03080074CO
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CITY OF CUPERTINO
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BUILDING DIVISION PL`RMITCONTRACT�ORsINFORMA='ION,`;
BUILDING ADDRESS:
SP HOME IMPROVEMENT
PERMIT N0.03080074
R'S NAME:
1030 WINDSOR ST.
PERMIT LSSUE DATE
STEVE YANG
NE:
(408) 777-8918
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATIONlob
Description
1 hereby affirm that 1 am licensed under provisions or Chapter 9 (commencing
with Section 70(111) of Division 3 of me Business end Pmfessinm Cnde, enJ my liccnu ih
in full fosceand effect.
MODIFICATION
License Class Lie. x
Dat Contactor
NIT ISSUED/ORIG. $03010105
ARCHITECTS DECLARATION
I understand my plans.hall N used as public rtWrds
%VISION-�-Blvl
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt romp the Contractors Lleenae Law (or the
Following area (Section 7131.5, Business and Professions Code: Any city or county
which myuira a permit to construct, chat, improve, demolish, or repair any somemro
prior to its issuance, also rtqums the applicant for such Permit to file a signed statement
Sq. Ft.
Area
Valuatio$107
WL be is licensed pursuant m the provishumiff the Conlrumr's Lima. law(Chaper 9
or
(commencing with Section 7O)B of Division J or IM Business and Professions Crick) or
that ha is exempt therefrom and me beau for me alleged exemption. Any violation of
��t�p�
3 JpV 1x9 V V4 r0 0
Occupancy Type
Section 7031.5 by any applicant for a Permit subjects the, applicant o a civil Penalty of
not more man five hundred dollar. (3300).
❑ 1, m owner of the property, or my employe. wins mgt,. u Meir sole compenssdon,
RR r dInspections
will domcwons end thehe Commnoti Lummus Law redfm pkpply anowner
Professions Code: The Cs License law doh not apply l0 an owner of
doemor.
pro,and
y who builds vi impraw Thereon, and who esauch wad himulredthrough his
101 -
FOUND T �
own cr tintS m for ale.
dm
impmssmwithin not ear
oftenement
1O2 —
PIERS
leered
r.f.
however. theWildingoricul improvat
of
builder the Wilding orimprovementi.hold within one year or completion, me ownco-
builder will .arc me burden of proving than he dial not builrt or improve for purpose of
103 -
UFER
rale )
104 -
REBAR
❑ I, as owner of the property, am exclusively competing with licensed mform op e
105 —
ANCHOR BO S
moswa Our project (Sec. 9044, Business and Prdfusime, Code: The Conn.,.,. Li.
come law does noupply to an owner of property who Wilds or improves themon,sort,
106 —
SEWER & WA R
who contracts for such projects wins a contractor(j) licensed pursuant to the Contractor.
License Law.
202 -
UNDERFLOOR UMBING
❑lamat, Ian rSee ..ya '2from? rkhdn
203 -
UNDERFLOOR M HANICAL
s WO TION
204 -
UNDERFLOOR F E
:R'SCOMPENSATIONDEC47
205 —
UNDERFLOOR INS TION
I hereby affirm under penally of perjury one of the following decimation:
301 -
ROUGH PLUMBING
ban and will maintain aCertificate ofConsent toself.imurerarWorker's Comfort-
..tion, as; provided for by Section 3700 Of be Labor Coale, for the performance of the
302 -
TUB & OR SHOWER
work for which this .if is issued.
303 -
ROUGH MECHANICAL
1 have and will maintain Workers Compensation Insurance, as required by Section
37M of me Labor Code, for the performance of the work for which this permit is issued.
304 —
ROUGH ELECTRICAL
My Worker's Compensation Insurance carrier and Policy number am:
305 —
FRAME
Carrier: Porky No.:
306 -
HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE
307 -
INSULATION
(This section need not he completed if the Mrmi, is for one hundred dollam(61(m)
308 -
SHEETROCK
drlC9t.)
309 -
EXTERIOR LATH
1 certify but in the performance of the work for which this permit a issued, I ohm not
ers'Com Infusion
employ any PersontoI any manner spas become subject to the Wdrkfu
310 —
INTERIOR LATH '
Laws df Celifornia.DakAppl
311 -
313 -
SCRATCH COAT
ROOF NAIL
cant
NOTICEafter this Certificate Exemption, you
NOTICE TO APPLICANT,te
Worker's Compensation previsions the bor ,you mull
become subject y the Warh re Compensation Permit steal civ the Lmedr Coke, you mull
fonhwimcnmpiywimmchprmi.ionsnrthis permh.hanhcdccmcdrevoked.
501 -
.FINAL ELECTRICAL ENERGY
502 -
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
I hemhy affirm but mere is a construction lending agency lot the Performance or
503 -
FINAL MECHANICAL ENERGY
menworkfor which this permit is issued (Sec. 3(N7, Civ. Cd
Londs Name
504 -
505 -
FINAL BUILDING ENERGY
FINAL ELECTRICAL
LinderaAddress
1 certify that I have reed Ibis application and state that de above information i.
506 -
GAS TEST
control. 1 .gme to comply with all city and county ordinances and state laws relating to
building construction, and hereby amhmike representatives of this city l0 enter upon the
FINA PLUMBI G
ah rn-o eramod property for inspection purposes.
(We) egme Io rave, indemnify and keep harmless the City of Cupertino against
O S
FIN N L
liabilities, judgmentscosts and expenses which may in anyway scenic against said City
in consequen t, of me granting of this
5
A
Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WLNPOINT
Issued by:5_
NG Dale
SOUR GU TI NS.
Re -roofs 6Q2 -
OOF PLYWOOD NAIL
ore Applican ntr DataJR4
H 2.ARDOGSMATERIAfSDISCLOSURE
Type ofR 3 -
ROOF BATTENS
Will me applicant tar future building Occup.M.I.m Or handle hayaNOus match.]
as denned by the Cupertino Municipal,Code, Chapter 9.12. and the Health and Safety
604 -
ROOF IN -PROGRESS
. Section 25532(.)? �Y^✓/
All roofs shall be inspected
prior to any roofing material being installed.
❑ Ya
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupaotuseequipment ordevices which
II harardnus air cmmorimnts as defined by me Bay Arca Air Quality Management
all new materials for inspection.
DisVict? V
Dyes
'
I have mad the hazardous notorious requimmcnts under Chapter 6.95 drunk Califon
nim Hralth & Steely Code, Sedum 25515,25533 and ]5534.1 and ca=d ma if the building
Jots nor currently have a ¢pantimal is is my mspomibiliry to Ibe mcupium of the
mquim If must pc melpdortu issuance c
Signature of Applicant Date
e
All roof coverings to be Class "B" or better _
or --6Z
c A em.H.d PVI