03040006 CITY OF CUPERTINO • "r4 wry"�'•' 'Ir "` +"'�, ' al7,S""''� ,' _.
BUILDING DIVISION PERMIT ,QNT ,CTOR�N�UTtMATIO„N t;
BUILJ93lyBiTEVENS CREEK BLVD PPnMrrNO. 03040006
PERMIT MUE DA
4 )9RPREIENCE3 HAIR & NAILS 04725/2003
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECIIENOINBER:
BLDGELECT PLUMB MECH
O O O D
+06 LICENSED CONIAACTDRSDECLARATION Job Description
1 hemhy aM That 1 em lian�����eddddd under provisions of Chapter 9(commencing
with Sect n7M))ofoivisioa3o —1 fes I ndm Itcenwig
jNmmRmjcr TENANT IMPROVEMENT
Licanm Lk.I �h
J Dm mracur CONTRACTOR: THANH HA CONSTRUCTI N r+Uy b
un J my p`lle^s NII he ss Public rccnrJa T"`• �v
Licensed Licensed Pndessioml'7 b J/g�
OWNER-BUILDER DECLARATION V �oo�
g I hereby alarm that 1 am exempt from the ConinctoYs License Law for the
to following reason.(Section 7031.5,Business and Professions Cade:Any city or county atilt
g
$ which requires a Permit to c mama,alter,improv.&mulish,or repair any nrucmVre P%.,
�n prior its iguana,also requires the applicant forsuch Permit o rile aligned statement S FL Floor Area Va uatioN
that he is licensed pursuant m the provisions Of the Comracim's Llan.U.(Chapter 9 q•
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
..
that ha is exempt thesefrom and the bass for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects tic applicant in a civil Penalty Of APN Number tiEecpadcy T! pe
not more than five hundred dollen(5500).
❑h u Owner ofthe Property.0,mycmployces with wages,g their solo compensation, 31621029 . 00
wiildo the work andthe stmdure lsomimunded oraBerW furssle(Sec.IDµBusing Re sired Inspections
and porrin km Code:The Commutes tdcensa Law does not apply m an awaer of 101 - FOUNDATION p
property who builds m improves themon,and who does such work himself or through his
ownemployces,provided thauuch improvements arc not Intended mattered for ale.If. 102 — PIERS,
however,the building or Improvement is gold within one year of completion,the owror-
builder will haw ac bufden of proving Nat be did nm Wild or Improvefor purpeae of 103 — UFER
'°le')' 104 - REBAR
❑1,as caner of the properly,am exclusively contracting with Banged COMMemg Is, 105 — ANCHOR BOLTS
convect the project(See.Toga,But..and Profmslans Code)The Commodes Li.
cense Law does not apply to an owoer of proPeny who Wilds or impraws Nmeo.and. 106 – SEWER & WATER
who contracts for such projems with a contnmartq licensed pursuant te the Contnctafa
License Law. 202 - UNDERFLOOR PLUMBING
O lamexemptunder See. ,B&PCfmthismason 203 - UNDERFLOOR MECHANICAL
0 os," 204 - UNDERFLOOR FRAME
WORKERS COMPENSATION DECLARATION
l hereby stand under Penalty of perjury one of following declarations: 205 — UNDERFLOOR INSULATION
❑I haw and will matntaina Cenlfinuaf Canssnt10 self-msum For WorYmYCompen- 301 — ROUGH PLUMBING
goon,As provided for by Section 3700 of the tabor Code.for the performance of the 302 - TUB & OR SHOWER
work for which this Permit sisued. 303 - ROUGH MECHANICAL
❑1 haw and will imain ign Workers Compensation Insurance,As required by Section
3700 of thOlabmsCade,for the performance of the work for which this Perna is issued. 304 - ROUGH ELECTRICAL
My WorkaYSC ansatl m cecari d oliry a art• �M 305 - FRAME
Cartier. / Icy
lRTIFICAT7 ex•MPno OM WOR 306 - HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(Dis section need not Wcomple¢a line Most,is porton,hundred dollars($IM) 308 - SHEETROCK
or les.)
I
anify Nel Int rfn ante of the won fm which Nla permit u Issued,l shall not 309 - EXTERIOR LATH
employ an r ymannergoss to -.,ObjalmNewoeken'ComPewtion 310 — INTERIOR LATH -
Lewg a nia.Date 311 - SCRATCH COAT
App cam''- — .
APPLICANT'.If.attermaking n rCisions eof Labor iodyou should 313 ROOF NAIL
bemnteh comply subjecim
tic Worker's CompeCusses r this ermisiom of Ne Ishan Code,you moat
,Jz mMwimcomPlywlmmehPrnvslnnsorNnt<nmiuhanbcdamedrevnted. 501 — FINAL ELECTRICAL ENERGY
z 0 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
E~ 1hereby Arlon that Nensaamtmctlanlending agency for the performance uf 503 - FINAL MECHANICAL ENERGY
> the work for which this permit is Issued(Suc.3097,Civ.C.)
u)QLeader's Name 504 - FINAL BUILDING ENERGY
]Z LenderIAddrcse 505 - FINAL ELECTRICAL
UO IttgreeNu1haw stdthis itCity liccounand sanewttheshowInmmlNuns 506 - GAS TEST
corms.I agree to comply with dl city sna county oNinanar and sate Isw relating m
0 building construction,and hereby authorize reprearlatim of this city to enter upon the FIN PLUMB G
L37 ahow,menlioned property for inspection purposes.
Lk, (We)agree to an.Indemnify and keep harmless the City of Cupertino against O$ F I L
rn luddliflujudgments.costs and expenses which may in any way name against said City 5
C) In consequence of the granting of this pmxdl,
p APPLICANT UNDER S N WILL COMPLY WITH LL NON-POINT Issued bY:5 ING Date
SOURCE e L - � Re-roofs 4 NAL PUBLIC WORKS
tur
;Diwicl?
uuk of Appli HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will Ne applicant m future building=upset Store or handle harardou material -
rt ed by tic Cupertino Municipal Code.Chapter 9.13,anti lit Health and Safely
e,Seetin25537(s)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will the applicant ch uturc building acupant use equipment or devices which If a roof i5 installed without first obtaining an inspection,I agree to remove
havani air cnnuminan g defined by the Bay Aral Air Quality Managcmcnt all new materials for inspection.
❑Yes No
1 haw mW the hanmous mwrialsrcquiremew under Cheptcr6.95 of Ne Cslifor-
niAH.IN&Safely Code,Soci.25505,25533and25534,1undCt dNuIftic Wilding
Jou not currently haw a tenant,gul1j,is my responsibility to notify do n<upanl or the
maul (Occ c. Signature of Applicant Date
oeau
am All roof coverings to be Class "B"or better