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01120006 OF CITY I BUILDING DNEISSIIONNOPERMIT CONTRACTOR INFORMATION: BtµY991DDMADOWHILL LA TONY & HELEN CHUNG PERMIT NO.7 yy�� 01120006 (AfbV I HELEN CHUNG AP12/1035/ 2001 AL 4 LONE: SANITARY NO. CONTROL NO. n O_O ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �U aC,6 Ny LICENSED CONTRACTT OR'SDECLARATION Job Description j z:o It a n thin I am liccn d o Wor provisions of Chapter 9lcommencing REPLACE WATER HEATER. witM1 Scctian]IMNII a!Division J of the Business and Professions Code,and my liter'. 6 m is in full force and effect, e m 6 Liam.¢Cma Lic.% 0 a`� Dam Commctor +�3 0 v ARCHIrECT'S DECLARATION °—' g I undcmond on,plane shall be used as public aveorde oec.p Licensad Professional OWNER-BUILDER DECLARATION aai=' hereby affirm that 1 i m cvc.pl from the Contractor's License Law far the F Z< fallowing reason.(Section 7031.5.Braine,and Pmfe.,om,Codc:Any city or county $250 E x❑ whmh requires a e it construct.ah improve.demolish,or repairany structure u°r6132 poor to its assandacc.also requirestit ..ii,ma to,such permn a)file a signed smaera.m. J�N.�}r�M,. that he licensed p tram to they of the Contractors License La (Chapter 9 .. 3.9 W 6 9lY YYr�� Valuation (ammo.[ng with Secd 7M))of Di,idon 3 of the Business dProfession,Cade) p„�!,'+ n Js ,y s, �,,.. f.", q.,(.., 7.i i" r or that he is exempt thcrcf mnf and the basis for the alleged acmpuon.Any violation of Section 7031 5 by any applicum for o Permit ubjec.the.,,I icant to a civil penalty of not moa man five hundred dollars($500). 502NPNhb3PIbAL PLUMBIN 'ENERGDccupancyType own.,of the pmperi,oram employees with wages as their sole compensation, 506 — GAS TEST ill'Jn'ihe an and the structure is not Intended or nlfcred far attic(Sec.]Iw. 507 — FINAL PTR j•&Wmpections' alines,and Professions Cod,:The contractor's License Law docs nm apply m an owner of property With mild,or improves mereon.dad who docs such work himself or throogn his own howeicces.pmvidia that such imp,oveis of are not intender or .. ___ -offered for i9c.If.however,the huildin6 m iniprovcmrnt is old wimin one year of, ”"-'--"--'--"-`-- ""-- '---'-` '_.... ._.__. r completion,the owtmrbuilds,will have the huttlen of proving that hadid not build or ❑L us owner of the pmpenR am Business d Professions with licensedcontractorsC mecors m enhancer (gee. to a.Bamerof a�Prose„ion,Gore,n,.ves thero;, � 5. -2001 Licence law does not apply m an owner th property who Halide or improve,thio the DEC- i. O .. .and who conhdns for_such Raleeu.vim a contnctor(s)licenxd pursuant m me .._ . . ._. __ .._._... _ Contractor's License Law., ❑I am eaemPt uglier Sec. ,B&P C fonhis mason •1' ^'• Owns, WORKER'S COMPENSATION DECLARATION U I LDI NG I hereby affirm under,penalty of perjury one of the following declarations: \ Cl 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcdsation, as provided for by Section 3700 of the Labor Code, for the _ performance of the work for which this permit is issued. ❑I have and will moinmin Wurkcr'a Comperaromm Insurance,as required by Senior 3710 of the labor Code.for the perfoni me.of me work for which tris permit is v - issued.My Worker's Compcbsotion Insurance carver and Policy number arc: Cams t PN'Policy No:. O• 1 t CERTIFICATION OF EXEMPTION FROM WORKERS' _ ...i. ' COMPENSATION INSURANCE`.;•u••�; .. ,.._._..__.__ _......_. ...._..._._.._.__._.____ __-_ ._ ____._.____ -_ (Thii'>eciion hoed not be,completed if the permit is for one hundred dollars (5Had or loss.) s•' .I'cra"Phan➢Person in .'a work for which this permit is issued.I ”`+ - uany antnntit ., r i.1 i• . shall not employ y men cr sit as m become sobjcn to the Workers Co-7.'uniodlawsof C"Bromars are Applicant ___ NOTICFIG., TO APPLICANT:IL afros making this CeniOcaa of Exemption.you shoultl hdmna'iubjcer m the Worker's Compensation pmvisionx of the Labor Code,you must Oforthwith mmPly with such provisions or is permit shall be deemed revoked. _ _ __, r.VJ ".. ., t"'CONSTRUCTION LENDING AGENCY t r yaPerformance 7 sof the nark for which this th,mti is iswcd(Sec 309],Civ.C.) for rite , lending agency Q a ...a., ... __-_ _.._. .... _... .... LendUrill Addy ..•.• —._ .. _ _ . . L e'r's Nati .� Z �, reds V 1 certify that 1 have rod Chia application and stag that the above information is W. F, torted.I agree to.amply with an dry dna.aunty nramaacee dna nate law,among Q Cm3 wbuilding construction.end herbyeotliorire repasentauves of mil city to rnter upon �] tit.obovcmrntioncd Propcny for,impcction puipasn. >; !L (We)egree tdwve.intlemnify and keep harmless ilia City of Cupertino against W liahilitica,judgments,acts¢and enpensee which may in any way acerve againstsaid 1 r C.> Z City in conscqurntt of the granting of this permit. I 'APPLICANT UNDERSTANDS ND WILL COMPLY N'ITN ALL NON�POT Date SOURCE REGULATIONS.�, /' ` 61 Issued by: riga t e rApp1 �Ucnmmemr pace. . Re roofs HAZARDOUS MATERIALS DISCLOSURE - x n m app)cant r t bnaamg Paas stow h Jle M1aurdbus mammal Type of Roof - os def d d Sa iC pen Mumc pal Cod eh Pt 9 12 and to Healm Sal _ ., 1 •„ cod S fonon SSJ21a) I( ❑tis ❑rip' All roofs shall be inspected prior to any roofing material being installed. winme.Pplleant-orfum.e.buuaingoccupant me equipment or devices which If a roof is insialled without first obtaining an inspection,•I'agree to remove e it ndwamis au eminu unams n,defined by the Bay Area At,Quality Management District? 'r all new materials for inspection. Applicant understands and will comply with ❑Yes ❑No. .- . . all non-point source regulations. i'i haze reed the ha imkhii materials requirements under Choptef 6q5 of the Cilifomia Health&Safety God,Sections 8505,8533 and 25534.1 undersand that if the building does not curtently have a round.that it is my responsibility to nobly'be- occupant of the requirements which must be that prior to issuance of a Certificate of ° Raney ISignature Si natu_re of A_ pplicant Date All roof coverings to be Class"B" or better nr tram...rad agent', : n 1Due . OFFICE . ..