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04010012z .zi _0 a� az UO O Fcn �z CITY OF CUPERTINO s = '$$ ro r ,x 'zti r'r s^.na:'+ 7a' *ss..� u "' BUILDING DIVISION PERMIT C C0NTRAC'T0R INFORMATION hit BUIL DING ADDRESS: PETCY TAM PERMIT NO 04010012 NER'S NAME: PETCY TAM PERMIT ISSUE DATE ZONE: SANITARY NO. CONTROL N0. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH O O LICENSED CONTRACnOrpuiviCLARATION 1 hereby affirm mat I sin f he Bu under pmvisioa ofChapterCode, 9 (commencing with Section ]011e) of Division J of the Business and Professions Code, and my license is Job DescrI �.A �� /Y, O s in full forte and effect. b License Class uc.g KITCHEN REMODEL m Dale Contractor APR ARCHITECTS DECLARATION 2004 I undersand my plans,hall beused u public records BUILDING Lrecned Pmfcsgnnel 5 OWNER -BUILDER DECLARATION i 1 Wr.s..(firm exempt f em exempt from the Contractor's License Lew for the O following moon. m ) ]101.5, Business and Pmfdemoli Code: Any easy .r county c which Permitt re c.rstho apes morrow, demolish, terearepair any gruaum itsisssae.also Permit. ned prior to lensed the lheappliam for C terminhat bei pursuant to or the Comonrmiuoicense Law (Charter Sq. F[. Floor Area Valuation ringwidpSectiostnNeofDivions termini sion3oftheBuramhnis and Profesaw(ChapmrY Division of theitem Codc) or $ chat that is On exemtiScieioon and therefrom and the bare for the Any of unt,ton. An alleged exempnt io 31.5 b any subjects O 10 it penalty not on then reddapplicant for (S50Bpermit ¢ubjects the epplicanuo,civil peaky of not mart Ilan fiw hundred dollars (5500). ��A���»ay..��7,04.t p y' p 3V91L /VPoIWPirOO Occupancy e ❑ 1, as owner of the properly, or my employees with wages as Ono sale compensation, will do the work. and On structure Is not Intended OrOB,Rd for sale (Sec. 7W. Business and Professions Code: The Connectors Limes, law, dors not apply to an owner of Required Inspections propeny who builds monomers; thereon, and who does uch work himself orthrough his - Own employees, provided that such improvements art not intended oroffen d for sale. if, however. On building or improvement is within one year of completion, the owner builder will haw the burden Or proving that be did not Wild or improve for purpose of - sok.). ❑ 1, as none, of the property, am exclusively contracting with licensed contmcmn to construes the Pmjen (Sec, 7W, Rosiness and Professions Code:) The Contractor's Li. cense law does not apply to an owner of properly who builds or improves thereon, and, who common for such Projects with a contmelor(s) licensed pursuant to the Convenor's dicense law. ❑lam exemplum Sec. ,Bit PC(p this rtuon tier D m W RKER'S COMPENSATION DECZARON _ (hereby affirm under penalty of perjury one of f Owing declarations: I have and will maintain. Cortin... of Consent to selGinsum for Workers Compen. nation, u provided for by Section 3]W of the Inter Cods, for On pedorroui a of the work for which this Permit is burned. 1 have and will maintain Workers Compensation Insurance, a required by Section 7]W of the labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance canicr and Policy number am: Canis: Policy Nm.: _ CERTIFICATE OF FXEMPDON FROM WORKERS' COMPENSATION INSURANCE (Thu seclirm mend mol W completed If the permit is for one hundred dolout[.ISI W) or lcsa) I cenify Out In the perromtanee of she work for which this permit is Issued, I shall not employ any pato any manner so u to become subject to the Workers Compensation Laws of C¢IifRl9ihr APPIF. am Y Z'T b �0 W NO'IpDE. APP e'NaU'L err makmg (his Ccniff am of Exemption, you should b Subject m the Workers Compensation provisions of the labor Code, you must forthwith comply with each provisions or thin permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY I hereby affirm Out there is a construction lending agency for the performance of On work for which Nn permit B issued (Sec. 3097, Cii, C.) Landers Name Lender's Add. 1 cenify that I have reed this application and sum that the show information is conal.( gree to comply with all city and county ordinances and stale laws relating to Wildin{ conswnion, and hereby suNarion mpresenlatiws of this city to enter upon On ,nova -m, judgm properly for cannon porticwhich may (We) agree to saw, indemmfy and keep harmless the City or Cupertino against inninnies. encu of ts.On Ino and oftsnxes which may in any way accrue egeinsueid City in conseywnce of the granting of this permit. r. APPLICANT UNDERSTANDS AND WILL COMPLY WIT4 ALL NON -POINT Issued by: Date SOE Rp ULATIONS, `/ fib Re -roofs e " `curl l {nal of Ppl¢aVContracmr Our Dan HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will N, applicant or future bac' ing occupanamm or hanJlc hasrdous maned.] As dented by she Cupenion Muni a1 Code, Chapmr 9.11. and the Health and Safety ndc. Section zss3z(a)] Yen No All roofs shall be inspected prior to any roofing material being installed. W ill the applicant or future building occupant Luse equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove In lineations air conwminan6 p4 defined by the Bay Area Air Quality Management isein] all new materials for inspection. ❑Yes Nu ('n/ I have read the haaNtmsmaterials mquimmenn under Chapter 6.95 of the Califon ria N041,0& Ssfery Code, Secuoa 35505.15533 and 25534.1 understand then ifthe Wilding. Jos not tune. ly haw a .nam, mat it u my responsibility m noply Its ottupant of rite mqui setmug W inn prior to issuance of a Centric N�r `2dD� Signature of Applicant Date All roof coverings to be Class "B" or better net or authomed agent Dim r CITY l0 717,7777 T ", 7`' A r "'•- 'i- BUILDING DIVISION PER x~yCONTR I�RFQPM N BUILDINGADDRESS: PETCY TAM PERMITN004010012 NEWS NAME: PETCY TAM PERMIT LSSUB DATE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELBCT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Ib Description O m licensed under provisions of Chapter 9 (core cntlng 1 hereby affirm that 1 are P with Section 70W) of Division 3 of NC Business and Pruleuions Code, and my license is in full force ondeffect. KITCHEN REMODEL Llano cissa sec.« Dao: Cuntrsdor ARCHITECTS DECLARATION 1 understand my plaru.lull he used as Public records Llccomd Pmfeuionel OWNER -BUILDER DECLARATION Y/v I hdoom.(Sere the. 11. esempt from the Cm01nCreo License Law thefollo co ng mama. 703 1.5, Business and ens Any y or county which Vermont. de h, ., rapid, which ,cyulrta Permit re wL ellen impmsx• demneitu nr ¢Pair any structure Pandit 1 a teres firer IDca Pcrmiuufleme Llw(nammcnt Pdorm iceman the the Conwn Licenseuw(Chopmr9 acescing Sq. F[. Floor Area(co U Valuation that turatumq. rospmnsid wit Pu,mununthe of Division ssa Code) or with Diaiiiof r of lM Business and 3 on. Any vi . Net he Is eampt therefrom and Ne Ensu for the alleged exemption. Any vinlallon of Oat he is cieforen and du alleged 3WAP'Ia14tbgr00 Occupancy Type Section 7031.5 by any applicant for a permit subjecu the applicant to a civil Penalty of not mom than fw hundred dollars ($500). a ❑ I, as owner of the preperty, or my employees with wages u their sole compensation, e Required Inspections will do the work. and the sdvnure ismt intended or offered forsale(Sec. 7044, Business and Profession. Code: The Contractor's License Law docs not apply to an owner of q P property who build, or Improves themon, and who daauch work himselfor through his own employees. provided Nat such improvements; sn not mended oroffered for sale. If. howewe the building or improvement is amid within one year of completion. the cwnco- builder will have the burden of proving Nat be did not build or improve for purposa of um.). ❑ I, ea owner of the pmpeny, am exclusively contracting with licensed connector to , comwn the project (Sec. 7044. Business and Professions Code:) The ContrumYs Li. ave law does not apply to an owner of property who builds or improses daemon. and. ' who crennets for such pmjceu with aormracm,(s) licensed pursuant to the Contractols c1c.. Law, ❑lam nempt un Scc. .BBPC�, 01 resaon net D O W RKER'S COMPENSATION DECLARA ON . l I hereby sffor under penally of perjury one ofth f owingdeclan0ons: 1 hew and will maintain a Certificate of Cement o selfdnsum for Workers Centime. gotten, at provided for by Section 37M of the labor Code, for the perform eco of the work for which this permit Is issued. ❑ 1 hew and will maintain Workces Compensation Ivunna, as required by Section 3700 of the labor Code. for the performance of the work for which this permit is inui My WorkeM1 Compensation Ivunna artier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (This action need not he completed !film Permit is fvovhundredd dlan($100) v tees) I send fy Nat In the performance of the work for which this Permit Is load. I shall not employ any perm iy many an u m become subject n the Workcri Compcvnlon aliR . Aw, PP cant o — _. of blame & N TO APPLICANO IC after making Nu Cenifi em mf Eacmption, you should subject on the Worker's Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit Mall be decreed revoked. 51 iCONSTRUCTION LENDING AGENCY I hereby amrm that mere is a construction lending agency ser the performance or the work fur which this permit is issued (Sec. 3097, Civ. C.) lenders Name Landes Address 1 certify Net 1 have read this pplication and mm met the above infomiliun 1. correct. 1 agree to comply with all city ad county oNinmces and cute laws rtl.fng in Wilding construction. and hereby su horiza mincommatives of this city lm entcrup le tem U ahmm-niceliunod property for Inspection Inquests. (We) agree to save, indemnify and kap hsrreleu Om City of Cupertino against Ilobllidcajudgnmeta cmau and capeves which may in anyway reeve ageivmi l City /o/ in of the granting of his APPLICAeNTeUNDERSTANDStAND WILL COMPLY WIALL NON -POINT Issued by: Date (I SOU ER QULATIONS. � Yfb l2 ____ .,ly �-� - cn L Re -roofs Type of Roof gnat o of pplicoHAZARDOUS MATERIALS DISCLOSURE Dare Will dheapplicantor future (Jing acup.m.t.re or handle harmdma material u dcnncd by the Cupertino Muni of Code, Chapter 9.13, and the Health and Safety Cale, Section 35532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yns Nu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant orfuture building occupant use cyulIndent mrdevices which ..It hazardnv air Memoriespi defined by the Bay Art. Air Quality Management all new materials for inspection. DisRlct7 ❑Yes No I hew real the hazardous materials mquiretanu under Chatimr 6.95 or the C.Ilfv. nice Health A, SafetyCodc. Savoy 75505,25533 arm 255341 undersand the. if on Wilding Joca net torten ly how a moan¢ mu it u my maimnsibility to emity the opccupant of the myui UIkhmustbcmdpriolmiSSnNCem(dCcrltneam Signature of Applicant Date �bN�2UD� 1-- Ar b All roof coverings to be Class "B" or better 04cr or authmizcd agent Dam JAN 0 6 2004 h p&.l 111^ t A'e APPROVED IN ACCORDjMQE WITH THE CITY OB This6K& p!ans and specifications MUST be kept on the job at all times and it is un, Lawful to make any changes, or, alterations on same without written permission from ahe building Dept., City of Cupertino.. The stamping of this plan and specifications SHALL NOT be held to permit or to be ar, Y pravtsion.9 ,r znv City Orfinance or Ste e4 LaW-- L 0 n U SIB CITY OF CUPERTINO OCITY OF CUPERTINO* PERMIT APPLICATION FORM / —1 APN # / O Fee Group Date: Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot Building Address BBOILERI Boiler <= 100,000 Btu MECHANICAL �3sG ose 67 '. Z", . 'AJ 5-1 Owner's Name; Rtco T.en", MECHANICAL Phone #: Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 dJ- �P6 /-O/`%2 Contractor: 0 BCONSTAX Construction Tax License #: Contact: Ind/Off/Comm/Quasi BUILDING Cupertino Business License#: ,Building Permit Info: BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Bl Elec Plumb Mech Job Description: d �� BELEC1001 Residential ElG-A z- ercial ❑ Sq.Ft. Floor Area: ELECTRICAL $/Sq.Ft.: Energy BUILDING \ Cost of Project: r BINVESTIGA Occupancy Group: �. BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING E lof3 �`i/I S JC a r