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03030001CITY OF CUPERTINOa 'GTOR N, TTION,,, 4, BUILDING DIVISION pER TCONT F� _ BUILDING ADDRESS: PERMIT NO, 11238 TERRA BELLA DR 03030001 NAME: PERMIT OUE DATE 5R'S CHING CHENG CHAI' 03/03/2003 PH ONE: _ SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 ON Lm that I DCONTRACnORS &,pmvisl.m, I hap 1 hereby affirm that 1 em If under of Chanter 9 (commencing Job Description p d ftfuss With SmtionAnd of of ecDivialon 3 of NC Buainw arM Proraulnm Code, and my license 4 ON Bt mrmlfomeandcfrem. - Class Lic.A REVISION --IN NO NEW PERMIT - - HOUSE USE ONLYLiceL ISSUED, ORIG. #%9298yvozr V OI J Deunse ARCHITECTS DECLARATION 1 understand my plans Nail he wed u public recouls RELOCATE SHOWER Licensed Professional • OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt form the Comrmmra License Law for the - following mason. (Suction 70313, Business and Professions Code: Any city or county which requires a permit to construct, alar, harrow, demolish, or repair any structure ' poor In its issuance. aim mquires,M applicant formals permit to file align of atstement that he is licensed purm.m to the previsions of the connector's License Law (Charter 9 - Sq. Ft. Floor Area Valuation - (commencing with Section 7000) of Division 3 of the Buonus m l Professions Code) or DLit he is exempt therefrom and gte basis for the alleged exemption. Any violation of APN Number OCcu Type p y 'TryJ p Section 7031.5 by soy eppliesnt for a permit subjects Ne Applicant to a civil penalty of not mart Nan five hundred dollar (53( L ❑ I,uownermfthepmpcny,mmyemployemwiffimpsutiulrmlacompewtion. will do IN work. and the structure is not Intended oro0ertd forule(Sec. 7044, Business And Professions Cade: The Convector's Liam. Law does not apply to an owner of Required Inspections q p property who bulldsor improves thereon, and who doessuch work himselfor through his own employees, provided that such lmpmwmmu sn ore intended ora@red for We. It. _ 1a1 — FOUNDATIONS however, Ne building or Improvement Is within one year ofcompl,don. the owner. 102 — PIERS builder will have tin burden of proving dear he did not build ars Improve for purpose of Asia.). 103 - UFER ❑ 1, as owner of the Property, am emlwively competing with licensed mnnacbn In 104 - RE BAR construct the project (Sec. 7044. Business and Proletarians Code:) The Commerors U. sue Law data not pply to an owner of property who builds or improma thereon.rod, 105 — ANCHOR BOLTS who cmmracu for such projects with a com uctor(O licensed pursuant to Na Connecta, 106 — SEWER _&' WATER, ' License Lew. am exAmpwnderSec. B&PC for thiso mss 202 - UNDERFLOOR. PLUMBING r Data 203-- 204 - UNDERFLOOR MECHANICAL UNDERFLOOR FRAME - WORKER'S COMPENSATION DECLARATION IherebyAfnmtmderpenaltyofperjuryone of the mnowingdecl.rations 205 - UNDERFLOOR INSULATION ❑Lluve and will meloid. A Certlficsteof Comet to self -swum fm worker, Comeau. 301 — ROUGH PLUMBING ution, u provided for by Section 3700 of the labor Code. for Ne performance of me _ workforwhichthisPeroithilaand. 302 - TUB & OR SHOWER ❑ 1 nave and will maintain Worker's Compensation Warm¢, u required by Section 303 — ROUGH MECHANICAL 7700 of NA labor Code, for Ne performance of the work for which Nis permit is issued. MyWorkcrgcnmpensauonWunncecarierandPoncynumberam: 304 — - ROUGH..ELECTRICAL - Carrier. Policy No.: 305 - FRAME CERTIFICATE OF MEMPTION FROM WORKERS' - 306 — HOEDOWNS COMPENSATION INSURANCE -- (Thlameticancumnot ccomplutedlfdeepermitisforms,hundmddnllan(SIM) 307 - INSULATION miass') 308 - SHEETROCK - I certify that in the performance of AN ..,it ser which NIA perm, is Issued, 10.11 not 309 '— _ EXTERIOR LATH employ any person in my manner an u m become subject to IN Workers! Compensation Laws of Celifomla. Data 310" —. INTERIOR LATH' Applies., 311 —,,SCRATCH r COAT, - NOTICE TO APPLICANT.If. after making this CertlOceu or Exemption, you should become subject m Ne Workers Compmutlmn previsions of IN Labor code. you muss 313 — ROOF NAIL forthwith comply wide such Provisions or this permit shall be deemed revoked. 501 - FINAL ELECTRICAL ENERGY 1, cushy afl,m thalal ft. NSTRUCTION Lia connnmctinol lending LENING agency for Ne parromurceuf 502 — FINAL PLUMBING ENERGY - dwwork for which this permit tsissued (Sm.3097. Civ. C.) Lender's theme 503 - 504 - FINAL MECHANICAL ENERGY FINAL BUILDING ENERGY fenders Address I unify that l have rod this Application and suss that the shove bar..line Is 505' — FINAL ,ELECTRICAL contact. I agree m comply with all city end county ordinance, and data laws relating to .'%6 -GAS 'TES T building convection, and hereby authorise representative, of this city u color upon the- above -m nfloned Property for inspection purposes FIN PLUMB G(We) agree u Live, Indemnify and kmp harmless the City of CupeNno against11militles, juegments, costs and expenses which mag in my way accmc agaiw said City I C ICAL in eoneequmec of Na granting of Nis permlt APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT - Issued by: Date SOURCE REGULATIONS. Re -roofs 514 ,. Type Of ROOF INAL PUBLIC WORKS Slgnuum al ApplicaAZAR Dau HAZARDOUS MATERIALS DISCLOSURE I u H building rccupmt nomm anodic Willy eCupertino Muni sal de0eCupertino Munlclpal Coda. ChaPur 9.12. end tin HuIN end Ssldy Health and ' Secure 25 0Ys 35532(a)? ❑Yes, C] No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the Applicant or future building occupant use equipment or devices which emit hanrdow air contaminants u defined by tis Bay Area Air Quality Management all new materials for inspection. - Dlmict? - ❑Yes (:I No I ban mad the hannlnus materials requirements undo, Chapter 6.95 or the cables. A le Health& Safety Code, Secuou 25505,25533 and 25534.1 understand that KIN building docs not currently haw a um.4 that It is my responsibility in Audi the occupant of the requirements which mon N met prions issuance of a Comficate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better owmr arantharved seem now