00030112 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO
10726 RANDY LA 000301.12
OWNER'S NAME APPLICATION SUB MATT'.
LIEM, SAM Dw1 /i5x— 03/20/2000
PHONE: SANITARY NO, CONI ROL NO.
o rc z ARCHITECT ENGINEER: BUILDING PERMnINFO
k 0 O BLDG ELECT' PLUMB MECH
H 1".._I 1=1 1-1 1=1
LICENSED CONI RACTOR*S DECLARA'I'[ON
% N z Job Description
1 nercby ora,That 1 am trached under p and
Profs of n,Colli 91ann,nenense
wiI.fill Imeemd l'f DYieiun3orJle nluine4FLl,d rr"reFli06[eMle,:+nd n,y hen,,.n
�y ur"rceandeu« 2—STORY, 1972 LIVING SP. � 624 GARAGE
o�u Licmw CIa, Lie.a
3 a H Dae Con Irw o,
ARCHH ECT*S DECLARATION
C O.di 1 undao i d my plana Ball be used m pr:blic record,
Wa p o I,ittneeJ 1'n+f�winnW
o y thin I a.rwo
OWNER-BUILDER DIiCe ARAIConti cler
vl=' LE
1 naso affirm Inco 1 L cBusin hunoson the Cuntrnemrol License law for Inc
C%¢ following rites..(Senior 1LA allea,and ce,de.iun.Code:Ary an o,-Cie.
ace
which t, pc 't, consumer,'h p 1 I h psipped
Y la mum
�3o Prn t 'Iminimsrl 'lll If II 11 8 J.rr nem
that he licensed roti the pro , the Contractor's L 1 f aper Sq. Ft. Floor Area Valuation
n +nam,rgwfhs.vl0n71N01onry'ann3tnnoBa.mea,.,ndvmre,.,'ne 3 $285000
or,pm he ie esan,pt.minion end the basis 1", he olcsed escup,io c Any ,I'
,if Sectio 70315 hyunemplicanfor eperfornobjeets the applican..... vin shy
:,I m,f nm+re conn live hr:ndre.f dmh+ra fs5Bn1. APN Number Occupancy Type
L: sum 1emoTPrm,,o r.yemployee winwaga,:.,mnir.a,laenmpen,mi 31602072. 00
will do the sunk,and the dructum is nor intended or cohered fur.aIle(Sec.71 W.
Business and Professions Cale The Contractors License Law area not appy u,an Required Inspections /�
viOncrof proper,will'builds or improves clinician,and who mel., I,wort himmlf 1.01 — FOUNDATION FINALaF13
or through his own employ.,,provided shot such impmicmcnts u -not imcmleJ or
oared for cam.E:hosteler.he budding m h.,prn...uem I,sold ww,m one year or 102 — PIERS
lmnpletion,the owner.IwJder will have the bnrden ofpmving that he dldnothuild or MAR 1 3 2002
op,u e homirpo"ot'atic 103 — UFER
❑Lae owner of the property,am exclusively connectins with licensed contractors to 1.04 — REBAR
conelmm Ilie muiea(See 7(W,Budnea,Ind Prolroions Code:) file Con(color's
License law does not apply to an owner of property who Builds or in,prmxs thereof. 105 — ANCHOR BOLTS BWILDING
Cid who emmlml,Ibr o0i pmjcros with a c umetorel liocnwd nf Pur m, u.the
ontractors License la". 1.06 — SEWER & WATER
❑l am ,npr unIcr Scc H R I+c lin this rcn,nn
aZllv� 202 — UNDERFLOOR PLUMBING
His. 203 — UNDERFLOOR MECHANICAL
WOI COMI'IiNSAIION❑ECLARA'Il(lN r.
n+ereby drrnlm,Je,pmmllyof,laprylow orrnefnBnwmgdeelarahon 204 — UNDERFLOOR FRAME '
�p have and will m,intain a Ceriaea ce of Closer,to se161murc for Wnrkcr'a 205 — UNDERFLOOR INSULATION
Ls.„pem1allon, a, pnwmed b,r by ScYaon 370 of rte Lab... Code. for n„ 3{711 — ROUGH PLUMING
performance of he work for which his pencil is issued. _
0 have and will mainmin Worker',Compensation lroumnec.as required by Section 302 — TUB & OR SHOWER
37m,of the labor Code,for the performance l'f he work for which this permit is 303 — ROUGH MECHANICAL
issued,lily Worker's Compensation n Insurance tamer and policy number am:
Currie: Policy No, 304 — ROUGH ELECTRICAL
CERTH;ICAI'ION OF WEMPTION FROM WORKERS' 305 — FRAME
(OMPENSAI ION INSURANCE
(This section need not be completed if the permit is for one hundred dollars 306 — HOLDOWNS
udBull'rle,..1 307 — INSULATION
I eerily flim i,. he perfo.,noer,l'nbe wutk ria,wldn,dao renal I,rand,1 308 — SHEET ROCK
.Baur.,it employ any person in any mane na,,o a,I„heenm ,object to ore Works 309 — EXTERIOR LR TH
con radwM'
on Los Calocria,Dae
Applicant
N(YI'ICHTO APPLICANT.It.offer Dinkins this Certificate of Esemp,ion, no should 31.0 — INTERIOR LATH
fission,subject m rte workers Coinpcnaation provisions of the labnn Code,you nuuar
O z0 forthwihcomply with such pmviemn,orhi,Permit mallthe deemed minkm. 311 — SCRATCH CURT
fZ^" ti CONSTRUCT[ON LENDING AGENCY 313 — ROOF NAIL
I heahy uffinn that there is x mm�tnmfinn ImWing agency for the prrenmm —
nce
nfmworktmwhot, ]Ii,penitisissued(Sec.vnn.On.C.l 501 FINAL ELECTRICAL ENERGY
oW. Lend"e Name 502 — FINAL PLUMBING ENERGY
"L Inm1r,'s AJJrew
v O1 cv,fij,fl.tlh l his fz 1 Iac, h,m Noce infoolouion is 503 — FINAL MECHANICAL ENERGY
tr E correct l agree to .ply with all city and county ordinances and slate laws elating 504 — FINAL BUILDING ENERGY
O !) n
bmidia,c,nournOi I.I I hereby'nithorila spreworclor-ofh oy morril,mic
Bre citure-unnolincrodpropInyl .p r vmpow,. 505 — FINAL ELECTRICAL
P. (N ) k , sae d Tv d keep h I s,theCity f Cupertino ga rot
VN 1 iabililic,sjJgf lb.vast,a,dssp, w,cluch I r.1y on.ry ck cy accral,tga ,msaid 506 — GAS TEST
T. City in consequence of the granting of his remit.
^ APPI AN'1'UNDERSTANDSANDWILLCOMPLYWITHALLNON-POINT Issuedb 507 — FINAL PLUMBING Date -wmi. Q
SOU r E REGGLA 1 / Z U y'
Si a V�na — 4� Dare � 'zl — ` v
HAl kRDOUS MATERIALS DISCLOSURE Re-roofs —
I1l'herr,hcomnrInane huimic,occup.m,flue mhonme hllardon,m,tc,id Type of Rb5t99 FINAL GARDE
asde0medby(he Cupertino lumcipaf Coote.Chapter 9.12.and the[Icahn and Safety 510 — FINAL PLANNING
Code.Seen on125532(u)r
Cl5'ea • " All roofs 51l4be-inpticWIpri6tldliluj[FooWAIRMEerial being installed.
Will o+eapl,hcamor mlam bonAingneer:pam use ewpnnem ordevice,which If a roof i& biRalled RM Bt 11P1106b1@0136 Altif1tUpection, I agree to remove
emit hvandous air ecemniI defined by he 13,Armor Air Quality Management
all new mB0''r4)lslorRp ti(yA-{vp@'N&t understands and will comply with
GYet No all non-pt3 s4oarc,WW"qcilil—PROGRESS
1 have read the nmmJoua conferrals requircornao under Chaper 695 A rhe
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
it the building tine a Bar cuncn0y have aLLe 1.Onm it is myoc,ponsthilhy mnoflfy the
ocoram o he rcyuircmm�rz x hicIt mu he mer prior In issuance of a CertiOeme of
.rupanc
/s //S�0 Signature of Applicant Date
owns,on -odea solicit l / D,�— All roof coverings to be Class "B"or better
OFFICE