02020079 CI BUILDING `UDPERNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
02020079
OWNER'S NAME: APPLICATION SUB DATE
LEUNG 02/21/2002
PHONCE: SANITARY NO. CONTROL NO.
w ARCHITECTIENGINEER: BUILDING PERMIT INTO
z00 0OF V BLDG ELECT PLUMB MECH
OL i'I LJ L_I
ya4 "
LICENSED CONTRACTOR'S DECLARATION ofC ON .lob Description
D a-o I hereby affirm Nm I oro licensed antler provisions of Chapter 9lcommenctng
m with Section of Division of the Bu.zinessa dPon riotersCWe.and an license
<x to ra�u Is as ^m. 6 f/�,T REPI PE.
E e,rc 6 aL�is¢pIC Clan �-H
o a f nContractor
ll u i ✓` A H 'S DECLA4
O-5 odersmn y plans shall be used az public records
�so-
0 Licensed Pmfcasi...I
OWNER-BUILDER DECLARATION
vi= I hereby affirm Na,1 am exempt from the Contractor's License Law for the
y
fz .following _reason.(Section J' 3,Bassinadd Professions Cade:Any city or county
: o whichrequires apermit to , I h improve demolish, p y tmemm
r '
$1500
Prior Ix' eloqpser such . mmmem -
:2 that he is licensed punoandteI sxiii,o Commerce,License Law(Chapter 9 Sqq F6Floor Valu.
a ti.o_n
tag Ingecto Jfran,fD.stivn3 asnea aor ..n,Coae) 1m <vs the�froand the basis the
allnemptioa:Any.mlmmnNE .N363-2046` 100xt.''` �' )^''
of Section 703L5b aapplicantforopermd, tidjmcufr vppliam to.civil penalty
.ornanm,nainfiisenaddreddollars(sso ).
APN Number Occupancy Type
C1 1,as owner onneroert,orm employees with wages as their sole cora tion. 202 - UNDERFLOOR P BING
P P Y temp y pensa
at11J N 'work, it ffir wtrc' not intended or offeredro sal (See.7p44 - --'- ---
Bus d Professions Cad Th Contractor's License La does not apply to an p p - "
,we- fp nyWn I builds a d n does such workn stir 502 FINAL P li tt ndY I
orthrough h own employees.pdeth,such improvements are not intendedor 507 ..- FINAL PLUMBING
offered f ale If h tit bu ld' g iir Id- 'nn Ycar of .. --.. _ _. __-
_
ompl f the owner-build ill have the but den of pros i ng that lie did not be'Id or
improve for purpose of sale.),
con f je p pony 1 Business
ell t ofe i 'N Id
consumer the pre,;r (Sec JBIi Bu. s d Prof Cade)The Conwno
Lice L w does not apply m un owner of
- _ end ho cssuch.protons with a commutator)
ommnmfs)u licensed Pursuant hwe<the
Contractor's Licerse Law:
❑1..reen:pt
_.. .. . .......... j�
.. _. ........ _
undcr5ee" ' ' : � �,B&PCfor this reason ..,. , .,
Ownar `Dam
WORKER'S COMPENSATION DECLARATION
! I hereby affirm under penally of perjury one of the following declarations:
❑ I have and will maintain a crar Ecale of Consent to self-insure for Workers
Compensation, as,provided for by Section JJIXI of the Labor Cale, for the
_ _ perfomun<e of Ne work for.which Nis permit is issued. ,
01 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Cade,for the perforrnance of the work for which this Permit is
Issued.My Workees Compensation Insurance -nier and Put i yunbe
Cart k l - .'. 1 t 1x:.Poli YNo' 1 / y
I'SlT! CERTIFICATION 01 EXEMPTION FROM WORKERS' . '' f lt..1 'U �. a ..1.+i\ Edi . ;'i' s'
_.,.. .- ...--__..vCOMPENS. - INSURANCE°'._......... a-.- -._ .._. .._._..._____.
' Thiiliedion need not he tomP I td if the t is for one handled dollars
n
( modered perml
(E 10o)or len.) '
_...- .. ._
1 ri fy Na in N ped Im < f the work far whits to pc 1 s .sued,l 1 .,
sM1all nm emPloy'any persunm ony
' '� Compcnw}fun L,ows oWf ConrkLePor's CIoo.
hoom theW
�Y - e't:
$
Dr7s__; r
NOTICEXOAP , A akingtM1 venerate of pi should
he inversions of the Labr Croft. must
Ofonhwitn comply with such provisions or this permit shall be deemed revoked.
F - - '
'
j.. -
l I' ^'CONSTRUCTION LENDING AGENCY '
I thenctry offirrn that there is a canswceon lending agency for Nc performance -
,., of the-work for which dak permit ismood(Sec.3097,Civ.C.) _
.Lk7 Lenders Name ,
Lender's Address'i
I ttnify,hat l have read this appli<mivn and some bar the above information is
fie F correct.1 of ree to comply with all city and countyordinances and stmt laws relating
OU to building constoctio¢abd hereby a Nome representatives of this city memo upon
;„ fill the above-mentioned plapeny,for inspection purposes.
t:.y (We)agree m sada.indemnify and keep harmless the City of Cupcitino against
y liabilities,judgments,costs and expenses which may in any way accrue against said ,/ �J1
L) City City in conscyuence of ttie granting of Ih permit. . '/ k/ !/
_ APP BCERE ULATRSTANDS' r MPLY WITH ALL'NON-POINT Issued by: Date
t
'sen 1- rappl<and ' 'fit Re-roofs
lARGUES MATERIALS DISCLOSURE
II
will die applicant co f t building occulsant stom or handle hazardous material .Type Of Roof
as defined!by the Cupertino'Man aripai Code.Chapter 9.12.and the HeaIN and Safety
Cod S,t ori 255321a1
OYci" q ..
ATI roofs shall m
be spected poor to any roofing,materlal_being installed.,
:W TIN app!ica t or future building occupant ave equipment or devices which If a roof is installed without first obtaining an inspection, hagree'to remove
trod hariardent,ii,immidmirumb,as defined bribe Bay Area Air Quality Management
Driblet? .. all new materials for inspection. Applicant understands and will comply with
'9 ❑Yes.. ..
. d,4fi`;°, . , , all non-point source regular S.
I have read the haxardoos'matenals requirements under Chapter 6.95 of the
California Health&Safe(y CWe:Sections25505.25533 and 25534.1 understand Nat
-if,nebulldingdocenotcerred hove nnnL Nm i,is my responsibility to notify the
occupam of the reyuirem tis wbic st be met prior,tu'issuan<c of a CcniE<a¢of
` p Y/ ?i Signa r_e of Applicant Date
oa riaep t o„e All roof coverings to be Class "B”or better
`:.- �. •._-- OFFICE - -- . .. .. _. . ..