02030110 CI BUILDSIONvO
BUILDING DIIVISIPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10425 N. STELLING ROAD SI-TAUR WANG 02030110
OWNER'S NAME: APPLICATION SVB DATE
3I-TAUR WANG 03/21/2002
IHONE: SANITARY NO. CONTROL NO.
pa
WOO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
E
to BLDG ELECT PLUMB MECH
F LICENSED CONTRACTOR'S DECLARATION
•O'2- I hereby affirm that 1 am licensed under provisions of Chapter (commencing Job Description
>y tai with Section 7000).f Division Sof the Business and Professions Code,and my license �rs�s,,., WINDOW REPLACEMENT
5,2-1 is in full force end effect. F. *gd
.
all q a License Class Lic.p
l 3 a V Dam Commnm
ARCHITECT'S DECLARATION {
�g 1 u Wemand my plans shall M1e.sail as public records t ,t„
3 O O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby.(Brei that 1 am exempt from the Contractor's License Lew for
t < following reason.(Section 703).5.Business and Professions Code:Any city or coun $3500
IFC which requires a Permit to conswct,arer,improve,demolish,or repair any amcturc
a.B; primusis issuance,al req theapplicant for such permit to Elea signed summem f ....
hat llidicensed pars eto the p'n nsofthe Conuanors License Law(Chapter 9 rr �„ Valuation
(co mennngwish Sedo ]OOb)pf Drvis on3ofthe Business and Profess ons Code) (J,�, ; �3H• $;eiT6,r;y}.�e ,Q,
or that he If exempt therefrom and the basis for the alleged eiempuba.Any violation /
of Section 7031.5 by any applicansforts permit uil the applicant m a civil penalty
.fnmarm, he.Five hundred dollars($500). 10 1APN NRTkPDAT I ON "r" Occupancy Type
❑1,as owner of me property,or my employees with wages as their sole compensation.
-will'do the workfand the mdnure is not unloaded or offered for We(See:7(l
•Business and Professions Code:The Convector's License Law does not apply to an 103 - UFER Required Inspections
owner of property Who builds or improves thereon.and who docs such work himself 104 - REBAR
or through his own employees.provided that such improvements arc not intended or
-'.Rated for sole.-17:however,ase Wilding or improvement is s.IJ within one ycai o(- - '----" '------� -�- - - - - - --�--�"�- '-:'--'___._
completion,the owner-builder will have the burden ofpmving that he did not build or 105 - ANCHOR BOLTS - " ^-
improve for pa'maofaale). 106 - SEWER & WATER
- --
wn
❑Laa . q.nne propcny,reit excrosfvelY contracting with ii&mud c.ntmnas m- --.--- - ---202-._"". UNDERFLOOR PLUMBING__-__
- ,
- :
construct the project(See.7W.Business ora Professions Code:)The Contractor's 2 O3 - UNDERFLOOR MECHANICAL`''
License Law docs not apply to an owner of propeny who builds or improver thereon,
..and-who.contracts forsuch projectiwith a,comractods1-licensed motion.in me. __--__.._._.2.04-___._.UNDERFLOOR'-FRAME'._ _-
Contractors License Law.
- - ❑Iemexempt under Sec.' '" '' ,B&PCfonhisrcamn 205 - UNDERFLOOR' INSULATION
- .. .,
Data 301 - ROUGH PLUMBING
'WORKER'S COMPENSATIONNDEC DECLARATION
302 - TUB & OR SHOWER
I hereby affirm under Penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL
❑ I has.and wig maintain.'carificme'of Consent m seff-mo s for Workers 304 - ROUGH ELECTRICAL
"l..q Compensation:as provided for by Section 3700 of the Labor Code, for the 305 - FRAME
-- performance of the work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,a required by Section 306 - HOLDOWNS
c 37W of the labor Coda.far me performance of the work for which this pertain is 3 07 - INSULATION
Iasuetl My W k Cut a ion Insurance carne and Policy be rt -
came id,ti.'.v' ,Poll=yN . 308 ;',`.- ' HEETROCK, •'.,��..r.,,
CERTIFICATIONOFEKEMPTIONFROM WORKERSr t a t '30'9 ='EXTERIOR-'LATH•
COMPENSATION INSURANCE' .. _ .
(Th ssccndn need not be completed date Permit is 3'lO +I.
: -^TNT.ERI OR -"L7ATH-"""; , ' — - �
s fed one hundred dollars '" . . - �'CI Rr' R' }i.:
�($100)maaa.) 311 - SCRATCH COAT
y ,.313' '- '°ROOF'NAIL...,, :... , . ._ . .
shall n II mployat In
so a nod y millear so inak mfoorqi��.w..H¢hsmn parm't is me h..ad:1 - 1 .'. '
Compemat on laved of Cdif role.Dat ':3/0�' `�`-�a 501 FINAL EI�ECTRI'CAli"ENERGY
-Apel am """` - -502- FINAL—PLUMBING. ENERGY...-_ ....-._.. _..._ _.
lawn APPLICANPIf.fmrmakingthuCnfcomofl rep nyoush. la 503 - FINAL MECHANICAL' ENERGY
O Cbeco sublect t the W rken Compen.at on Prov s o s of m Labor Code,you must
ronn th reply ahaaenp dorm a trhanbeaeemeate ked _ _ -504_- -._FINAL BUILDING..ENERG$_._
> of me .kfm wh 'CONSTRUCr PION LENDING AGENCY 505 - FINAL ELECTRICAL,
I hereby affirm that th se c swction lending.geh y for the performance -
..
�hrlus t FAR 506 - GAS TEST
LA ..Lender.Name- t �,tu':_ . ._. _. .0 .. - — ..
lkmer nap ... 507 - FINAL PLUMBING-
U-0
. ' 1atifythat1havereadthisapplicmonandlamthatmeaboveinformationis 508 - FINAL MECHANICAL
comm:f.gree m comply with all city and county,oNinances and sum laws miming
509
- FINAL GRADE
rebuilding cmmtraction;and hereby authorise reprcsenmtives ofthis city to enter upon
fsa
the sh, emi.pedp pryforumpectimi uryp a_ 510 - FINAL PLANNING
4'
(We)agree to save indemnify and keep harmless the City of Cupenino egamst
"rA tub Ire ) dgmen ossa and expense wh pct may in any ay deem against mid 514 - FINAL PUB IC WORKS
U.Z City m camequcn f me rung of rets pe"a r La
SP7LICANT,UNI - $NS ti'ILL COnA LY sSgTH ALL NON-POINT Issued b Date / v
ZO 10d y
Sigirilh.of Applican✓Co tenor ';" " ,Dam „', Re-roofs
HAZA DOUS MATFRI DISCLOSURE
Will Me applicam or future W Idmg occupant store or handle hazardous material Type of Roof
all defined by the Cupertino Municipal Code Chapter 9.12.and the Health and Safety'25532(.)" -1. 'S.' i .. . `
Code,oY`.. l S. : r`� ' - _All roofs 86all,be inspected priorao any roofing.material being installed.
W Bme.ppbea to fumm Wilding pent use equipment or devices him If a roof is installed without first obtaining awin spection"; I'agree'to remove
nit humorless air contaminants as defined by me Bey Area A Qual tY Management _ .
District? all new materials for inspection Applicant understands and will comply.with
all non-poim-source regulations:..
h
I have read the hazardous mammals req,25533 a d 255 4.1 understood
of the
Coliform.Heahh&Safety Code,ave a to 2ot.tht it
endlSSJ'.1undersand mat
comabuildin8docs not correndyheveatectum;et itt is mYm'.0re off toil( the
occupant of requ' 'emu hieh must mn,Pdor m Issuenc<oh CeniE6ie of
Signature of ApplicantDate
_ _
owaerpr aN.d:<e agent 3 Daia All roof coverings to be Class"B"or better '
OFFICE ... .,, . .. _. . . .,.._ . .. ..