01110125 OF
CI eat o nc DIIV�1ISIONNOPERMI CONTRACTOR MORMAT
BUILDING ADDRESS: PERMIT NO.
19191 PHIL LN PHAN CONSTRUCTION CO INC 01110125
�OWNER'S NAME: APPLICryTION SyB DATE
870 S WOLFE RD 11/ 29/2001
Ii PHONE: (408) 737-8323 SANITARY NO. CONTROL NO.
'�.
o c Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u
y a L7
N i LICENSED CONTRACTOR'S DECLARATION Job Description
Z_ 1 hereby affirm that l am licensed under provisions of Chapter 9(commenting
tar wiinSection7")ofDivision3onheBusinesandProle,ocnsCode.and mylicenw ADD 1324 . 50 SQ. FT.
ixEl isinm reeandmRmc -r 16 (2ND STORY ADDITION,
w Dian um. Z7
's3 ac Da cant 1ST. FL. NEW LIVING RM. ) r�
O fi. ARCHITECT'S as ON FU Ih1 II /�Y n E
j 1 undmntand my plans shall he orad as public records �J Gil t3.,r
r
5 O O Licensed Professional
St OWNER-BUILDER DECLARATION /1 O 2002
q
- 1 heaby affim that I am exempt from the Convanor's License law for the OCT U O Go OL
t'Z a following reon.(Section 7031.5.Business and Professions Coale:Any city or county
fFo m
c 9 crmil to construct, l,improve,dcariolkh,or repairany structure a,.`.`
to _pnorm u' Isaraq resthapplicant for hpe a fl gm
edstatecm ..-. __ _..
that OneitlnttinFdpurtantwm(po,.lonsoftheCmctrLicense La (Chapter 9 S Ft.FloorAre n g
" ,: a 4 -r r 'a�. . 1340�ationQ
(rnmme e w th Sibb n 7(X1(1)ofhe s 1 of the 1jiM i a Pr re i ns Code) l �-y ,,•L, s Y,Ly, t.',.I (.�It.,\(:M A a(v,,
or Sere Section
7 31iti b an, pli iam he basis for the subjects
th d acmpnoo Any l Pennon
-
ofit.,mite ban leanydpplia liar, 500). subjeEutheapplimmmacivilpenalty-
ron,ommorcmon file hundred almmrs(ssw). 3 7 r� uJnt0rd -o Occupancy Type
ED I,as owner of the property,or my employees with wages as their sale compenson.,
will do the work,and the strucwre'Is'not Intended-or offered for',le(Sea.'7044,-
Busincsi and'Professions Code:The Contractor's License law docs not apply no an 101 - FOUNDAT IIG41 fired Inspections it, c
Owner of property Who builds or improves thamn,and who d«s such work himself 102 __- PIERS
or eyed o his awn howeveec..provided thin mph improvement,are ria intended or
offered fO7 ialeTlChowever.the buildin �� - � tis wlJ within one-mer of �---��- _ .... ;_.__...____.__.__..._...
gob improve ma r 103 - UFER ...n „ ;.0'.1.,,d,:c:
ioprovei for the nwneo-lwBd<r will have the bursa of prating that he dire not build or
mproo<rm paq.,se of reale.). 104 - REBAR
Ol,as Owner of the property,am exclusively camrening with licensed contractors to 1-0'S`= -ANCHOR—BOLTS- ,.h.Ii;a.+_Will,f::0
- _ consumer the ii,cat S,r.70w,Bovine..,and Pmra.mns Code)The Contractors 10 6 - SEWER & WATER I t�:1t '.i'• l+
_ - License law does not apply to an owner of property who Wilds or improves thereon.
-. .,and whocontracts for such projects with,a.coutacour s).licensed.pursuantto the _.. _
- 202 '- 'UNDERFLOOR-PLUMBING--' -- - - - --1 0am -
exempt
License Law.,
-- am<nemptundcrSa. '• ,9&PCfonhis.reamn 203 - UNDERFLOOR''MEGHAN'ICAL
owner"' - :..Bate':..'...• ", ' ' ' "� . 204 - UNDERFLOOR FRAME
" WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
Ihereby aM.tordgpe9glty,orp<rjp;yone ofthgmuowingaecmmrnns: 301 - ROUGH PLUMBING
❑ 1 have tine will maintain a'CimiOcaa or Cooum m self-insdrc for Worker's 3 02 - TUB & OR SHOWER
Cwmpempdon, As,pro00 provided for by Section 37of the Labor Code, for the
perforianceofthework(coolish this permit,isiotted 303 - ROUGH MECHANICAL
- ❑Ihave aralwillmaintain Worker's CompensaiionInsurance,azrequired by,5enion 304 - ROUGH ELECTRICAL
- 37M of the Labor Code,for the performance of the work for which this innards is 3 05 - FRAME
.. issd<0 MyW k,,sCo p io 1 a aCv and I y mbc e
306 .. HOLDOWNS : . -
Cam S 1/b '''rr PolicYN ,.� .• O�"% > r T-. r- v, ♦ s ' s'?.i, ., x 1 - -
CERTIFICATIONOFE%EMP, NIAOM WO KERfS'1 s t G-\ 3 ,307 �f-`'INS ULAT IONA''
" COMPFASATIONI SURANCE c
�-
nee Out he Completed:fthe armt is for one hvndrtd dollars 309 EXTERIOR LATH '' •
0) I 7
" "' -3.10 INTERIOR• -LATH
( 1
1'cen f-mat in the Ku' a ce'of th k fo which rat I.i is issued I "COAT
e,,� - Y _.m.��F� -�• -
Y pe pc 1
shall not employ any person m any,nannc�sda.m become sublca to,the Workers 311 - SCRATCH COAT
Compe s Laws ofClf ,mate' .
_C-ro ant ..ROOF- NAIL.-- - ._. _ - -
NOTICETOAPPLICANT.IC efmr making thirovli'o zaof thclatioC -- -- - --- - - - -_—
wayogmgmd 501 - FINAL ELECTRICAL' ENERGY
hccome sidate m the Workers Cbmpensasion p ode,you must
O fonlwithcomplywithsuchProvisim,snrmfspcm,itshad,chemicalof nkea. 5-0,2 _ .-.__FINAL PLUMBING._ ENERGY, ...._ .. ... .._
._
F>4 ;It 1 +, CONSTRUCTION LENDING 503 - FINAL MECHANICAL ENERGY` t
�.' I hereby rim,mat there oconnotation lending agency f the performance -
orme erkmrwmmhmsp ils ::<e'(see.eo97,o..ed 504 FINAL BUILDING ENERGY '
yA
ria r e -Lender's Adarests, 505 FINAL ELECTRICAL '- - - ---- -
U O506 - GAS• TEST
1 ri fy th s I h...rtaa th PPliws d sr t th nh ebo a informer on is
rJ+ [r a.t INac s comply with II lyanal county,Ordinances and fare how,n,linin, 507 - FINAL PLUMBING
O U tabu Idng ca inatio and hereby authome rtprasentativesofths city winter upon 508 - FINAL MECHANICAL
the ab ,c mei cd p pcny f union i rposa.
;.i- the (We)�gprce ms dionnyand keph lis the City of Cupertino almost ///
V] 509 - FIN
liabilities.judgments. t ape pe ses which may in any ay Aetna,Aetna,agamnasaid AL GRA
City :4 «of meg nt g fth, perms . ' 510 N NG /
APPLICANT UNDERSTANDP AND WILL COMPLY�W�ITH'ALLN N.POINT � Issued l� Date
'JOURCE'REGULAT O\,I s 5, �— V q/��
Cmar
t
.,Will f peppy<l a Vii Rf�rtre bti Id ng^ceA p m store -J\e! Re-roofs
:lh LOSURE
%.A an or handle material . Type of Roof. . -
asvdef nes by me Cu,niroMmicripsil Cade,Chap¢,ll13 ruddin Health arrodS.Inly i s
Code Smi on 25s3Na)+ .: - .;y- I't fI.
r`',sire: t,
❑Y<. +� 1 91t?p:., ') I`, 1 All roofs shall be inspected prior to_any_roofing material being installed.,_ ,_,__. ..
HIW.4ha pp If a roof is installed without first obtaining an inspection--agree'to remove
lith t hanandion,air awrionionant, dictined by theRayAne.Air Quality Management
Dmnct all new materials for inspection. Applicant understands and will comply with
" - - - - . -: - . . ,..
A ? QY 9�" , all "non-path[source regulations.
I have read rhe hawdous marenah rcgmrcmenu under Chapter 645 of rAe
Celifdr6ia Health@'Safety Codd;Sections 25505,25533 and 23534.1 mtdemand that
y t,that it is my responsibility to notify the --
t_. rcnot rand have -- -
g oeuiremenss hich must bo mei poo m issuance wf a Cert,fcate of
, t c udalt d
occ pe rot the q
loL Signature of Applicant Date
P
All roof coverings to be Class"B" or better
-ages ate
•l c•r- -.OFFICE- .. .. . . . _. .- - .. . _. .. ._
OF
CI eat o nc DIIV�1ISIONNOPERMI CONTRACTOR MORMAT
BUILDING ADDRESS: PERMIT NO.
19191 PHIL LN PHAN CONSTRUCTION CO INC 01110125
�
870 S WOLFE RD 11/ 29/2001
Ii PHONE: (408) 737-8323 SANITARY NO. CONTROL NO.
'�.
o c Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u
y a L7
N i LICENSED CONTRACTOR'S DECLARATION Job Description
Z_ 1 hereby affirm that l am licensed under provisions of Chapter 9(commenting
tar wiinSection7")ofDivision3onheBusinesandProle,ocnsCode.and mylicenw ADD 1324 . 50 SQ. FT.
ixEl isinm reeandmRmc -r 16 (2ND STORY ADDITION,
w Dian um. Z7
's3 ac Da cant 1ST. FL. NEW LIVING RM. ) r�
O fi. ARCHITECT'S as ON FU Ih1 II /�Y n E
j 1 undmntand my plans shall he orad as public records �J Gil t3.,r
r
5 O O Licensed Professional
St OWNER-BUILDER DECLARATION /1 O 2002
q
- 1 heaby affim that I am exempt from the Convanor's License law for the OCT U O Go OL
t'Z a following reon.(Section 7031.5.Business and Professions Coale:Any city or county
fFo m
c 9 crmil to construct, l,improve,dcariolkh,or repairany structure a,.`.`
to _pnorm u' Isaraq resthapplicant for hpe a fl gm
edstatecm ..-. __ _..
that OneitlnttinFdpurtantwm(po,.lonsoftheCmctrLicense La (Chapter 9 S Ft.FloorAre n g
" ,: a 4 -r r 'a�. . 1340�ationQ
(rnmme e w th Sibb n 7(X1(1)ofhe s 1 of the 1jiM i a Pr re i ns Code) l �-y ,,•L, s Y,Ly, t.',.I (.�It.,\(:M A a(v,,
or Sere Section
7 31iti b an, pli iam he basis for the subjects
th d acmpnoo Any l Pennon
-
ofit.,mite ban leanydpplia liar, 500). subjeEutheapplimmmacivilpenalty-
ron,ommorcmon file hundred almmrs(ssw). 3 7 r� uJnt0rd -o Occupancy Type
ED I,as owner of the property,or my employees with wages as their sale compenson.,
will do the work,and the strucwre'Is'not Intended-or offered for',le(Sea.'7044,-
Busincsi and'Professions Code:The Contractor's License law docs not apply no an 101 - FOUNDAT IIG41 fired Inspections it, c
Owner of property Who builds or improves thamn,and who d«s such work himself 102 __- PIERS
or eyed o his awn howeveec..provided thin mph improvement,are ria intended or
offered fO7 ialeTlChowever.the buildin �� - � tis wlJ within one-mer of �---��- _ .... ;_.__...____.__.__..._...
gob improve ma r 103 - UFER ...n „ ;.0'.1.,,d,:c:
ioprovei for the nwneo-lwBd<r will have the bursa of prating that he dire not build or
mproo<rm paq.,se of reale.). 104 - REBAR
Ol,as Owner of the property,am exclusively camrening with licensed contractors to 1-0'S`= -ANCHOR—BOLTS- ,.h.Ii;a.+_Will,f::0
- _ consumer the ii,cat S,r.70w,Bovine..,and Pmra.mns Code)The Contractors 10 6 - SEWER & WATER I t�:1t '.i'• l+
_ - License law does not apply to an owner of property who Wilds or improves thereon.
-. .,and whocontracts for such projects with,a.coutacour s).licensed.pursuantto the _.. _
- 202 '- 'UNDERFLOOR-PLUMBING--' -- - - - --1 0am -
exempt
License Law.,
-- am<nemptundcrSa. '• ,9&PCfonhis.reamn 203 - UNDERFLOOR''MEGHAN'ICAL
owner"' - :..Bate':..'...• ", ' ' ' "� . 204 - UNDERFLOOR FRAME
" WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
Ihereby aM.tordgpe9glty,orp<rjp;yone ofthgmuowingaecmmrnns: 301 - ROUGH PLUMBING
❑ 1 have tine will maintain a'CimiOcaa or Cooum m self-insdrc for Worker's 3 02 - TUB & OR SHOWER
Cwmpempdon, As,pro00 provided for by Section 37of the Labor Code, for the
perforianceofthework(coolish this permit,isiotted 303 - ROUGH MECHANICAL
- ❑Ihave aralwillmaintain Worker's CompensaiionInsurance,azrequired by,5enion 304 - ROUGH ELECTRICAL
- 37M of the Labor Code,for the performance of the work for which this innards is 3 05 - FRAME
.. issd<0 MyW k,,sCo p io 1 a aCv and I y mbc e
306 .. HOLDOWNS : . -
Cam S 1/b '''rr PolicYN ,.� .• O�"% > r T-. r- v, ♦ s ' s'?.i, ., x 1 - -
CERTIFICATIONOFE%EMP, NIAOM WO KERfS'1 s t G-\ 3 ,307 �f-`'INS ULAT IONA''
" COMPFASATIONI SURANCE c
�-
nee Out he Completed:fthe armt is for one hvndrtd dollars 309 EXTERIOR LATH '' •
0) I 7
" "' -3.10 INTERIOR• -LATH
( 1
1'cen f-mat in the Ku' a ce'of th k fo which rat I.i is issued I "COAT
e,,� - Y _.m.��F� -�• -
Y pe pc 1
shall not employ any person m any,nannc�sda.m become sublca to,the Workers 311 - SCRATCH COAT
Compe s Laws ofClf ,mate' .
_C-ro ant ..ROOF- NAIL.-- - ._. _ - -
NOTICETOAPPLICANT.IC efmr making thirovli'o zaof thclatioC -- -- - --- - - - -_—
wayogmgmd 501 - FINAL ELECTRICAL' ENERGY
hccome sidate m the Workers Cbmpensasion p ode,you must
O fonlwithcomplywithsuchProvisim,snrmfspcm,itshad,chemicalof nkea. 5-0,2 _ .-.__FINAL PLUMBING._ ENERGY, ...._ .. ... .._
._
F>4 ;It 1 +, CONSTRUCTION LENDING 503 - FINAL MECHANICAL ENERGY` t
�.' I hereby rim,mat there oconnotation lending agency f the performance -
orme erkmrwmmhmsp ils ::<e'(see.eo97,o..ed 504 FINAL BUILDING ENERGY '
yA
ria r e -Lender's Adarests, 505 FINAL ELECTRICAL '- - - ---- -
U O506 - GAS• TEST
1 ri fy th s I h...rtaa th PPliws d sr t th nh ebo a informer on is
rJ+ [r a.t INac s comply with II lyanal county,Ordinances and fare how,n,linin, 507 - FINAL PLUMBING
O U tabu Idng ca inatio and hereby authome rtprasentativesofths city winter upon 508 - FINAL MECHANICAL
the ab ,c mei cd p pcny f union i rposa.
;.i- the (We)�gprce ms dionnyand keph lis the City of Cupertino almost ///
V] 509 - FIN
liabilities.judgments. t ape pe ses which may in any ay Aetna,Aetna,agamnasaid AL GRA
City :4 «of meg nt g fth, perms . ' 510 N NG /
APPLICANT UNDERSTANDP AND WILL COMPLY�W�ITH'ALLN N.POINT � Issued l� Date
'JOURCE'REGULAT O\,I s 5, �— V q/��
Cmar
t
.,Will f peppy<l a Vii Rf�rtre bti Id ng^ceA p m store -J\e! Re-roofs
:lh LOSURE
%.A an or handle material . Type of Roof. . -
asvdef nes by me Cu,niroMmicripsil Cade,Chap¢,ll13 ruddin Health arrodS.Inly i s
Code Smi on 25s3Na)+ .: - .;y- I't fI.
r`',sire: t,
❑Y<. +� 1 91t?p:., ') I`, 1 All roofs shall be inspected prior to_any_roofing material being installed.,_ ,_,__. ..
HIW.4ha pp If a roof is installed without first obtaining an inspection--agree'to remove
lith t hanandion,air awrionionant, dictined by theRayAne.Air Quality Management
Dmnct all new materials for inspection. Applicant understands and will comply with
" - - - - . -: - . . ,..
A ? QY 9�" , all "non-path[source regulations.
I have read rhe hawdous marenah rcgmrcmenu under Chapter 645 of rAe
Celifdr6ia Health@'Safety Codd;Sections 25505,25533 and 23534.1 mtdemand that
y t,that it is my responsibility to notify the --
t_. rcnot rand have -- -
g oeuiremenss hich must bo mei poo m issuance wf a Cert,fcate of
, t c udalt d
occ pe rot the q
loL Signature of Applicant Date
P
All roof coverings to be Class"B" or better
-ages ate
•l c•r- -.OFFICE- .. .. . . . _. .- - .. . _. .. ._