00100125 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10190 S. TANTAU 001001,25
OWNER'S NAME: APPLICAT101
5�11/I f_4/•`���
TANG 1�
PHONE: SANITARY NO. CONTROL NO.
00 ARCHI'rEC'r/i?NGINHL'R'.
BUILDING PERMIT INFO
w IH' 'LEC' PLUA1R MIiCH
NSE f'_ 1 J IJ l"J
FF y In LICENSED CONIRALTOR'S DECLARATION
Con'C I hereby affirm that l ani licensed under provisimum
ol'Chapter 9(conuneing Job Descrip ion
_ with ACCESSORY STRUCTURE — UNCONTDITONED SPA .
-� is in ntll dna amI erre.,.
—0" Dne°s`cI°' C�ractor ALTERNATIVE PERMIT TYPE)
t a v< ARCHII'13Cl- DIiCLARATION
o,LL O J I undersand my dans shall he us,d as public mcoNs A-b
w p Licensed PnsfcssionalOWNEWBUILDIiR In the RATION
I ser .. alit ism chat 1 um,Bene,mea the G,mm..Co LiAny c L+w lin ane
followingaioc'a.IScceloI )0]L5. 1,all., and ,,Iden... Code'.Nry city oanuay
yZ O which requires a ncrnlu m a,mvuca,ulmr,Inepnrvc Jcennlixh,ar rcnuir any xtrvcmrc
6 that hoirccensedersu myuim,th,uppllam for suchpcnnit accense ignalnha,i9
watheensim,s,Jnmsaam wth)of Divisinrthe commenes Land Pr Lswar,Coe) Sq. FL Floor Area alio
oris.,he
wish Section7000)of DivisionJofthe Husin cs and Iran&Anions Cade)
or that he is exempt themfrvm and or base,for the all the uenanoo Any I Penann
of Section 7031.5 than vanyapplicantfor arennet aunjeas the applicant a+aciv il penalty
or not nlnm man hn,hundred dollars(sslkn. APN Number Occu ' e
01.a, weCr ol'IhupnTcnyn my,ninlnye, will'negro as eheir.,Ac roe+q,cmalnn,
will an we work,Pad:nal the ode:]'re Is Bol inandod er Ill coed does
sale(Sec.'In an 3
ownerof and erty Wio b Calc:Th,Coes hers.a License Law s such
nm apply In an aired Inspections
r ug pm,o,W'la,builds or improves thereon,and wen Jaen web work himself
offered for
his .If.employees. budded that men iernern is of arc am intended or
oRemJfor rule.ILhowuildethe building ofpnon sold within one year of 101 —' FOUNDATION
I"prove for weponeof elder will have the burden of Proving mm he did nm build or
nmrnv,sea parpnsc nfxale). 102 — PIERS
I"II,o,Own"'d,rroperty,on'oBelnxivdy c.unia,fin,wow ne,owd comrvt,na w 103 — UFE R
. ct the pn+;cei(Sec.704.business and Prefevnionx GNc:) He Contrvenni
e vc Law doe,aol aFply to entwine,of n,o,ny sit mild,or impmsa lhercon. 104 — REBA R
and who contracts for such PnI;,ets wise a,rardctora)licensed personal In the
Co105 — ANCHOR BOLTS
mmcmr's License lar,
❑lam/,�'nm'nn/derS�I` �BkPCfortle,rcaw 106 — SEWER 8' WATER
� f`"� MP ,snnoN111)�<n N 202 — UNDERFLOOR PLUMBING
n+er,ny murne andcn+cenat fI"r;aD on,Inns a+unwwg eccmmdmtx: 203 — UNDERFLOOR MECHANICAL_
° 1 have and will nairain a c,nifica,of consent in self-insure for worker: 204 — UNDERFLOOR FRAME
Comprnsaann. as provided sur by Semon 3700 of he Labor code. for the 205 — UNDERFLOOR INSULATIONlcrformane,of the work rnr which this parmlt is issued.
°Ina,e;dwo0 m;dnwin l4'orkcry Comren,aion lmm�a',,a.,rcgaired by Section 301 — ROUGH PLUNKING
pal of the Laken Cod,,no,11s,prd a..a cc of me weak for wha,h this ramie is 302 — TUB S. OR SHOWER
sued.My Wa ken's Cmupeaewiun Inwnence cane',and Pubic, aaher are:
Carrico PolicyNao 303 — ROUGH MECHANICAL
CUR'1'II9CATION OP EXEMPTION FROM WORKERS' �r04 — ROUGH ELECTRICAL
COMPENSAI'10N INSURANCE
cI his cilli need not be,omnlacted if the permit is liras,hundred dollars 305 — FRAME
(Su.norwsrl 306 — HOLDOWNS
I,enols mat in J+c p<dimnoncce of he work for which this perms i,island.1 307 — INSULATION
shall not employ any Paxson in any manner so as to hecomc subject to the Worker%
Compennatinnlro,ofCarlinmia.Date 308 — SHEETROCK
Applicant
NURCE TO APPLICAN'PIf,alter making this certificate of Exemption.you should 309 — EXTERIOR LATH
ex,coae,tm;cctwme worker..cdenp,nrati„n Pro 'i—sal he LoMrtcale,you nost 310 — INTERIOR LATH ..
Q Q I th,uh rn,Iy w'nh such pre esmm o+this ry;noul vhall he denci ccervoked.
CONST RUG I ION LENDING AGENCY 311 — SCRATCH COAT `
' 1 hereby allinn that them is n cowa¢tion lending agency far the pennaance
"fine work for which this permit is issued(Scc.3097.Ci,C.) 313 —
ROOF NAIL
a ° 'edi'"'"t` 501 — FINAL ELECTRICAL ENERGY
1<nd,r's AJdrens
U O 1 ecrily let,I he d mka,,l ea'ran and.,,are net the n ofnation oB 502 — FINAL PLUMBING ENERGY
V. [^—e lonell.I a y t Orly lid, IIay ora ty f cc 1 t.t F seting 503 t ' g ,1 lmt do hy� One p e I e. tit': lytenter +n 50.. — FINAL MECHANICAL ENERGY
Q tonld
y w
the aNwe-m,min.rednnop,ify]or hrix,nnnpnmow,. 504 — FINAL BUILDING ENERGY
F 9L (We)ugrcewsuve.inderady and keep ha-ade,the Cityof Cupertino against
7A liabilities.iodgtn,nt,.costs and,.Pens,,which any in any say aame against said 505 — FINAL ELECTRICAL
) Z City in consequence of the granting of this Pemti. _
^ APPLICA TUNDERSTAN SANG W COMPLY WITHALL O POINT ISSICd b 506 — GAS l'ES f Date
souR c ecul.n oN . �� (pl Y
seenat "'rnhnh,;ee uc,nu ,tor n' Re-roofs "a 0 -
nnzneoouSMAntRh Dlscu)SURIs 508 — FINAL MECHANICAL
N'ill IM1c:yp+licam nr furore MIilJing tar ran score or natal,n:�nwna,'nacos! Type of Roof
usdefneJ by me CarCNan Municipal Cale,Chapnr 9.12.and the!l'at'h anA Sulery 509 — FINAL GRADE
Cal,.Section 2553210)?
°Yes ON” All roofs shall 6eli6Specld2�. H ll.to 6dy.rRWt11Igiliraterial being installed.
Will Jm.1"dicam or fowre huilding+ccupans use c,.i,awa,or devices which If a roof is inst5tlbc#withcUtI4dAlobtfilhiRA-Will &Rbifal agree to remove
,mit h:...Nbns:or conwmimmts av doF ed by she Euy Amu Air Quality Manugomm..I
Districn all new materials for inspection. Applicant understands and will comply with
f ❑have
❑w' all non-point source regulations.
1 have mad the hit Code. mamoials m 5.25533dunder55 4,1 teroar h95 of the
iflteCalifornia ing do k Safety Coe,.atSection,25505,25533 and 25531 1 undo unify
thea
ifcubuilding Jasnotonens haveomwm,thatitie myssuanceolitY nsnaify dee
ooccupant of m rcyuirmnemv whi a not he met prior to issuance ofu Cenili,nm of
ampan'y.
T II I � Signature of Applicant Date
Dwn,r+n- Ieoriacdagcnt rt D,t All roof coverings to be Class`•B" or better
OFFICE