02070169 CITY OF CUPERTINO revs +t
BUILDING DIVISION PERMIT CONTRAI
CTOR NFORMATION:,
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BUILDING ADDRESS: PERMIT NO.
19191 PHIL LN PHAN CONSTRUCTION CO INC 0207 1
dMOWNER'S NAME: APPLICATION SUB DATE
IKAM CHU 870 S WOLFE RD 07/26/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 737-8323
ARCHITECnENGINEER: BUILDING PERMIT INFO
pl❑O❑ BLDG ELECT PLUMB MF.CH
Z S m z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby;firm that I um IiccnscJ under provision.mf Chapter 9(commencing
pM with Section 70(k)of Division 3 of the Business and Professions Code.und my ficemse SIDING TO STUCCO - -IN HOUSE ONLY
7 is in full foam and effect.
a s Lima.<Cla.ss Liug (ORIGINAL 401110125)
3 Date Contractor
u. ARCI(13ECr'SDECLARATION (REVISION 402050053 , NO NEW PERMIT ISSUED
t t= 1 understood my plans shall be used as public tecoNs
ea ear
i p O Licensed Pmfcssinn0l
a'R 2 OWNER.BUILDER DECLARATION
V
H- 1 hereby of.them 1 ton csemfrom the frothe Contractor's License Law for the I
t z< following mason.(Section 7031.5,Business and Pro(easions Code:Any city or county
SFO which rcquim,0 .,it to consumer.alter,improve,demolish,or repair any mrvewm
ca c� prior to its issuance,also umpires the aM1hant for such permitto Glc a signed♦mremmar
3— dem he is licensed position m the Immersion,mfW commerce.License Co.fchapte,9 Sq. Ft. Floor Area Valuation
(commencing with section 7W)of Division 3 of Business and professions Code) $2000
or that he is exempt therefrom and the thesis for the alleged exemption.Any violation
of Section 7031.5 by any applicam for a permit s0jece,the ap,lica.t to a civil pewlty ppN�f
.foot m.m than five handled dollar.x500). 375 4 0 04 3u.18r Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation, U T\ n t—
Business
do the work,and the structure is not intended or offered for sale(Sec.7614, u L[/,.has,LL,t—
O
Business and Professions Cale:The Contracor's License Use does nor apply t.an 101 - FOUNDATI wired Inspections
ow r of property Who builds or improve%;hereon,and who docs such work himself
r through his own employee..provided unit.such improvemcris am nor intended or 102 - PIERS
OCT 0 3 2002
.lfcred for sale.If,hoer wevrhe building or impmvemou is sold within one year of
iompletion.the.wnerbalder will have the huMcn of proving that he did not build or 103 - UFER
mprove for purpose ofmdo). 104 - REBAR p�
❑Las owner of the property.am exclusively contracting with licensed contractors m 105 — ANCHOR BOLTS BUILDING
consumer the project(Sec.7044,Business and Profession,Code:)The Cmmmcturk
License Law does not apply to an owner of property who bni Ids or imprwes themon• 106 - SEWER & WATER
and who contracts for such projects with u contracmr(s) licensed pursuant to the
Contractors License Low. 202 - UNDERFLOOR PLUMBING
❑l am escmpt under Sec. ,B&P C for his mm.n 203 - UNDERFLOOR MECHANICAL
Owner Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I bomby affirm under penalty of perjury one of the following declarations: 205 UNDERFLOOR INSULATION
❑ 1 have and will maintain 4 Certificate ficate of Consent m self-insure for Worker's 301 _ ROUGH PLUMBING
Compensation, as provided for by Section 3700 of the Labor code. for the 302 TUB & OR SHOWER
performance of the work for which this pounn is issued. 303 - ROUGH MECHANICAL
❑1 have and will maintain Worker's Compsmation insurance,as required by Section 304 - ROUGH ELECTRICAL
3700.f the Labor Code,for the performance of the work for which this penni,is
arum.My workers Compcosntion Insurance carrier and Policy number arm: 3 05 — FRAME
Canner: Policy Nor: 306 - HOLDOWNS
CBRTIFICCOMPENS TION INSURANCE N Or EXEMPTION FROM WORKERS' 307 — INSULATION
(This section need not be completed if the permit is for one hundred dollars 3 08 - SHEETROCK
DIO(r.rless.) 309 . - EXTERIOR LATH
1 modify that in the performance or the work for which this pamh is issued.I 310 - INTERIOR LATH
shun not employ any person in any nonce or as to become subject to the woken 311 - SCRATCH COAT
Compensation Law..of California.Date
Applicant313 - ROOF NAIL
NOTICE TO APPLICANT:If.aMr making this Cemificme of Exemption,you should
Zbecome.suhjccttothe Worker'sConficamuunprovisions ofthe LUMnCode,you must 501 - FINAL ELECTRICAL ENERGY
ZO Forthwith to ply with such provisions or this permit shall he deemed revoked. 502 - FINAL PLUMBING ENERGY
F s� CONSe.is. ON LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby uffrm that mem M ICONLENDI lending agency for the peAormunce
of the work for which this permit is issued(Sec.3W7,Civ.C.) 504 - FINAL BUILDING ENERGY
ra Lender's Name
Z Lender's Address 505 - FINAL ELECTRICAL
U O 1moify that l have mad this application and state that the above inf.mmauon is 506 — GAS TEST
h p comet.1 agree to comply with all city and county ordinances and.mm laws relating 507 - FINAL PLUMBING
O U ro building construction,and hereby minimize representatives of this thym enter upon
y W nim aWw-mentioned property fa inspection purposes. 508 — FINAL MECHANICAL
Fa. (Wm)agree m save,indemnify and keep homeless the City of Cupertino against
rn IiabRhies,judgments,costs and expenses which may in any way accme against said 50 9 - F AL
C.1
City in comrvcnm of the graining of th is permit.
APFLICAN'r ON DERSTAN DS AN D WILL COM PLY W ITH ALL NON-POINT ISSUe� 40 L
r/ A Date VV
SOURCE REGULATIONS.
Signature of ApplicanUConm4o Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Willthe applicant or future building occupant stole in handle hamaN.us material Type of Roof
as defined by the Cupertino Municipal CWe.Chaptcr 9.12,and the Health and Safety
Calc.Section 25532(0)'!
0 Yes °No All roofs shall be inspected prior to any roofing material being installed.
Will theapplicam or future building necupanr use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit jar.don,air conmmiumas as detincd by he Be,Aron Air Quality Management
District. all new materials for inspection. Applicant understands and will comply with
❑Ye. GNo all non-point source regulations.
1 have read the torturous materials requirements under Chapter 6.95.1 the
California Health&Safety Code.Scerions 25505.25533 and 25534.I understood that
if the Wilding docs not currently have a tame,that it is my responsibility to notify the
nmcupam of he mcirmomms which mus,W mer prier 10 issuance of u Certificate of
Occupancy. Signature of Applicant Date
Owne,or nmhmbed.gan Dare All roof coverings to be Class "Bo' or better
OFFICE