01060168 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
20660 RODRIGUES AV 01060168
OWNER'S NAME: APPLICATION SUB DATE
JANE & RICHARD WANG 06/28/2001
PHONE: SANITARY NO. CONTROL NO.
o-z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
s'ca BLDG ELECT PLUMB MECH
aiy L_7 I� I_J I —'U
8NH
Z 5 H z LICENSED CONTRACTOR'S DEC ns of CON Job Description
O Z—0 1 hereby affirm the 1 an licensed under provisions of ns CW 9(commencing
f,_[_u withsenioreandofers. on3ofthcUusinessundProfessinnsCNoar.dmyleenu 2 BATHRM. & KITCHEN REMODEL.
a,j y is in full fore[and effect.
m z a License Class Lic.a
D q. Date
ARCHITECTS DECLARATION FI NA E Cqu On
g1 understand my Plans shall be used as public records 1 1 n
2001
a 6 p p Licensed Professional Iv U V l7 2
nn OWNER-BUILDER DECLARATION `•
ca or 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
s-z'a following mason.(Section 703 L5,Buslni and Professions Code:Any city or county $18000
15i p which requires a pcnnir to mmmiap nlicr,improve,demolish.or repair any nmanrcBUILDIN
a 3< plot .t I. d y�l' tl I pc 'tt I I g d.ric tau -
t12tla itl dl n del t far CmIl"Iml I Lilorlo Law(Ch,acr 1'[,J-y� 1' d Valuation
(Cr rte iy with Sector 0000)orDivisioni3 of the Buxnca ndrnfe.ons CNet C', 1 13`.�"`J.:1�U-1�::-U V. ,:'-S{,-.i r
or that he is exenipl therefrom and the basis for the allied cempili Any violation
of Section 701 by any applicant for a Permit subjects the applicant to a civil penalty
of nm mum than fire handled dollars M500). 10 V N §"DATION Occupancy Type
❑I.as owner of the progeny.or my employees with wages as their sole compensation, in9 _
will do the work.and the structure is not intended or offered for sale(S«.7044,
Business and Professions Code:The Contractor's License law does not apply to an 103 — UFER Required Inspections
owner of property Who builds or improves thereon,and who docs such work himself
of through his own employees.provided that such improvemcros am not intended or 104 — )ZEBAR
offered for sale.If,believer,the building or improvement is sold within one year of - 105 - ANCHOR BOLTS
completion,theer Id will he the burden f Ping that he did not 'Id o
p i rp . nf:,l i
106 - SEWER & WATER
)4f.itsmorarlit he frollsow si lycommoti.,withu<enxed<nntrsomoa° 202 UNDERFLOOR PLUMBING -
construct'he pj tOra 71 Business and Professions Coll imefortior rs 203 - UNDERFLOOR MECHANICAL '
License Law drops not apply .an owner of pmpeny who Na Ids or reproves thereon.
_ . ane who.contreats.mr sum.projeuts with a amumcladsl licensed pursuant to the 204 UNDERFLOOR FRAME " - " ... . . .. .
Commctoes Licensee Law.
. - ❑[am exempt underS«.' " .0APCfor this mnson 205 - UNDERFLOOR INSULATION
Owned' F Date ' 6/2-f 301 - ROUGH PLUMBING
WORKER'S CO ENSATION DECLARATION 302 — TUB & OR SHOWER
I hemby affirm ander penally of perjury one of the fadawing d<aan rum: 3 03 - ROUGH MECHANICAL
ID I hire amt will maintain a C<m0eam of 6menrto ell-insure for workers 304 - ROUGH ELECTRICAL
. Com,samminn, as porosities] fill by Seenan 3700 of the Labor Code. for the
pcoftonuce.fdo work mrslikh his gssa
eminix icd. 305 — FRAME
El have and will maintain W..me,Compensation Imurram,as required by Section 306 — HOEDOWNS
3700 of me labor Carle.for the Performance of the work for which this Permit Is 3 07 — INSULATION
issued,My Workers Comprwition Insurance carrier and Policy number art: - _
Corrin308 - SHEETROCK'
e ' Policy No.: rx t t
tf 7E TIFICAT10NOFEXEMP IONFROM.WORKEM'k " `3O9 — EXTERIOR LATH '
COMPENSATION INSURANCE
� ._ . ... . ". 3T0,i"'=,'INTERIOR'-LATH. .... .";. ._..__, _. .. _... _._ .
,'•" TrbG eend',.ap 'nut h<<mnilcled ifm<permits I...nue hindrm dollar.
(S I W)nr leu) 311 — SCRATCH COAT
"'I ccnifd the in the Mrfmnunee of the woiQ for which his permit is issurd 1
313.,._..ROOF NAIL .... . .
'shall not employ any hermit in any manner so as to become subject to the%Vorkeri 501
- FINAL ELECTRICAL' 'ENERGY
Compcnmdon Law,of califnmia.Date. - 502 FINAL PLUMBING ENERGY
Applicata —_ - - '
NOTICE TO APPLICANT.If.after making this Cendleme of E.xempti.......imuld 503 - FINAL MECHANICAL ENERGY
Z become subject m the Workers Compensation provisions of the Ltbor Code, .mull
O O mnhw;mcomply with such provisions orthis peonnshall bed<ernelmrakr.l. 504... — FINAL. BUILDING ENERGY .
r
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
Ih b'affummt there is a constructionfornia•encY for the Inrmance
agencyLor woforrk men m. pe t'x.ssued(seean97 or.c.) 506 — GAS TEST
0.,4Z0.,4ZLed sNName .. _ _. .. .. ..
C,o Led Address'• i 507 _ FINAL PLUMBING , ,
I ccnify that l have read this application and state(bat abuse information is 508 FINAL MECHANICAL
til E. correct.I agree to comply with all city sad catmry ordinances and slam faro,celaing 509 - FINAL GRADE
O V 1.building m d amb,orlimize mporonnomisp, t h. 'Y to enneupan
me abs i d,p penyf .Peet Ptpo: 510 — FINAL PLANNING
(W
a, )agrc to indemnify and keep
• ' k ep harmless
the City o
�f C,/pOnD n/atto<against
5
1
4 - FINAL PUBLI-C WORK
liabilities,lagmisms.<ac expensesnn y nn r « gnst•sad
tiCity consequence of the minting m per t
APPLICANTUNDERSTANDS AND WILLCOMTLY WITHALL NON POINT
SOURCE b IssuedbY ..S..lt.e
X,,, ` 1c
signoa orAppllcnUConmoral.
w0ALD 15CLOSURE Re-roofs
itdpairiui^ u<budda,«[pn store or handle wandura,material Type of Roof
as defined the pc peChapter a 9.1l,and the ewlth and acry
,
Cade:section 2553!(x):'. l�/;� 1 I. .)- -
❑Yes -Al"°• + All roofs shall beinspected prior to any roofing material being installed. .. . - .
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
mil haordoiss air contaminants as defined by the Bay Area Air Quality Management
`nstrice . all new materials for inspection. Applicant understands and will comply with
lr`. `I all non-point source regulations:,.
1 hovcmad Tri huradous imaranals ie,mmincas under Chapter 6.95 of the
Calilornia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that ..
if the building d«s not nmently helve a mnaat,that it is my responsibility to notify the
occuham of the rcquircmems which man be ren prior to insmn<e of a Cenificam of
6Signature of Applicant Date
_ owncrprea adxeeagept Date . All roof coverings to be Class "B"or better
OFFICE - . .