00100026CITY OF CUPERTINO',
DIVISION
CONTRACTOR INFORMATION:
,. ,
BUILDING
PEI RNUT
BUILDINGADDRESS:
.,
PERMIT NO.
10109.TANTAU.AVENUE., ". ''
-
00100026
OWNER'S NAMEi- ., „ �,,.. , o: � �u" . '.' .: -'
APPLICATION SUB DATF.
MRS'KYU LWIN
10/04/,2000
PHONE: -• ._..._._. .. ...... .. '.
' i. ''.:,, ..:. ,-
SANITARYNO.), ,. _,, ,CONTROLNO.
Z ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLOB r1.ECr PLUMB MECH
i' .., .. LICENSEDCONTRACfOR 'SDECLARATION.
Job Description
1 hereby edam dul I am licensed urWer provision> of Chep¢r 9 (commencing
ao iwithsedeon7") ofDis ;,tnn3oftheBusinessandProfessmns aaaaaamyR<eaxe
SFDWL 4089 LIVING S ,(; SPACE
��
is n full r and
'
N, Umd 11 n3 �C �rmcroll""��-
�M fl-r� .i•A,Ir i ,. ..
�.'..
AR HITtamed.ECLA ACw
4 be
.•. _.'
-' .. MAY 01'9'20OZ
I J rswnd my Plprts shall used us pub n
ee 9 l -
MAr a q 2002
createdPmreasionai:.: .; ..
ne OW NER•BUILDER DECLARATION
mI mica, annum that I'am escmpl from the Conlr om', Li=eme Law for the
B 1 L ®I NG
a following maven. (Senioa 7031.5. Buvinev, and Profession, Cade: Any oily or roomy
C which requires a permit to consvvc,, alter, impmvc, demolish, or repair any suucmrt
�UI 407622
- _ — ... _� -_ -----
',
.pd ng is e.m 9 she applicant fa such .it fl signed stmemem
t ,( r a y .,
} l r37 �/ � 4i.t i�11 f.`.
n-' •V31UBIlOn
- that Tes Pursuant o the provision f the C Contractors L Law (Chapter 9
(rn ma< 'thSeMO 7W0)of Division 3 fth B,ine d Prpfe.si... Code)
6s
! or th f h is exempt tgemfroin and the basis for the allegcil eitimajoion. Any violation
Lf� -s .�"U�l
-of "I mom by any hundred dollars fora permit wbjeas rue apPlieem m a civil pcnahy
' ornolmoreu ,anrvenandredtssw). ..
101'N1''"bATION
I "''` -''' Occupancy Type
❑Las owner of the property, or my employees with wages as heir sole compensation.,
J02 - P
!
103 - UFER Required Ins "' ='• '• " _
will do he work. 'end the structure is not intended or offered for sale (See: 70.W4,
' Bniriness and Professions Gone: The Contractor's License Ww:docs not apply to an'
owns of property Who Witch or improves thereon, and who does such work himself,
a m ggn n ply provided Iran such Improvements are MI intended or,
- dfo sale If, h ,fi Wilding or mpnVvemaot , sold within one year of
iections
- 104 - REBAR _ ._....- - -- --
a pl i the } W We will have the ht kn of p�ly ng that he did ne W ld or
105 - ANCHOR. BOLTS' -
mpro fa pate° faal ) " _
106 - SEWER- & WATER " --
pa ox' of the propcnY•am exdusi ¢ly uxi ewtnr a ummcrors m-
"_- 202 - UNDERFLOOR PLUMBING
_ construe, he ml soc 7(Il•l. Bn,iM , ad Prot Ions Cad ) The Cormactol, ,
ismy who lds or imp e, ere
License Law does am apply to an owner of p W v thon, .
203 - UNDERFLOOR MECHANICA li
" . and who <o tracts.r r such.pralecls with a conlracwax) ranod.pumuant to the
2 04 - UNDERFLOOR - FRAME_
ool � ` entrap, `under sK BsPCro tms Yn
205 - UNDERFLOOR'' INSULATION
Owner
301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION.
h:'. •',,,
302 -. -TUB & OR."SHOWER .
(1 hereby WRim aMCr pcoalry of perjury orc of the followin8 declarations:
303 - ROUGH "; MECHANICAL--•.
❑ I.hiosvona .41'riu atiiafa Eenificam orcdnse8r to self- insur, for Pbrkcr'x
304 - ROUGH ELECTRICAL
Compenm,lon: us provided for by.Sectian 37W of the Labor Cehc. for the
percomunce orthe work for which this perml�is issuM.:,,,�
305 - FRAME
' tam Worker s Cor pc t 1 'M6 u requ mJ by Sat o »W ar: nn workr nthm perir1 ,
ss ed Co per non I ur 1 nd Pol y i her arc
ICIR
306 HOLDOWNS
307 INSULATION �_ _
% - - .
co, ! PolcyNO_C %�%'.
-I 308 =.,�SHEETROCK t e., '•' I i I lr
TI CATION OF E%EMPNo. MWOR CERS
I.,
'309 - 'EXTERIOR -_- LATH___
"COMYENSATIONINSURANCE
„___
310`;( = ;...3NTERIOR LATH "..�. C•.x.t' I)e.
T hissemi,{ nnerandlhropplmaa 'nhepermlisforonchundreddolmrs
311 - SCRATCH COAT
` '(SIW)nn ss)
rl<erurythayk
31:3 ROOF NAIL- "...) ;..t.
peeaani anwasrofor m <no
'Com
,pl„iI•,r.t'
c,anitxWermo,
me ply nypc nyate .roiecpme qat, mew leers
501 - FINAL ELECTRICAL ENERGY
Comjcant' L' orC 1 f m Date
- 'FINAL PLUMBING ENERGY '
v�NPOT3CET0APn the Work r ft- ale gth ov nfc t fE p, on Y should'
hoc me sib e<uo c n, I provisions ufth Labor Code. You muss
503 - FINAL MECHANICAL ENERGY
y suchp
'roan n with hp his
qY
504 -- .FINAL -- BUILDING ENERGY - - - - - - --
"�'CONSTRUCTIONLENDINGAGENCY
505 - FINAL ELECTRICAL,,r. � ",.,.r,.
' y firm that them s o run i n lendid ugen=y for the perfdrmance
Inaob
!'
of me no tk for which this per,ail is issa<d (See . 3Z1iv. C.) ,I
506 - GAS .TES T
] Lcbder's Name°
lsnae,.Aaal :
507 - FINAL PLUMBING:•, ;..❑
� •„
.'f cenify lam Thayer reaJ',M1is application antl vaster thus the above inf mwlion is
508 - FINAL MECHANICAL
r. "rzd21. 1 agree to comply is i,h all city and <vanty oolmonces and stem laws reiating
509 - FINAL GRADE
a Wilding as cridn:andhereby Swhorize mprcs<mmivex ofthis city to rnmrupon
",he above -memi yf iaspeclinnpurposes....'- '..
510 - FINAD PLANNING , .
y (l d to' ; i ni(y a d kern A m lus,he Ci,y of Cup vino against
n, [is hill .j, e g aptxaie
a•
514 - FINAli PUBLIC WORKS
c.rasun i onsaawnienmpy,ipgywayaq
z cityrran, d" q rrnis'permic." -
`AIIP,ICA S >NDN'ILLCOAfPLYN'ITHA N- PO.YI"
_
Issued 2 OF Y D NAIL, Date
•
lure a] p c ,. ,., Date
Re- roofs04 - ROOF IN- PROGRESS
' c"i in US MATERIALSd ImeorSURE ^"
LOSURE
Wlllh'eirylicanror r building pant1 "or handle hw.NOsma'al
�Code,
Type of Roof - . -.<J_0 _.....
1 /1Jn'.I
= oSMATERTALSDIS
de Hem,na,nas,f
e the Cupmti IY'
I{•. .. _ .." a ,. G.
Section
t'q, ,.,
. _ -All roofs shall be inspected prior [o any, roofing material being installed __ _..
lzss3x)
„ ,winmeavpnr 1 future Wild ll, ay ,us.eq'p 1 rdeviceswhich
If a roof is inst'all'ed without first obtaining an inspection ;,,I -agree to`.remove
cmn harardoas an a.. it, as defined by the Bay Area Air Quality Mmfagemen,
D. ter � . .. :
all new materials for inspection. Applicant understands and will comply with .
PY<s ono „• i
t
�Chapter
all non -point source regulations.,,,
hsc} 6.95 of rue rI
e.
. Califomn alt a&' e' ions 25505:25533 and 25534. 1 understand thtt
- -
if Ifid .. ing n y a a mnem, the, u is my responsibility. notify the
Dore t of 1 m Is mum he men pct r io ixa once is a Cdnificme of
G"se p ry,'. �• �J, I
Signature of Applicant Date
_..
All roof coverings to be Class "B" or better .
wn mm d ay..
CV
OFFICE - - - -'"
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