03020021 CITY OF CUPERTINO 'It �e
BUILDING DIVISION PERMIT .4CONTRACC R INFORMATION:
l3xs Ry.o?2�1
BUILDING ADDRESS: PERMIT NO.
20286 PINNTAGE PY 03020021
OWNER'S NAME: APPLICATION SUB DATE
STEVEN CHAN 02/06/2003
NE: SANI'T'ARY NO. CONTROL NO,
ARC111777c]YENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IOo LICENSED CONTRACTORS derp DECLARATION
u+ Ihere0(a))o mthaiamfdueBuinss and ProfesaonsCoprer9mommencmg lob Description
in ' with Semon add
Division lof Ne Business and Professions Code.andmylittnseis
ala„ mm�hneanderrec'. KITCHEN REMODEL
I z o g z License Class Li 7`b -
F_-'c Dare Contractor CONTRACTOR: OWENS CORNINFINALED
o 1',y ARCIIITECT'S DECLARATION
U 1 understand my plans shall W used os public records
wow LicensedPrnl'essional MAY 2 2 2003
OWNER-BUILDER DECLARATION
ti 2 I hereby affirm that 1 am exempt from the Contractor's License Law for the
4600 following reason,(Section 7031.5,Businnistand ProficasioncCude:Any cilyor county BUILDING
x 2 K which requires a permit to construct,alter,improve,demolish,or repair any structure
Fz� poor so its issuance.also requires the applicant for such Permit files signed statement
x< That he is licensed pursuant totheprovisions ofthe Contractors License Law lChapter9 Sq. Ft. Floor Area Valuation
itiF$ (commencing with Section'1001)ofDivision 3(if the Business add PromationsCode)or
Wu $1500
.. t he exempt therefrom and the basis for The alleged cacmption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penalty of APN Number Occupancy Type
not more man five hundred dollars 01,00). 36947024 . 00
- p Y YP
0 1,as owner of the property,or my employees with wages as Their wbe embpensminn,
will do the work,and The structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License I.T.fres nor apply to an owner of 101 - FOUNDAgd Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements am not intended or offered for sale.If, 102 — PIERS
however,The building or improvement is euld within one year of completion,me owner,
builder will have The burden of proving That he did not build or improve for purpose of 103 - UFER
asle'). 104 - REBAR
0 1,as owner of the property,am exclusively mnuacting wish licensed commeton l9 10 5 — ANCHOR BOLTS
construct the project(Sec.7814.Bustness and Professions Cods:)The Contractors Lt.
cense law does not apply to an owner of property who builds ori arrows thereon,and. 106 — SEWER & WATER
who License
Law. rsuch pmlecushmaz
wianutorp)littrsuammmContractor's 202 - UNDERFLOOR PLUMBING
0 l am exempt under Sec. ,B&P C for this reason 203 - UNDERFLOOR MECHANICAL
Owner Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
(hcrchy ellirm under Penalty of perjury one of the following decimations: 301 — ROUGH PLUMBING
❑1 have and will maintain a Certificate of Consent to ad6insum for Worker's Compete
nation.ax provided for by Section 3700 of be talar Cale,for the perrormance of 3 02 — TUB & OR SHOWER
wmk for which thin Permit is issued. 303 - ROUGH MECHANICAL
0 I have and will maintain Worker's Compensation Issurance,as required by Section 3 04 - ROUGH ELECTRICAL
3701 of she undrCode,for me performance of the work for which This permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 305 — FRAME
carie': Policy Nn: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(Thissection need not M completed Rik Mrait is forone hundred dollars IS lot)) 308 - SHEETROCK
ces''
I309 - EXTERIOR LATH
employ mat m ton perfomtanne of as work fm winch mire perms is issued,1 shall not
Laws of
Deny manner snasln hemmc subject it)ThC Workers'CompcnsminD 310 - INTERIOR LATH
Laws or California,D81BAppi311 - SCRATCH COAT
NOT cant
NOTICETOAPPLICANT:ILCompensafter ationpovisiosofctur of Exemption,Labor
you multi 313 - ROOF NAIL
become subject to the Worked Compensation or thin provisions of me labor Crate,you must
� Z Bmhwith comply With such provisions or permit shall Mdeemed revoked. 501 — FINAL ELECTRICAL ENERGY
z0 CONS RUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
F IherenYafrmchat the.is.construction leading agency fee The lurformancc of 503 - FINAL MECHANICAL ENERGY
a � The Work for chthis Permit isissued(Scc.J1Y1].Cis.CJ
Under'.dcr'.NamNaimc
504 - FINAL BUILDING ENERGY
LSt Q
� 2 cwer'eAddmas 505 - FINAL ELECTRICAL
U O 1 cenily had I have read this application end stare that the above iofmmation is 506 - GAS TEST
l!. correct.l agree to comply with all city and county ordinances and sure lawsrdatingm
OU building construction,and hereby amhormrepresentatives ofhis city u)enter upon the FINAL PLUMBING
G
WD.1 above mentiturdproperty fnrinspecdonpurposes. OB FIN L
(We)agree to save,indemnify and keep harmless the City of Corinna)against
W liabilities,judgments.costs and expenses which may in any way accrue against said City 5 A
U Z in consequence of The granting of This Permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SOUR- REG L TIONS. —
/ 514
r pianconRe-roofs
CIZ
nature conicmr
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant slum or handle haardous material
as defined by the Cupertino Municipal Ciale,Chapter 9.12.and she Health and Safety
Code Section zss3z(a)] All roofs shall be inspected prior to an roofing material beim Installed.
.5- ❑tion No - P P Y g g
Will the applicant or future building rrcupxnt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
/ emit naeaNnm air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District/
D Yea 0N
1 have mad The hiendmis materials requirements under Chapter 6.95 of the Califon
nix IIcahn&Safety Code.Secuom 25%5.25533 and 25514.1 undersand Than if the building
does not currently hast a¢nano mm it is my respomilash y in notify the aaeupant of the
rego9mmenI,which must he met prior m I..'if.Certificate of Occopancy. Signature of Applicant Date
nmma Thr neJagcnl Date All roof coverings to be Class "B"or better