01120078 CITY OF CUPERTINO
BUILDING DR7SION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7770 ROBINDELL WY JU KEN JEN-GOW AND WANG DAPHNE 01120078
OWNER'S NAME: APPLICATION SU DATE
JU KEN JEN-GOW AND WANG DAPH E 12/2012001
HONE: SANITARY NO. CONTROL NO.
O o ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
5„sthatensedhapter Job Description
ir- Sectioficuchn 7000
).f tord (com
Irncing KITCHEN REMODELING
;HtuOi with Senior and orect. onlnf the Business and Professions Cade.and my l'ceti
ed 2 is in full forte and effect.
O.U Date Clens Lic.M
Date Convenor
1 it m nARCHITECT'S D' R O
u'O 1 under mrd my plana shallu b
I 0 0 Licensed Profcssio i
W LD DE A N
m 1 here a firm than 1 sit rcpt omr or' icense
t:Qfollowing ren (Section]031.), usincss d Pmfc., y cit county $20000
which res,IA rmrt con.I aha i rove.demo o pa to y t cmre
prior to w's 5�alr e9u rcse a man such perm TI signed statement -
Nat hesIcense poison t to Ih ostyi♦p Cmoult sLc Lo IChrter9 c 35,r*`Rh Rl,.r,st p„tgp s ,. 1 - Valuation
(commccng wn ali ;ivi, a3of the Easiness and Professions Code)
or m t he is exam the bass far the Idlijad ck'enapohm.A y vialauon
M Section 7031.5 pplicmo fora pcim,subjectsthe.,heann0 a civil penalty
of hot marc lion,five hundred dollars(s5w). 10?PN N'PUtNDATION Occupancy Type
❑L as owner Of the properly,W my employees with wages as their sole compensation,
wen do'the work:and the'mmrtun,is rat imanded-m afrc.d farad,(Sec:7osa: 103 - UFER Required Inspections
evimesi aid Professions Codven
Code:The Conor's License Taw docs not apply to an q ns p
Owner of properly Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided that such impmvenmms arc not intended or
ofYerea fdi sale If.howevci,the building ur imp year - -" BOLTS- .
mem n sad avenin not or 105 - ANCHOR
intpowtion,me owner-builder will have the burden of proving that he did not Wild or
improve ren purpose of sale.). 106 - SEWER & WATER
.I. .. -. . _ - 'UNDERFLOOR---PLUMBING" -
El1,urnwnerofthepSec.oamcxdusiv. can dPronssion.W.:) hcn.O or Oto 202' _ .!;�'. ..,
Limmac t the Profen(sae.]040,Business one Profession:code:)The improves
tmcmr's 203 - UNDERFLOOR MECHANICAL
- - Littme Law does not apply m an owner of pmpeny who builds or improves mmun.
.._ ane who comenct;for such pmjmB.wilh a cmucst tors)licensee paisvam m die - - 204 --- -UNDERFLOOR -FRAME
Comoro rs Lima.l.2w.
clam - p[uiWer 6 ,B&PCfonhisrtaaon 205 - UNDERFLOOR' �INSUL'ATION
.m
wa` ORKER'S Eius,ksreN�EcL aAno�N� 301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
I hereby affirm underpenalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL
0 1 have and will maintain a CemRnme of Consent to rely-insura for Workers 304 - ROUGH ELECTRICAL
Compensation, as Provided for by Section 3700 of the Labor Code, for the
. - perfomnsom of the work for which this permit is issued. 305 - FRAME
❑I have and will maintain Workers Compensation Insurance,as rccuired by Section 306 - HOLDOWNS
3700 of the Lahar Code,for the performance of the work`for which this permit is 307 - INSULATION
issued.My Worker's Campmsmkm Insurance comer and b
Policy numer ort:
308;,- :SHEETROCK. — —
Geriiee} C ..,_f f' ' Policy TIO ("' ,. . ;'309�'�` -EXTER'IOR`' LATH
CERTIFICATION OF FATIONIIONRANCE'FROM ORKERSt' '-
,.- -•,_ '. COMPENSATION INSURANCE" -, -,-_- -, �-
-- `3T0-� -INTERIOR'-L;ATH_.._
° ''(rhissec;kmiiednot Wcompleted ifthe Permit isfor one hundred dollart
($1001 or less.) 311 - 'SCRATCH COAT
"i cenif mat in me rfoimance or me work for which this 3 13 - -ROOF NAI L -^° - •'- "^ ^-'^"' -'
p cta.th Worker,'
501 - FINAL ELECTRICAL"ENBRGY�"
sh mpent employ any person in any ma as m become subject to the Workeri
Compensation lswa of cdrcami,.oate-Applicamn°` 502 . _._ FINAL .PLUMBING ENERGY -
becomeETOAPothe Worker's afmrmasationthis CesionsoftheLabcate of Exemption,de,youould 503 - FINAL MECHANICAL -ENERGY
iZO pbecome subject In the Worker's Compensation provisions of the Labor Code,you muse,
mrinweh damply weN sueh pmmsmm art Nia permh,hau rte deemed revakea. 504 -_ FINAL BUILDING ENERGY
F, N� CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
t ��then there is a conswcaon I yo cooingagency morthe arfi. omm
'W 'of Neworkfor which mfspe'moisissued(Sm.3o97,ci..C.) _ 506 - GAS TEST
Q L'ehdefe theme - - - '
E� z Ldeeranaerea. 507 - FINAL PLUMBING,.
U O T certify that 1 have read this applimnom and state thm me.Wve information is 508 - FINAL MECHANI CAL
w:F 4orten.I agree to morpl"avah all city and county ordinances and state laws relating 509 - FINAL GRADE
O V .10 Wildingconswciimandherebyeuthdnacrelmsentativesofthis city toenter upon 510 - FINAL PLANNING
r� she above-mentioned property for inspection purposes.
ya d (We)agree to sow,indemnify and keep hamdess the City of cupenino against 514 - FINAL PUB IC WORKS
'kr-p0 liabilities norms,costs and expenses which may in any way arae against sand O
V' n
material a of Ne granting of this permit. JJ
A SICA1 U 2R STANDS'ANDWILLCOMPLYWITH/LL NON-POINT Issued /��2�-y/
TIONS - y: Date
Srgmet ApplicanVCmunn,m Date Re-roofs
_ HAZARDOUS MATERIALS E
% me applicant m f tum building cecupmi st m or handle hauoeous matenal a of ROOF _. .... - -- -• - -- -
asdefinedbyth Capenm Municipal CM Chpt 912 and the Health and Safelyk.
n'P
Code Sect on 25533(a) r t -
OY°s I "a All,roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building cm.pam use equipmem or devices which If a roof is installed without first obtaining an inspeetion,'I agree to remove
emit hazardous air Omminimm s as defined by the Bay Aida Air Quality Management
District] ' all new materials for inspection. Applicant understands and will comply with
Dy. a all non-point source regulations;
�1 have read the herardoux materials requirements under Chapter fi.95 of the
Gallfd n.Health&Safety Code:Seniors 25505,25533 and 25534.1 understand that
If
Ne buil not cortically have a lenam,that it is my oo moibilay m notify the -
occvpam or me rt ircmenis which moa W met prior toj-ssum a of a Car ificate of
Signature of Applicant Date
Owner at at as agent Dam All roof coverings to be Class"B"or better
OFFICE - -
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