AND CHIA C
02/11/2002
PHONE:
SANITARY NO. CONTROL NO.
O O
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MF.CH
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LICENSED CONTRACTORS DECLARATION
Job Description
1 thereby affirm list 1 am licensed under provisions of Chapter 9lcommrncing
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mm�vtroO,nrDivi,mnJnnheBasies, d],role...on,Code-indor,rtan`e
REPLACE ELECT SERVICE PANEL.
fall force and effect.
A1� go(,
s<
;ate
ase class � m.p --
FROM 100 A TO 200 A.
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D�je tar
5 DECm
ARCHITECuse DEC ION
I undersand my plans shall he used as public records
Professional
pLicensed
a.OWNER
BUILDER DECLARATION
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I hereby afran that 1 am exempt from the Co maeum's License Law for dre
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following reason. (Section 7031.5, Business and Professions Code: Any city or court,
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which requires a permit to construct, alter, improve, demolish, or repair any svunure
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Prior to I ah q e til to
pplir II suchportion
a� .kS Ft.FJoor:Area��nn t' ss
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i.•CiNTI.,,-ti.a9�:trEr
anon
that hdat n l Pursuanttoto pand,odus ofth Contractors License Law (Chapter 9
(crm c g '\hSu4 7000) fD'iv J of the Business andProressonsCode)
or that fie i5 eaamp( thereft m and the basis for the allegW aEmptinh. Any violation
LI'1v`CIRA,
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--of Socotra 7031.5 by any applicant Earn permit,.bjers the appli<em to a civil pxii
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', Occupancy Type
for not tame than five hundred robots ($500),
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❑ I, as owner of the property, nr an, employee, with rages m Ihcir sole compensation,
'-will dothe work,' and the'struowrc isnot Intended or offered for sale (Sec: ]044.
Bhom6 s and' Professions Code: The Contranor's License Law does not apply to an�i��;
— -' - -103---- -
ChOIlS'
a wrier of property Who builds or improves ihneon, and who does such work himself
304 - ROUGH E&EeM2 :At,
mr his own employers.pmvidrddhf, sich improvement, are hot imeaded.or_..505----
FINAL-ELEG-TRIC-AL ... ___ _ .
b Id will have the b ben fproving that h dA Ibu ld or
e6hilphidion,
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improve far purpose of sale )
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01.as ownerofthep pent. am exclusively contractingwith ficensedcontractors to
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construct 1h project (sec 7044.BusinessJP( il1) The Contractor_
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doe. mot apply to an t rp open, nulla v es thereon
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-and. ho,conlrua for h projects. wroth w rhes). hccnud pursuantm Ne
andLiermewh ,c m( r
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❑ l em exet under Sec' I' , B & P C fa—,hi, re, son
1 tarn a.mp
Owner'... •. "L Date
"- WORKER'S COMPENSATION DECLARATION
I hereby affirm area, penalty of je jury one of the following declarations:
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❑ 1 have and will maintain a Cenifcme of Consent to sdGimure for Worker's
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Com,ematirm, as iced for by Scniom 3]00 of the Labor Code, far the
perrrrmanm of the work for which this permit is ).sued. .
.
❑ 1 have and will maintain worker: competis nioo jnsorarce, as requited by section
377 of the Labor code, for the performance of the work for which this Permit is
issued My wo.rker,.. Compensm on Insurance comer and Pol cy umbo 6 .
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LffLY.
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"w51 jt YC[RTIFICATION OF EKEMPI'ION FROM w,ORKERS
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"' `COMPENSATION INSURANCE'^-' `x a '"
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'"I" l(ThiA'eO;.need not be completed if the Permit is for one hundred dollen
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1 I cerfY that m the ce of the ark f iich N perdt' ` forced,I
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shell t ploy dy pe any manrlrfso n� tq¢C'ae �en to she W k
compo t i l of c /m at 4h1 0
.APPIa m v /
ILI
NOtICET If, 0 ria gthms Cenmfcateol Exemption, you should
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nLIeANT
become sub cit Ih Wo ker s Compenshuon prov s ori of IM1e Iabar Codc, you must
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fonhwiJi comply with such provisions or this permit shall be deemed rooked.
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s, mCONSTRUCfION LENDINadio, CY
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if
hje idfi that issueWaic. lendingugencY for the performance
rth1"Imkfar
'i Civ
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which permit is issued (Sec 3(19), C)
or the kf hcM1 tM1. pc,
-Lender N .¢. m -s• .. �m, m... .. ...' ._.. ":
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Lamfic*:iAdd. vs.
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I ccnify that I have head this apdiwdon and state that the above information is
kronen. 1 agree to with and county ordinances and state laws hearing
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comply; all city
to 1mbihngcon.lrucbm:end hereby amlioriu rcpre,emmives ofthis city former upon
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the above-mentioned property for inspection purpous.,,,
(We)agree mdcmnlfy and keep harmless the City of Cupertino'ogains
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save,
liabilities, jail u, costs and capt n., which may in any way sector against said
City cos u ce of the ng of this
glom permit
WITH ALL
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A(P)PLICA DERSTANOS WILL COMPLY NON-POImNT
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Issued by: Dale 1
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\IURCE
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wig ado"Vie-' : 1-
Re-roofs
` t HAZARDOUS'MATERIAIS DISCLQSURE ' '
WII dk pPl t f t Mild' g pe t t re o handle harudoas mat I
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Type of Roof - - -
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'as dein d by tM1 C pen o M P cod Cn pt 9 12 d th Health and Safety
ChdeSecfon255J11e)fJ
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1 1+51„ Ott 1°i'nt al$g
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Ss to
roofs shall benspected prior to any roofin material being Installed._
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Will the pp! ct or future building occupant useamf prem m d ¢ncwhicn
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If a roof is installed' without first obtaining an inspection', 4 agree-to'remove
sm, hanandicsmr cianommusas defined by the Bay Alen Air Quality Management,
Dlatnct4
all new materials for inspection. Applicant understands and will comply with
t oY . ,.III Na' ;,. 1x �. -
all'non-point-source regulations. I: t• t -
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I have pica a hazvdoua meteriali requirements under, Chapter 6.95 of the
Cali forms Healt afcty Code. Sections 2 5. 15533 and 25534, 1 understand that
- fthe Milding s of curtcn0y haveam n that myresponsibility to notify the
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accupdn; ort rt j`o, s which off be met prior to issuance ofm6 cm-iifi, df
pd9!a
.•
_• 2
'Occupancy. ::
-
of Applicant Date
_Signature
Al] roof coverings to be Class "B" or better' '
xmeror ager, Data
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