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04020072 CITY OF CUPERTINO COI "i'Y C �o, BUILDING DIVISION PERMIT s- ; ., BUILDING ADDRESS: TIEP D. NGUYEN """""04020072 �;-7n PANT TTMN RID EWS NAME: PERMIT ISSUE DATE 12 ONE:- SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ;j moo LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that l am licensed under provisions of Chapkr 9(commencing with Section Tastier Division 3.fthe Beat.and profeastom Code,and my license is iicenforcaand erc t. INTERIOR REMODEL/RELOCA C E�/FIREPLACE Sg? License Class Lts.M , 1; `��2I/ Date Coptmmor CONVERT CARPORT TO GARA TO MEDI ARCHITECTS DECLARATION I undcraand my plans shall be used as Public records REPIPE/REWIRE GUEST HOU Ce JAN 1b� 2005 3 8t; Licensed Prufcasional &'yI OWNER-BUILDERDECLARATION EQ I naso alum Net 11. exempt from the Common's Co :Any c Law for the E S o following meson.(Section 703 1.5,Business and ere.de nm Code:Any city or county k$� which requites a permit m construct.alcor,improve.demolish,or repair any structure r i prior to its issuance,also requires the applicant for such parraft to file a atgnnd staumem P NatheislicenudpunuanttoNepmvisionsoftbcContrecwesL'u:cnwUw(Chaptcr9 Sq.Ft. Floor Area t yrcF$ (commencing with Section 70110)of Division 3 oftim Business and Professions Code)of �.. that be Is exempt therefrom and the basis for the alleged exemption.Any violation of O Section 7031.5 by any applicant far a permit ubjects the applicant to a Civil penalty of APN Number Occupancy Type not mon than five hundred dollars(8500). - ❑1,as owner of the property,"my employees with wages as their hole compensation, willde the wodc and theswcwmi,notintendedaroRered forsale(Sm.7044,Business 3 4 2 18 U 2 0 07Required Inspections and prefeasions Code:The Contractor's License Law dors not apply w an owner of q ns ons p , propeny who builds or improves thereon,and who does such work hirese If or through his we employ=,provided Nat such improvements arc not intended proffered for sale.If, t however,the building or improvement is sold within amYear ofcompledon,the mener- builder will have Ne burden of proving that he did not Wild or improve for purpose of u1c.). LI�, s owner of the property.am exclusively contracting with licensed contractors to wa the pmjem(Sec.7014,Business and Profusions o Cade:)The Contractor's Li- Law does,not apply to anowner of property who Wilds or improves thereon,and, who mom=s for such prokcho with a eonnacmr(s)licensed pursuant m the Contractors 7sw. a rept under See. .B Ar PyC f r thi reason Do. t� 0 WORKER' OMP A"0a of CLA[lA'nON I hereby affirm under penalty of perjury one of owing declarations: 1 haw and will maintain a Certificate of Content W self-insum for Worker',ComNn- sation,u provided for by Secdon 3700 of Ne labor Cade.for the performance of the work for which this permit is issued. ❑I Mw and will maintain Workers Compensation Insurance,as required by Section 3700 of the Isbor Code,for the performance of the sop's for which this permit is loved. My Workers Compensation Insurance carrier and Policy number am: Center. Policy No.: CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (Dttssoeuon mad notWcompiewd If the Permit is form=hundrcddollars(8100) or less.) I certify Out in the performance of the work for which this permit is issued,I shall not employ any person in any mannersn u at become subject to the workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL spur making this Cenificase of Exemption.you should Wcome subject to the Worker's Compensation previsions of the Loam Code,you must .J Q forthwith comply with such provisions or this Permit&ball W dammed nuked. „z„ r~N.. CONSTRUCTION LENDING AGENCY [r I hereby affirm that there is a construction leading gency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) V]Q Lenders Name 7 Z Lender'sAddoess V 1 certify that 1 have read this application and show that the above information is LL,F correct.l agree to comply with all city no county Ordinances and stem laws mining to O V building cousbuction,and hereby authorise repnsenhotiwa or this city to enter upon due above-mentioned property for inspection purposes. (Wes)agree to save,indemnify and keep harmless On City of Cupertino against ti y liabilities,judgments,costs and expenses which may in any way acerae against said City U Z to eonsequmue of the grunting of this Permit. �--� APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date OU EGu}�oN 4A4eh- elm Re-roofs Signet cof SA piranVCoaWr Date xAZA OUs ATERIALS DISCLOSURE Type of Roof Will Nes applicant or future building oecupanutore or handle haurdous material armed by the Cupertino Municipal Codc,Chapter 9.12,and Oar Health and Safety Cie. ss3x(a)? Ely. No All roofs shall be inspected prior to any roofing material being installed. ❑Yrs �9rI 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 mit harallous air Contaminants as dcfncG by Ne Bay Ama Air Quality Managcmmm all new materials for inspection. District? [3 You No It ve mad the harasdousmaterlals requirements under Chapur6.95 of the Califor- nia Health&SafetyCDde,8ecuou 25505,25533 and25534.I understand Owif Oe building dons not urrently have a umn4 Nat it is my responsibility to notify Oar occupant Of the requimmc �`w'hIt hmust m priorWivu ccofaCCmfcauof an Signature of Applicant Date o &who zctl agent Dal All roof coverings to be Class "B"or better CITY OF CUPERTINO BUILDING DIVISION PERMIT C(1jTRACTf12I1L7ItMATION BUILDING ADDRESS: TIEP D. NGUYEN PERMIT 1%4050079 22570 SAN JUATIT RD OWNER'S NAME: PERMIT MOE DATE TIEP D. NGUYE E: SANITARY NO. CONTROL NO. (408) 972-2575 ARCHITECDENGINEER: BUILDING PERMIT INFO BO E� PLS MECH O y00 LICENSED CONTRACTOR'S DECLARATION Job I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JoP with Section 70M)of Division 3 of Ne Business and Prufessloct Code.and my license is =0 in fullforeehndc cele REVISION--IN HOUSE USE ONLY j License Class Lic.A Z''Z Dak C...tor NO NEW PERMIT ISSUED/ORIG. #04020072 ?Lp�i ARCHITECTS DECLARATION 1 understand my plans shall he used As public records Licensed Professional , S OWNER-BUILDER DECLARATION affirm hereby arm Nm I am exempt from the Conlmemr's License Law for the p O following reason.(Section 7031.5,Business and Profcamoos Cade:Any city or caunty 9 which requires a permit to construct,alter,Improve,demolish,or repair any structure prior w its issuance.aim requires the applicant for such permit to rile a signed statement < that he is licensed pursuant to the previsions of the Contractor's 1-cersoUw(Chapter 9 Sq.Ft. Floor Area Valuation 0 �$ (commencing with Section 7000)of Division 3 of NC Business and Professions Cmlc)or .. that he is exempt therefrom end the basis for the alleged exemption.Any A.Atfon of Section 7031.5 by any applicant for a permit subjects the applicant an a civil penally of APN Number Occupancy e not more than me hundred dollen(5500). P y TYP ❑I,as owner bribe property,m my employ=with Miles as Weis ask camPensstlon, 34218020 . 00 _ will do the work and Iheavuet m,is natimanded proffered farsale(Sec.7W,Business .rad Rafaseirt,Cade:The Conuactera Lia ree doer not apply to an Law doowner of Required Inspections property who bui Meer improus thereon.and who ties such wok himsel f or through his own employees,provided that such improvements arc notinkndad mo0ered for mile.If. however,We building or improvement is said within rete yes of me ve Wthe owner. builder will haw burden of proving that he did not Wild or improve for purpose of sale.). 1.as owner of the property,am exclusively contracting with licensed conuamom to o as the project(See.70x4,Business and Professions Code:)The Contractors U. \ cense law dors not apply An an owner of property who Wilda or improves thereon.and who Comercio for such projects with a corachans)licensed pursuant W Ole ComacmYs License law. ❑1 area atop,under Sec. ,B&PCfo thisreason Own Data ORKER'S PENSA ON LARATION th ereby affirm under paally of perjury ow of o wing declarations: will maintain•CcAfteak of Consent m self ort fm Wmkerf Compcm provided for by Section 3700 or the labor Code,for the performance of the work for which this Permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Scatan 3700 of the labor Code,for the Performance of the work for which this Permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Policy N¢: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissection need nobeeomplckd If tbe remit is Intent,hundmddollms(SIM) or lash.) 1 certify that in the performance of We work for which this permit it issued.I shall not employ any person in any manner an As in become subject to the Workeri Compenadon Laws of Caffi m A Dak Applicant NOTICE 7D APPLICANT.IL after making his Cenifrcale of Exemption,you should become subject ro the Workers Compensation provisions of the labor Code,you mum �z forthwith comply with such provisions or this permit shall the deemed revoked. z OCONSTRUCTION LENDING AGENCY rN-, l hereby affirm that there is a convection lending agency for the Performance of ai the work for which Nis peril is issued(Sec.3M,Ci,C. QLender's Narm 7 z Leader's Address U O I certify that 1 have read this application and sum Wet the above information is IT, correct.I Agra to comply with ell city and county eminences and same laws relating to - OUWilding convection,And hereby amhodm representatives of this city to enter upon the W above-mentioned property for impaction purposes. gY (wt,)acme an save,indemnify and keep harims the City of Cupertino against t..a VI liabilities,Judgments,costs and expenses which may In any way accrue against avid City C.1 z in consequence of the granting of this permil. APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date OUR LATIOI(A^ _ S Re-roofs signs rt,o IianUCont for JA ek Type of Roof HA2A OUSM TERIALS DISCLOSURE Will the applicant or fuarc building occupant stare or handle hazardous material As defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Cale,Section 25532(e)7 Ycs No All roofs shall be inspected prior to any roofing material being installed. � Will the applicant or future building occupant Me equipment or aewiec whichIf a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. Viet? DYcs No 1 have read the W ardnus materials requirements under Chapter 6.95 of the Califon rata He.1th&SafctyCodc.Sections 25505,]5533 and 25534.1 undereand that if the Wilding dos no,curntly ha tenant,that it is my responsibility k notify the occupant of Ne- aqui mawhm matpoor to issuance ofaCcrtifcateofOcupanc Signature of Applicant Date Owaar o own agent 'S� ( beic All roof coverings to be Class "B"or better