01080082 TY OF
CJ BUILDING DIVIISSIIONN � PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10726 RANDY LA BANG' S ELECTRIC 01080082
OWNER'S NAME: APPLICATION SUB DATE
SAM LIEM 18940 NEWSOM AVE 08/16/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 378-9971
00 ARCHITEC(ENGINEER: BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
N Z LICENSED CONTRACTOR'S DECLARATIONp
Job Description
i_C„ 1 hcrtby.ffL m that 1 am licensed under provisions of Chapter 9(commencing
vj wiinfall o. AdAfDivision3uftneBusinessandPrufess,onsCode.vndmylicensc REVISION/PICTURE WINDOW—REFERENCE ORIG PE
it.full tome and eReet.
i 0�6 Datayse Class- Lic.tr a 00030112
0 a O Data S Contractor
:3 u. ARCHITECT'S DECLARATION
co]N I��o
''=O g I uMersteM my pians shell be vud ss public records F I e V
i a O Licensed Professional
OWNER BUILDER DECLARATION
I hcrtby.alum that Ism exempt from the Commcmr's License Law for the MAR 13 200
t? following mom..(Semon 7031.5.Business and Professions Code:Any city or county
S G which requirts a permit to consumer,alcor,improve.demolish,or repair any structure -_ —
o .,pnwb its issuance,also rtquim shgaFdkem for such permit m like signed smumismo- - ------ - -- -- - ----- - - - — - ----- - ---
° 3m Nm hd i5lianuO Pursulu,l mthi provisloru of the Comnaols License Law(Chapter 9
Sq:Ft-F1oorA'rea: , ,--r marten
Icomme«in6 with Section?0011)of Division Sof Ute Bs9ircepW Pmf,sswnu Code) �':\NTVZ L_ F ao -Area vAk.�t.a
or that he Ta ekempt therefrom and the basis for the alleged exemption.Any violation
of nor m n 7031.5 by any hundred
dam for v permit subj¢ts the epplicem m a civil penalty
ar not mart than rive nundrea dmlars IBzw). '"- •• Occupancy Type
❑1,as owner of rhe and
the ,°r my employ«s with wages a ed f sole compensation, t
will do nets a work,and the macode:T e is not ctor's Li or License
Lad for sale(Sec. to an t
Business and Professions Code:The Contractor's unnw Law a«:not army m If 102 — PIERS Required Inspections
ow«r of property Who builds or improves mertam and who does such work intended
if
mmraanhi.,.wnempt Wiidiarea:ucnveramnemanlaam withinn.yinxof. . 103 —_ .UFER - - - -
of(cgd fon ale.If,comer-bander
however,Ina Wilding or Ire en of Prov is what within ane Weld or .n �, •, .:an: "
ebmmeban.tue , ofxilderwmnavemeWmenorprovingtnatneamnotWimar' 104 — REBAR
impro"er«p"'°°"ar.ale.). .. 105 . ANCHOR -BOLTS.
�whai�v(See.70U.arotasssand rofeiagwiwlme:)ThaCrmareww 106 - SEWER & WATER
..constrva the project(Sec.]014,Business eM Professions code:)Thc Contncmr's �
License Law does not apply to an owner of property who builds or improves themom 2 02 - UNDERFLOOR PLUMBING
'-' and.who Co.,,.s for such projects with a m axo nm(s3 licanaed w...at to Ne. - ---_....
Gonvnnar.Lia'n: sc p oNDECLARnno" 301 - OUGHFPOLUMBINGNICAL
❑lame BAF,Cforthis maden 204 — UNDERFLOOR FRAME
o LATION
" I hereby aRfm under penalty of perjury one of the following decimations:
❑ I have and'win ma maintain a certificate of Coi an aeR-insurt.ror Workers 3 02 - TUB & OR SHOWER
campen..tian, a,,vaeviem rot by Secede. 37W of me IaWr code, for me 303 — ROUGH MECHANICAL
p a anaonhawetrorwnienmiap m ehue.; 304 — ROUGH ELECTRICAL
❑1 have and wili maimaia Worker.Compensation fasuarica:as mquired by Section 3 0 5 - FRAME
3708 of the Lathan Cade,rum Ne perforri of the weak for which this pcmnit is
lasuea:IM Warkcrx Corn mation 1psurann"cortin oM Policy number tie:,�..� 306. -..HOLDOWNs
, ? . poh ry
CERTIFICATION OF EXEMPTION FROM WtORKERS'k , 3O8 - SHEETROCK
.otw.:-cat ser; ,a is „ ) permn
COMPENSATION INSURANCE
:r "ss(This sembn ieN tont W<a lame inha 't i.rat a«Wrtamd dollars
309' EXTERIOR LATH; 1 �'': Clccupailc Fyp�
($I0p)C,LAxA) 310 — INTERIOR LATH :
_ _.
�1i I certify that in the pcRm
om«e'n(the workwhichermit is
far which this pissuN;l 311 — SCRATCHCOAT,;
'shall riot employ any pawn in any manner w ss m become subject to the Workers 313 — ROOF NAIL`
Compensation laws of Celifomie:Data
Applicantmar '' 501 FINAL ELECTRICAL-'ENERGY
NOTICE TO APPLhe Work is after Compinkinihpr provisions
Exemption. you should
Z became subject mtheWorkersGOTR^xmionprovmonsofthe lobo.Code;youmus,1 502 — FINAL PLUMBING ENERGY
00 forthwith comply with such Provisions or this perms shall be slimed nevokW.
� m " CONSTRUrnONLENOINGAGENCY 503- — FINAL MECHANICAL ENERGY , T:;i;;.
Ih by fri;m that thimis ac6.structimileadingugencyfortheperfmmmm 504 - FINAL BUILDING ENERGYn�t:i t k• _
of the worn:for anichtma permit is i...ad(s«.]097:Civ:C.) ,. � 505 . - FINAL ELECTRICAL
Name' . . .. - :.. "" ,._,.-. .. ..
Lentler's
D4Z Lesder.'Address 506 - GAS TEST
I certify that 1 have reed this application asM slam Inst me above infoamnion i. 507 FINAL PLUMBING
W'F' coricct.l agree m comply,vvoh all city and county mdinion;and hertby.mliiiu rapmuntadvunces and slam laws relininea alibis city to enter upon g 5 0 8 - FINAL MECHANICAL
C.7 to Wilding examme.
y .the above-megtipaedpmr,erty for inspection Purposes. 509 — FINAL GRADE
rr,Qs t
(We)ague to save,indemnify and keep harmless tha City or Cupertino against
.0 vy liabilities,judgments,costs and expenses which may in any way•accrva against said 510 — F NAL G
V ► City in mail of the granting of this pemut.' "
APPLICANT UNDERSTANDS AND WILE'COMPLY WITH ALL NON-POINT
Issued 4 ! ORKS Date
SOURCE REGULATIONS. .:-
• Sign ature ofApphcanJC naem - Date.': Re-roo&vo _ ROOF BATTENS p 1
HAZARDOUS MATERIALS DISCLOSURE
❑WYllea; paNa; Jlos mateelType ���, _ tROO,,F ItN:—S PtyRj OGt .RY s _
_.tkbplcntaft Wldin6 upant Nae«hrdl hazard ESSadfnWbytheCulxnamM cipalCodeChapter912, dCan Health And Safety it! ...
CaLa5ec0aa,M321e1 "y
i. All roofs shall be inspected prior.to.any.roofing material being installed._ - -
• Will she applicant for=Wildgoccupant W pmemo de icca hich If a roof is installed without first obtaining an inspecti6nt,T agree to remove
ermt hasardous air iontaurninams as defined by the Bay Ama Air Quality Mamagemem
Di.mctnall new materials for inspection. Applicant understands and will comply with
❑vest oNn all non-point source regulations. .., .
'1 h;ve'm.d'ih:neiurdats rnsane1,rtquiremems under Chapter 6.93 of the
California HeilN&Salty Code.Sections 25505.25533 and 255M.1 undersand Nati -
if the building docs not currtnrly have a meant,that it is my responsibility m nmify the _
occupant of We mqu tame ts which'must be met'Por m i m f a Ccnifieem of
Signature of Applicant _ Date -
r. All roof coverings to be Class"B"or better
Ownescomhoriaad agent', " Dem ,.
.... - ,n : OFFICE - t.