01080010 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
10109 S . TANTAU AVE. PIONEER DRYWALL & PAINTING 0001080010
OWNER'S NAME: APPLICATION SUR DATE
hillkhKYU L. & KELVIN LWIN 355 MAHONEY DR 08/02/2001
WNPHONE: (408) 929-1620 SANITARY NO. CONTROL NO.
O m z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
z o CBLDG ELECT PLUMB MECH
L_J 1--I IJ C_I
Zy= LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_ 1 hereby affirm that 1 am licensed under provisions of Chapter 9 gommencing
�y�u, with Section]000)ofUivision3oftheBusinessmdProessionsCale,an myhange DEMO.
gg,m M� is in full fomc and n t.
n z a Licosa Class ` _ Lic.p
i U Date q + Candia 1 d
W L
D. .7 i' _hRl �$r,pt'u p
{ ,v,g 1 undetstand my plans s i _ e
,D c o C Licensed Professional
OWNER-BUIL A I
DECLON
w 1 handy affirm that✓nim exanpi from the mmctor's License Law for the
h i< following reason,(Sea on 7031.5.Business and Pro esxions Cale:Any city or county $20000
<x e which requires a permit to construct.alar,improve,demolish,or repair any structure
w—, prior to its < I, I th r
pe - tf Inc It fl Lig attment, ._.. .....-._.--
hValuation
_.._.. . .
h."he ,I d1 t o ilI' f I11 C t t "L' (Chante 91 r[AL�,1 V81 n.111011
(co tmencn8 with sat - 70(10)of Division 3 of the Business and Professions Code) f' , •'37`JtO.`Oj.t7,..UV ,.. ; '. 1'•}.'t '
or that he is exempt thcrefn5it find the basis for the alleged excmpuon.Any violation
of Section 7031.5 by any applicant for a permit u.Dr,dx the nppltarot m a civil penalty
oraot more than me hundred donar.(s500). NO INSPECT ONS' I Occupancy Type
❑I,as owner of the property,m my employees with wages as their sole cmr,ag mbm,
will do the work.and the amctum is not intended or offered for gale(Sec.7044,
'Business and Pmfegsions Cale:The Contmcmr's Liman Law does not apply man Required Inspections '
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.Provided that.such improvements are not intended or ._._.,. ,.__..__ __.._._ .,,.._ _
__-.._ ... _. _... _.._ ._... . ..._....__........._-...__..._..
.bRcdd for she.IL how2Ler,the Wildin tis that within one��id or -
gor improvcmcn Yc . .• •,,- s;l •t
completion,the owner-Wilder will have the burden of proving Ilia he did not Wild or
imi for pmme of gale.) I
project
rec p(Seerty,am Business
Profession,
h,Compactor's
construct the does
n (Sec, to a Business end Professions Calea The improves
the mr's ( ,, 1, - •„
License Law rices not rapplysuch
to an owner of propcny who builds e se improves thereon,
.and who co Lia..forsueh pmjem with a.contrvcmrts)licensed pursuam.m the '
01 m age License Law.
❑lam exempt under gee. .B.&PC,tot his reason
Owner Ddtc
WORKER'S COMPENSATION DECLARATION
' IM1crcby affirm under Penalty of perjury one of the following declarations:
❑ 1 have and will maintain Cenificale of C t to self'nsom for Worker's
Compensation. provided for by Section 37W of the Labor Code fro the
'partormana,of the wo k for wha It this permit is iond..
❑1 ha- nd 'll maintain Worker's Compensation iii a requ red by Section
37M of the Labor Cale,far the performance of the work for which this permn is
issued.My W�Dysyycr's Compensation Insuran<vrorzier. d�p^cy�t rape' -
Camcr_i_PolicYNo.: L' M ( - j•v�, S v "1 �j
p 'ER FICATION OF EXEMPTION YROh1.wORKERS',• - - ••
,.. ., ,.. ., _..._._....._.
. . .. . .... COMPENSA'[ION INSURANCE'„ ..... .. .. . ..._.._.___._..___________ ....__.._.._.___.._.____._..._ ..__._.__ ....
"(This seLoo need not be cnmplcted if the permit is for one hundred dollars •.:.'is•r t'' •-r ,
S100)or less.)
I 1.
Q ' cenifytmain hepdormac<
of the I for which ubprmt n
ucd,I
Ibl any peaon in any manner w as to hm bject m the Woi
Compensation Laws of Cabalism.Da
Applicant
NTfAPPLICANT:Hatter dolingthapCerificamnfEcnpt youId
0beeome,subject theWorkeVC Compensation np oflLabor
forthwith comply wih such flai, .it hall be drecand revokird.
t^ CONSTRUCTION LENDING AGENCY
a.' 1 M1crebY affirm that herc is a construction lending agency for,thc perform ice
of the k for which this , .Permit issued(5 309];Civ.C) _
Z Lnr Leader's Aare..
_ I .
V O
. I certify that I have read this application and state that the above information is
correct.I agree to comply,with all city and county nrduorac,and Moe laws relating'
0'V
ED building construction.and hereby authorize reprcsenmtives of this city to enter upon
(Ed the b ncJ p pe 'f -nspen n p rp .
F,It 1 m e.dgJe nify and Reap herml!i the C ty fC p rtno ag mgt
to li t j�a nc Qs., t t apenu>which may in any Y cane against said
:V z tYnc Fy cc of the in,of th Permit.
. .. s E loo NoPo1Nr Issued by: Date
. ea rata Z OI
nature of PF nn ,emu g ;Date Re-roofs ,7
AI IIN^ill l' PHfST SAND WILL COMPLY W'ITH'AL Q
J
Ethic., DOUS h1ATERIALS DISCLOSURE '
or future h itdin'occupant gtae Dr nanme hai,mous material Type ofRoof
as Jelined by the Cu nine Municipal Code,Chapter 9.12,and the Health and Safety
i.. ,
Cal ±,
0 ❑N -, _- _-All roofs shall be inspected prior to any_roofrng material being installed.__.
Will in fpr t or t late halodan g ocau plant use eql t orca 'acs which If a roof is installed'wlthout first obtaining an inspection,filagree to remove
cruitM1 Nous air contaminants as definedby the Bay Area Air Quality Management
41, fn t a. - _ all new materials for inspection. Applicant understands and-will-comply with
°Yat CN" all non-point source regulations..
.have read N am o s mmenaN rtquirtmemi under Chaprcr 6.95 of Ne
C ornia f{ th& at" C ,.Scninns 8505,25533 red 25534.1 understand that, _
captain Jig which
trust
oflitymnotify chef
' cuPam c cquircn ,which must be'ma priono issuance of a �enificam of '
"Dpa"`' \ Sibnature of Applicant Date
u ,rat age --. -Dove t All roof coverings to be Class "B" or better,
t
' OFFICE