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02090022 CIT 62 BUILDI G DIVISION PERMIT CONTRACTOR INFURM TION. BGILDINGADDRESS: HIEN Q TRUONG PERMIT NO. 10628 RANDY LA 02090022 ERS NAME: APPLICATION SUB DATE HIEN Q TRUONG 09/04/2002 PHONE: SANITARY NO, CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO RLDG ELECT PLUMB MCCH pKZ O O 0 O pp LICENSED CONTRACTOR'S DECLARATION 6p 1,ad u Thereby daffirm lbat lamlicensed theBuiunder ssandprovisions ndsCodChapter nd(commencing SFDWL-LIVING SPACE 3J�38gscr I BB 7 y�iwith Seainn](NNq of Division Sof NC Business and Pufcssions Code,and my license is Yji`�LYyfENaN in full folic and effect. Leo Gy8&_Z License Class Lia K —p Date—Contractor F ARCHITECTS DECLARATION MAY 19- 2004 a< I understand my plans uball W used as public records Rail- Wu Licensed Professional I� ® opp^ OWNER-BUILDER DECLARATION B,LJtLD11Y'L9 I hereby afford that l am exempt from the Contractor's License Law for the 8U e Be—p O following reason.(Section 7031.5.Business and Professions QWe:Any city Or county which requires a permit to construct,alter,improve,demolish,or repair any s ruclum til poor In its ismance,also requires the applicant for such permit In file a signed statement 5�5�< that he is licensed pursuant to the provisionsof HC Cunvfcmr's License Low(Chapter 9 Sq.Ft. Floor Area $460 V041ation k€p (commencing with Section 7")of Division 3 of the Business and Profemines Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 703 L5 by any applicant for a permit subjects the applicant to a civil penally of Occupancy Type not more than Ove hundred dollars(5500). [:]I,as owner ofthe property,or my employees with wages a their able compensation, will do the work,and the svu da a is not intended oroffere l forage(Sec.7044,Business and Professions Code:no Correctors License Law does not apply m an owner of 102 - PIERS ;equired Inspections property who builds arimprovrs thereon,and who doessuch work himself or through his own employees,provici d difficult improvements are not intended or offered forsale.If, 103 — UFER however.the building or improvement is sold within one year ofcompletion,the owner- lO4 — REBAR Owner- builder will have the burden of proving that he did not Wild of improve for purpose of sale.). 105 - ANCHOR BOLTS I,as Owner of the property,am exclusively contracting with licensed conracmrs fo 106 - SEWER & WATER swot the project(Sea 7644.Business and Professions Code:)no Contract m Li- censeLawdoesnotapplytoanownerofpropertywho builds or improvesthemon.end 202 - UNDERFLOOR PLUMBING who contracts for such projects with a cortimmar(s)licensed purmanl to the Contractors 203 — UNDERFLOOR MECHANICAL CO.Law. I am exempt under see. .B&PC for this mason 204 - UNDERFLOOR FRAME Cr �� 205 - UNDERFLOOR INSULATION 1 ' WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby adimt under penahy of perjury one of Ne following decimations: 302 - TUB & OR SHOWER ❑T haw and win mainby a Cion 37 m of the Labor Colt-msnre fo Performance of the 3 03 — ROUGH MECHANICAL Cation.as provided for by Section 3](Nl of the labor CWe,for the performance of the work for which this permit is issued. 304 - ROUGH ELECTRICAL ❑ 1 have and will maintain Workers Compensation Insurance,as required by Section 3 05 - FRAME 3700 of the Ube,Code.for the peRormance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS Carver: Policy No.: 307 - INSULATION CERTIFICATE OF EKEMPI'ION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK - inissectionneednothecompldi emnheTcrmhif is hundred dollars 309 — EXTERIOR LATH Cries.) 310 - INTERIOR LATH I certify that in the performance of the work for which this permit is issued,l shall net 311 - SCRATCH COAT employ any person in any manner so as to become subject in the Workers'Compensation Laws of Califumia.Date 313 - ROOF NAIL NOTICEITO APPLICANT.ll;after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Workers Compensation provisions of the Tabor Coda you must 502 - FINAL PLUMBING ENERGY ,z forthwith comply with such provisions or this pmmitshall M dimmed revoked. z O 503 - FINAL MECHANICAL ENERGY t„t CONSTRUCTION LENDING AGENCY [r .N-t I hereby affirm that them is a construction lending agency l ie the performance of 504 - FINAL BUILDING ENERGY E D the work fur which this Permit isissued(Sec.YA7,CO.C.) 505 - FINAL ELECTRICAL W q Lenders m Lende506 - GAS TEST G rsAddAddress U0 1 scruffy that I haven read this application and .If that the above information is 507 — FINAL PLUMBING forma.1 agree to comply with all city and county ordinances and state laws relating to "— FINALbuildingconswmmn,and hereby aumorim rcprcaconlives of this city to enter uImn the 5 MECHANICAL above-meminned property foe inspection purposes. 5(We)agree m save,indemnify and keep harmless the City of Cupertino againsth liabilities,judgments,costs and expenses which may in any way aecme against mid CityCG'V in consequence Of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by5WORKS Date SOURCR GULATIONS. PT Signature A� n ontractor Dam Re-roofs 603 - OF BATTENS HAZARDOUS MATERIALS DISCLOSURE Type of WfJ - ROOF IN-PROGRESS Will the applicant m fmme building occupant stere nr handle hamrdous mamoal defined by the Cupertino Municipal Cods,Chapter 9.12,and the Health and Safety e.Seeaon 25532007 All roofs shall be inspected prior to an roofing material beim Installed. ❑Yes C1 No P P Y g g Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazamous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disr cn ❑Yes NO I have read the havarJous materials mquiremems under Chapter 6.95 of the Califor- nia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that iflhc building does not currently haw a tenant,that it is my responsibility to notify the occupant of due require re tech must W mel Poor issuance ofa Comficatm of Occupancy. Signature of Applicant Date oweefbranthen dna c — — Dam All roof coverings to be Class "B" or better i - - - �,_� �% � �.` -� � �� 3 i � � � � `. X� JJ /J � � '-Y' I w� { ,�