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02120103 CITY OF CUPERTINO r "^ +"�"* "'' '' '•s �i ^' ' BUILDING DIVISION PERMIT• CONTRACTOR INF,ORMATI• ': BUILDING ADDRESS: PERMIT NO. 20351 SILVERADO AV 02120103 OWNER'S NAME: APPLICATION SUB DATE JEFF & GLADYS KWOK 12/30/2002 ONE: SANITARY NO, CONTROL NO. ARCHITEC MNGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH �Op LICENSED CONTRACTOR'S DECLARATION Job Description F 1 hereby affvm dou I am licenxd under provisions of Chapter 9(enmescrp rnmems �¢ with Srollon71M)of Division 3 of the Business and Professions Cafe.and my license is < infmuo=andeffect. KITCHEN�BATHRM REMODEL & osgz Dries ass Lk.N WINDOWS REPLACEMENT �'����® F-F, De¢ Contractor ARCHITECTS DECLARATION oU 1 undcrsund my piens shall IN,used as public rcLnNa MAR 1 8 2003 uat0wU Licensed Professional ' N OWNER-BUILDER DECLARATION ¢� g; I herebymaxo affirm that 1 em exempt from the Contractor's :Any c Law for IW BUILDING woe-p0 whohrequiresafarmitto osrBmloeaand m.diohmsCnoc:Anycityorcoumy LDI �e$ which its requires issuance.eals re uimtme tlue improsu demntuh,or repair any swaure mI-Z r Metpriorthe its tered mumrc to Mi the applicant for such permit Lt..le a Ls.(Chumem g < Nmboinwdpunuam7")ofvivision3OfMeBuinssandPnsclaw(Code)or Sq.Ft. Floor Area Valuation $ (commencingheiseewiNgereirn7lXgt)th Division Mthecgtd Business andomissionsCWq or $20000 �t Nn he u exempt therefrom and the bss4 for Ne sllegad eumption.Any violation of Y section 7031.5 by any applicant for a permit ubjecB the applicant to a civil Penalty of APN Number Occupancy e not more than five hundred delta.(s5BB). 36939009 . 00 p y Typ ❑1,as owner of the propeny,or my employees with wages as their sole compensation. will do the work,and the nrocmre is not intended oroffered for ale(Sec.7044,Bnsloess and Professions Code:The Contractors License law does not apply to in owner of 101 — FOUNDArF1%fed Inspections property who builds or improv thereon,and who does such work himself or through his own employees.provided first such improvements are not intended or offered for sala.If, 102 - PIERS however.me building or improvement is to within ons year ofeompletien,the owner- 103 - UFER Wilder will ban the burden of proving Nu he did not Wild or improv for purpose of ale.). 104 - REBAR ❑I,as owner of the propeny,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. ronx law does not apply to an owner of property who Wilds or imprava demon,and, 106 - SEWER & WATER who comment for such projects with a contrxctorfa)licensed pursuant in Ma Co^vactorY LinLaw. 202 - UNDERFLOOR PLUMBING r x g�amexemptunder$eC. Bk PC far this eexa 203 - UNDERFLOOR MECHANICAL nerlsLab1 l S ��s�g' �ax/-,)- 3'--UZ 204 - UNDERFLOOR FRAME woa COMPENSATION 205 - UNDERFLOOR INSULATION 1lomby affirm underpenalty of Perjury one or the following decimations: 301 — ROUGH PLUMBING I haw and will maintain a Certificate Of Consent to self-insure for worker'sContrs. 302 — TUB Sc OR SHOWER anon,a provided for by Section 3700 of Ne Labor Code,for the Performance of the Werk for which this Permit is Issued. 303 - ROUGH MECHANICAL ❑1 love and will maintain Worker's Compensation Insurance.a required by Section 304 - ROUGH ELECTRICAL 3700 of Ne labor Code,for Ne performs a of the work for which this permit is issued. My Worker's Compensation Insurance eerier and Policy number are: 305 - FRAME Carver: Policy NO.: 306 - HOLDOWNS CERTIFICATECOMPENSATION IINSURANCE ON FROM ORKERS' 307 - INSULATION (This section need not be completed ihbe Mrmittsfnrowhundmddollm(SI(XII 308 - SHEETROCK or].a,,) 309 - EXTERIOR LATH I eenify mat intW petro anec of the woA for which this permit is issaod.Ishall not 310 - INTERIOR LATH employ any persons anner. b_;zyb1_c1yt worken'compemnion la ,nro t - calf CCS 311 - SCRATCH COAT APP f NOTI TOAPPLICANT:lf urmaldingthisCcnificaceofExemption,youahnuld 313 - ROOF NAIL Object to the worker' ompenation previsions of the labor Code,you must 501 FINAL ELECTRICAL ENERGY OO forthwith comply with such provisions or this permit shall bo deemed invoked. CONRUCfION LENDING AGENCY 502E — FINAL PLUMBING ENERGY SI' 4 1hereby affirm that them isaconsumcdi^nm lending agency 503 — FINAL MECHANICAL ENERGY � Mewok for Which this Permit isissued(Sec.3W7,Co.C.) 504 - FINAL BUILDING ENERGY W Ca Lender's Name �z Lender's Add. 505 - FINAL ELECTRICAL U0 I certify mat 1 have mad this application and sum that the salve information is 506 - GAS TEST W F contact.l agree to comply with all city and county ordinances and stale laws mating to 5 FINAL PL O building construction,and hereby authonx mpresenmtives of this city o come upon the Wabove-memioned property for inspection purposes. O 8 FINL (Wc)agrce m save.Indemnify end keep hemlcss the City of Cupcnino y Ilabilitles,judgamms.cmuandexpenseswhichmayInanywaysameagainstaidCip 5 �NNk V 7 in consequence of the grani^e of this permit F7APPLICANT UNDERS`rNDS AND WILL COM Y WITH ALL NON-POINT Issued by$1 Date SOUR] AnON Q //' Re-roofs sore of ApplicanVContr. m [C-`•N�K� Dam 1XoHAZAR OUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant or future building occupant store or handle haardous material as defined by Ne Cupeninn Municipal Code,Chapter 9.12,and the ROOM and Safety Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. El Yea a. Will the applicant or future building occupant use equipment in devices which If a roof is installed without first obtaining an inspection, I agree to remove emir hamf air eomaminants a defined by the Bay Am.Air Quality`danaCement all new materials for inspection. 'sum'? a- 0 Yes I Au I have read the havardous materiels requirements under Chapter 6.934 the Celifi . nia Health&Safety Cale,Sections 25505,25533 and 25534.1 understand that if the building door not cunentiy haus a to that it is my respomitelity to notify the occupant of the requimmen hick unbe.7prortoissu cofeCertificatcot c1petroancy. Signature of Applicant Date Dam All roof coverings to be Class °B°Or better cr or euthoriad e m _, EIVED BSC 8 0 20 BY - FEE 00 �-i -fi APPROVEd- IN ACCORDANCE WITH THE CITY OR CUPERTINO CO AND XDhNANCE9� SATE u slatfED U lhis s% of p a,- and specifications MUST nr kepi on the job at l angeso timesand alterations INvrfui to make any ch ,nt tamewithout written permission from the bonding NO City of Cupertino. iiia £Yarn{trn! of this plan and specifications • 'HALL NOT be hold to permit or tobe all sions pptoval of violation StateLaw- o y ,r ativ City Ordinance V U �i O*ER-BUILDER VERIFICATA 1. (Check one) I or my immediate family(parent,spouse or child) will perform: A. X All the wgrk authorized by this permit ._ B. _ A portion of the work C. _ None of the work REC�E .D If B or C is checked,complete 2 or 3 below. DEC 0 2002 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work(complete section below) Contractor Address/City Phone# State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office.. Person/Firm Address/City Phone Number Type of work to be erformed ...................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property Owner's Signat r Job Address: 20 t# ©c2 / 2 0(o3 . .Cl Any changes to the information Provided on this form shall be submitted to the City of Cupertino Build Department. - i I' PTY OF CUPERTINO • 2/ z c� / �� ZCITYOF PERMIT APPLICATION FORM CUPE'RT. INO 3 _ APN# Date:�+ Building Address: 2 03 Owner's Name: . Phone#: Contractor: License#: Contact: CT J Phone#: �pplic ontractor: Fax #: r . uildi rmit Info: Bld lect lumb ech ob cription: Residential; � 'f ++�� , oma _ vL om rcia ) Sq.Ft.Floor Area: + ' $/Sq. t.: Architect/Engineer: Valuati Type of Construction: Occupanc AIL R Fee ID Fee Descri tion Fee GrouAPPLOTHER Other A liances MECHANICCONSTAX Construction Tax BUILDINCONSTAX Ind/Off/Comm/ uasi BUCONSTAXB Con. Tax for B ZoneCONSTAXH Hotel and Motel BUILDINGCONSTAXR Constax—Resi/Mobile BUILDING ELEC1000 Elec 600V<= 1000A ELECTRICAL ELEC1001 Elec 600V> IOOOA ELECTRICAL ELEC200 Elec Svcs 600V <=200A ELECTRICAL ENERGY Ener BUILDING ENERGYADD Ener Add Multi BUILDING INVESTIGA Investi ation fee BUILDING MITIGATC Comm. Housin Mit. Fee BUILDING MITIGATR Res. Housin Mit Fee BUILDING MNEWMULTI New Multi-Famil Res MECHANICAL NEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 2 07304 lof3 ;'J' EFF TY OF CUPER'1'INOBUILDING DIVISION PERMIT CONTRACTOR INFORMATION ` DING ADIdRPSS: PERMITNO0351 SILVERADO AV 02120103 ER'S NAME: APPLICATION SUB DATE:& GLADYS KWOK 12/30/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECDENGINCER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 w00 LICENSED CONTRACTOR'S DECLARATION z emit 1 hereby nflirm that I um licensed under provisions of Chapter 9(commencing Job Description with Section VU(q of Division 3 of the Business and Professions Cmle,tend my license is �o„ in fullfnmeandeffect, KITCHEN/BATHRM REMODEL & FINAt- r=13 zoq? Dart moa Cmite WINDOWS REPLACEMENT FX12 Dale TS DEL MAR 1 9 2003 < As shall use DECLARATION C�y 1 understand my plans shall M used as public records dOyU u O 5 Licensed Pndcseinnal .] OWNIamexemDEROECeConlrON BUILDING I hereby maso .(Sent on 1 1. racmnt from the Crnions Cu License Law for the d 6 p o following mason.(cation]1131.5, ,.areu and improve. thro ns Cmlc:Any cin or roomy $(< which requires a permit re sore the altar.improve.demolish. file repair any suuctum thatheor itsissuance.prfrm 1.the the sofcant pace for such Contractors Livr.La (Chapter d�< thalheislicenwJPuesuan71XXEofDivions,oftheStnnessandProfenwlCode)or Sq. Ft. Floor Area Valuation $ (commencingwit therefrom and the basis rth the Business pt on,Any vi lotion or $20000 y�.. that he is cacmpt thertfmm end Ne oasis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit objects the applicant to a civil penally of APN Number OccupancyType nor mom than five hundred dollars(s5(ar. 36939009 . 00 YP O 1,as owner of the pmpcny,or my employees with wages as their sole c mopenutinn, will do the work,and the stmcom is not intended or offered for sale(Sec.](144,Business and Professions Code:The Contractor's License Law does not apply to an aware of 101 - FOUNDOIT*cd Inspections property who builds or improves thereon,and who does such work himself or through his man employees,provided that such impros'emanls are not intended moffered lar auto.If, 102 — PIERS however,the building or improvement is old within one year of completion.Ne owner. 103 — UFER builder will have the burden of proving that he did not build or improve for purpose of sale.). 104 - REBAR 0 1.as owner of the property.am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS construct the project(Sec.7(1 Business and Professions Code:)The Contractors Li. tensa Law does not apply no an owner of propcny who builds or improves linemen.and 106 - SEWER & WATER Lhnaccuutanuch projectswithacomracfor(s)licensed Pursuanu,the Contractor's 202 — UNDERFLOOR PLUMBING am e/xten/t,��� d��'er���fff$$$ccc ��� B&P C for this reason 203 - UNDERFLOOR MECHANICAL ,r� ��-✓'-�C -CD.,a g' �' 204 - UNDERFLOOR FRAME WOR COM Nse u N 205 - UNDERFLOOR INSULATION I hereby ditem under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING 0 1 have and will maintain a Cri ificau of C,nttnt m aelf-insure fnr Wmkef.Comprm anion,as provided far by Section 3700,of the Labor Cade,far the performance of the 302 — TUB & OR SHOWER work for which this perrnu is issued. 303 - ROUGH MECHANICAL 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3 04 - ROUGH ELECTRICAL 370()of the Inner Cock,for the performance of the work for which this Permit is issued. My Worwr's Compensation Insurance carrier and Policy number am: 3055 — FRAME Carrier: Policy No.: 306 - HOLDOWNS CERTIPICCOMPENSATONIINSURA FROM CEORKERS' 307 — INSULATION (This section need not W completed if line permit is furore hundred dollvs(Slp) 308 - SHEETROCK less.) 309 - EXTERIOR LATH 1 certify that in the patorryante of the work for which this permit is issued.1 shall nm 310 - INTERIOR LATH employ any parson imydM1annm w,.p beenp1jec�q, Wmkers'Cnmpensation Laws orcarfamialDa(( ll// 311 - SCRATCH COAT AppleIsr((annyy GtN/ C NDTIa/TO APPLICANT:If a fwr making this Cenificate of Exemption,you should 313 _ ROOF NAIL Ih; object to the worker ompensadno pmmame,of the Lihm cadr,you mast 501 FINAL ELECTRICAL ENERGY OO forthwith comply with such provisions or this permit shall be deemed revoked, z CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY P '4 I)icmhy affirin that there is a construction lending agency for the Performance of 503 - FINAL MECHANICAL ENERGY C4 tY ,>„ Underwhich this permit is issued(Sec.3097,Civ.CJ 'sName 504 - FINAL BUILDING ENERGY Q the work Na D z Lender'sAddreas 505 - FINAL ELECTRICAL U O I certify drat 1 have read this application and ante foal the above information is 506 - GAS TEST LS, Fcorrect.1 agree m comply with all city and county urd'mances and state Laws relating to buildingconawcdon,and hemhyannounce representativesofthiscitymeamrapnnrna 5 FINAL PLUMBING Wabovememianedpropeny(or aexpectionpurp,ses. O8 FIN C L (We)egrcc m save,indemnify and keep harmlcu the City of Cupertino against .F.a r�/1 liahilitics,judgments.ttuts and expenses which may in any way accrue again sail City 5j N in consequence of the granting of this Permit. �a APPLICANT UNDERST NDS AND WILL COM IjLY WITH ALL NONPOINT Issued by51 NG Date SOURCE�G ZATION /j / �� ,� ' (( Re-roofs sere of ApplicanarCont ter Dam IIAZAR OUSMATERIALSDISCLOSURE Type of Roof Will the applicant or future building,aeupanl atom or handle initiations material defined by the Capetian,Municipal Code.Chapter 9.12,and the health and Safety a.Siefert 25532h)7 All roofs shall be inspected prior to any roofing material being installed. Dyes x40 Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ,mit naeardous air nrmaminam as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Vas Ir,�I fp 1 have read the humidors materials m,dreamnu under Chapmr 6.95 of the Calif ll ria Hcalth&Solely Code.Sections 255115,25533 and 25534.1 understand that if the building does not currently have u¢nam,than it is my resp,nsi bilily to notify the occupant of the rcyuircm I hien relbemel rinnnissu cola Ccnidca¢nf up:ney Signature of Applicant Dale G��/C., �.�- ,0-02 ,rmaummimrda tit Dale All roof coverings to be Class "B" or better