06060258 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT ?,tC®NTRA AORANF0RMATI0N :
BUILDINGADDRESS: YD- U CHANG PERMIT N0.06060258
21720 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE
YU-HSU CHANG 06/30/2006
NE:
SANITARY NO. CONTROL NO,
ARCHITECTENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
i00 LICENSED CONTRACTOR'S DECLARATION
ro F 1 hereby affirm Nat 1 am licim ed under provisions of Chapter 9(commencing Job Description
W. with Section]gIB)orDivision3 of me Business and Professions Code,and my license is
+.,„ in full fomcand effect- REMOVE EXISTING BATHROOM FIXTURES, IS, WALL, WIND
>�z License Class Lien DOORS, REINSTALL TWO BATHROOM FIXTURES NEW WIND
-Fp Dow Contractor
ARCHITECTS DECLARATION AND WALLS
i m< 1 understand my it
shall neused as public records
u.pyU
e m Licensed Professional
3 OWNER-BUILDER DECLARATION
I 1 hereby al Nat I am Cu t from the Committees Litton Law for the
p O following mason.(Section 703 1.5,Business and Rafesiom Code:Any city or county
u m� which require chromium,permit to man
n,ar.impmw,demolish.or repair y struchare
u
-Z ui prior w its issuance,also acquires the applicant for such permit m file a signed sartmem
< that he is licensedpurnanttoMeprovidnes.fMaCarnahan'sUccnnLaw(Chapter9 Sq. Ft. Floor Area Valuation
er (commencing with Sermon 7000)of Division 3 or Me Business mal Profess ams Code)or $4000
e�$ drat he is exempt memfmm and Bre huis for me alleged exemption.Any violation of
Section 7031.5 by any appliam for a permit wbjects me applicant In a civil penalty of APN Number Occupancy Type
not mart Nan five hundred dollen($50B).
❑I.uowner of the propmy,amy employm with waguu the'v wlccampeuation.
will earth.sairrad me structure is CarinnrmedareBered farsale(Ser.701x,Business - Required Inspections
and Pmfmiom Cade:The Contractors License Law doe reet apply to an owner of q P
property who Wilds or improve thermn,and whodeessuchawrk himself ar duaugh his
own employees,provided that such improvements arenot intended oroRered formic.) -
howevv.Un oildinL or improvement u sold within ante year of completion,me ovvne
builder will have the When of proving the he did not Wild or improv far puryose
ole.
.o owner of the property,am=elusively contracting with licensed mom icmrs to tI^ n pc
consumer Ne project(Sec.7044.Business and Profesiom Code:)The Canmemr'a does LL I V JV �5
cense Law not apply m m owner of property who or improves tW asm.and a V J 111,
whocon as time pmjemwhhaconmacmr(s)Iicrnssdpunuantm Ne Conantoes
Lear L
❑lam aemJJunclear SePCforNis
OwnerC
��
✓WYORK SCOMPENSATIO LARATION
41 IMislay affrrse under pesWty ofpejuryaNe
fallowing daelaratiwts:
71 1 have and will maintain a Certificate of Comacm to elf-insure far Warkces Compen-
sation.As provided far by Section 37M of the labor Cade.for the Performance of Ne
work for which this permit is imuee.
❑I have and will maintain Wmkces Coar msatian Item .to required by Scene.
My of the Lobar Code,for the performance of Ne work far which min permit is issued.
My Workers Compensation Insurance carrier and Polity number art:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihu scctiw mash natWcamplcleJ iftW permituforone hundm4 dollars(SIW) 0 D
at IcssJ n
I C,mf matin c performance of me work far which Nis permit u.`^~4 I shall nm
cmpldy any'pers in am in mato 0 bj 11a Workeri Compcmadan '
Lawsof Calif is Dam e o
Applicant
NOD PLICANT:If.after making am of Exemption,you should .w
become aubyst to me Wor e s Campcuado vision of the Li or Cede,you muse
.,Q foMwith comply with such provisions ar mu permit shall o deemed revoked.
'Z.,'C CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a contraction lending agency for me Performance of
fLthe work far which this permit is issued(Sec.3097.Civ.C.)
aQ Lende'sName
7 z Lender's Address
U0 I certify that I haw mad this application am sate ren the move information is
Htorten.I agree to comply with all city and county ordinance and sure laws relating to
Q U Wilding construction,and hereby authonm mpsscnutiva of this city to cater upon the
a ebtw-mmdatea PmPetry ran cx,amem which a.
(We)agree to maw,indemnify and k«p harmless me City of cupenino against
H V1 u .ju n'",cosy see capcnsu which may in any way accrue against Mid lily
t.) z APPLI ANTDUNDERSIrng NDf AND WILL MnWITH ALL NON-POINT Issued by: Date
SOU EREGULAri S.
D
ignawrc of Re-roofs ApplicaMComractorData
HAZARDOUS MATERIALS DISCL RE Type of Roof
Will the appliant or future Wilding occupant state in handle hanNou material
as defined by the Capistrano Municipal Cade,Chapter 9.12,aro me Health and Safety
Code.odtea enxss5z(a)+ 6K. All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future Wilding occupant uz equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
cOm�c'mous air contaminate,u defined by the Bay Area Air Quality Management all new materials for inspection.
OYea di,4/
have read the limitations mmerialsmquiremenu undcrClu nm6.95ofthcCalifor-
miaHcal &SafetyCade,See atsx5505.x5533 53a.lun n=d Wtifthe Wilding
Joel not urmnJY have a and t u my 'bilitY to mofy thr oaupanr of the
require Gnaw icM1 p' rum' cc ofa Ccnificae ofa panty.
Signature of Applicant Date
0 0
net or aurhanzeE agent oto- - All roof coverings to be Class"B"or better