02050155 i
ct BUow PERTNO
DIVISION PERMIT CONTRACTOR INFORMATION:
BWl,ptyGADDRTbLA CT I WM H FRY CONSTRUCTION COMP 02050155
Offt IAJOHN K AND YUN W 10351 SAN FERNANDO AVE AUg7T .'"?JJ2
f PHONE: I (408) 996-8173 SANITARYNO. CONTROL NO.
M O O ARCHITECDENGINEER: I BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
i, LICENSED CONTRACTOR'S y1ECLARAUON
iZ Ihereby affnnthat lamlieenaaunder provisionxofChaner9(coaturra ng REPLACE PARTIALJo�. bl fib
.otI_y with S=nion]000)of Divisi"n3of the Business and Professimts Crdc.ondnry license
is in full force and eRcct.
tz z a License CLss Lie.
i 0""U 1- Do¢ SCo.DEC rot
?LL O ARCI{ITGCT'.5 DECLARATION
1 undemand my plans shall Is,used as public records
n Y- JUN 1 8 2002
J i o O Licensed Ism esslentl
OWNER-BUILDER DECLARATION
uai
n 1 hereby of ism that 1 am exempt from the Commeil 's License Law for the
?G
hollowing reason,(Section 703 S,Business and Professions Code:Any city or county B I V IA/ CPC+$3850
— which requires a permit to conslo c6structurealter,improsk,demolish,or repany sure YP,. a
i 3$ ono t s remove.also q toapplicantf such permits the air g dsaimment .. ... -_ _
thatn .1'c )puru Ilan on f n C ....License La (Chapter9 .. _ .. .. .._.. .
temp cog uh,Section7") rovii J of he B 'nev.nd professions,(bde) x '�j' 'f':. . . �,. , fly".j ;f ?•• Valuation
or that he is exempt thercfmnt:u,d the hasis li,r me ulleged exemption.Any on '�
-of section]03by any applicant for a pcmut zubjats me applicant m e civill penally
nrnot more manan ave handed anllats(asfro). 103APN Occupancy Type
OLa, at,of he property,"r my employees with wages asIheir.nle=ompen,ad"n. 102 - PIERS
will do the work,and the sttucmre'is not intended or offered for sale(Sec.701,E — ulik LHRequired Inspections
Business and Professions Cale:The Contractor's License law does not apply to an q p
owner of p"",who build,or improves,hereon,and who does such work himself 10 4 - REBAR
or through his own employees.provided root such improvements 1, of as not intended or .10 5 - ANCHOR- BOLTS
offered for sale.If;bowaxr,the building or impmvcm<m la sold within one year of - � -
completion,the owner-badder will have the Borden of proving that he did not Wild or106 - SEWER & WATER
improfor r p"ri"se nr s:de).
i�a,owimronGnlo,ri :amesdasively:ontmatingwith licensed contractors to 202 UNDERFLOOR PLUMBING ... .. .... ..... .. .
carrousel the project(sec.]w4.Basin=s,and Professions CMeo The Cortrocmr's 2 0 3 - UNDERFLOOR MECHANICAL
License Law does not apply toanownet ofpropenywho builds orimpramsthereon, 204 - UNDERFLOOR FRAME
and who contracts for such projens with.a comracions)licensed priuma"t.to the ... . ... .. _. .... ._ ._.. .
coma"'nr',Li"n Law' 205 - UNDERFLOOR INSULATION
❑lam emu pt sec. .B&re for rots reason 301 - ROUGH PLUMBING
D:-nes ,t.,.f�.=--t Dat< '.�423�O.L . .
\VOR 'S COMPBNSATIO.'UECL RATION 302 - TUB & OR SHOWER
Ihereby thorn under penalty of perjury one of she following decorations 303 - ROUGH MECHANICAL
•0 1 have and will mamma,a Certificate of conical to self-insure for Worker a 3 04 - ROUGH ELECTRICAL
Compensator. as provided for by Scctioa 3700 of the LAW, cod, for he 305 - FRAME
performance ortire work for ishichthis permit isissued.
. 306 - HOEDOWNS
01 rime and wits mal teln workers Cmnpensaaon'm�arance,as required by section 3 0 7 - INSULATION
3700 of the Labor Code,far he{,crm
forance of the work for which this permit is
issued.My Worker scom mutation mmranaaaricrand Pobcymarmot,or= . . 308 - .SHEETROCK
Carrier: • t '' "policy No: t . X30:9' ''liEXTERIOR .LATH; .
CERTIFICATION.OF EXEMPTION FROM WORKERS"' - - ✓ 0
COMPENSATIONINSURANCE _; 310..__.._.INTERIOR....LATH_.....—_.___.___— .. ..__
mm,section need no,kcompleted irmepmmitisfar arm hundred dollars 311'' - SCRATCH COAT 't "
313 - _ ROOF NAIL
1 certify that in he penormancr of me work'(or which tnis',cm,it is issnea,1 501 - FINAL ELECTRI CAL ,ENERGY
shall not employ any person an any manner so as to became subject to the Workers'
Compensation Laws of California Date 502 - FINAL PLUMBING ENERGY
. pli
NOTICETOAPPLICANT.If,mine,making this cettificamofExemption,you should 503 FINAL MECHANICAL ENERGY - - "-
Z Become subject 504 - FINAL BUILDING ENERGY
O wim=mmplywimsuenprnvismrsonntsp mhsnmlD deemed vokm' 505 = "FINAL ELECTRICAL'
r
t CONSTRUCTION LENDING AGENCY
�> 'I hereby affral hot them oast ll lending agency f mepprfnm,ince 506 - GAS TEST
� IRnder's,tti of the k forwhich this permit .t sued(Sec.3(197,Civ.C.)
Name - ' " - -' -' -507"- FINAL -PLUMBING
-
Z) Lenders N
Address, 508 — FINAL MECHANICAL
U I certify that I have read suis appBcation and:tide That the move information is 509 - FINAL GRADE
corrin.1 agree to comply with all city and county ordinances and state laws relating
O v mWilaie-construction.andhereinspectionloormsemmiszsofshiicisytoenmrupon 510 — FINAL PLANNING
W m<nnn(We)minnmpme,indemifyandikepep lamset. 514 - FINAL PUBLIC WORKS
CL. IWe)agmemsa4e,andepensesk which
in she way ermaainstsmt
h liabilities,judgments,costs and expenses whreh may in any way accrve against said
V City in Consequence R the gmming D tins permit.
APPLICAIT L' DERSTANDS AND WILL COMPLY WITH ALL NON-POINT
- souac iEr LAT s. Issued by: Dale
Y ��ti3/o i.
sigrmpp ma coTore"m Date Re-roofs
lib AZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazotaons arsenal .Type of Roof _. .... .. .. .- .. .
is defined by the Cupertino Municipal Code.Chapter 9.12.and the Heahh and Safety ,
Code.Section 25532(.)1
13 Yes t .... ', t - _All roofs shall be mspected,pnor to any roofing material.being.installed......-__ ---
M'illtheappliconsorfumrebuilding occupantvsecquipmentordevlccswhich If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by she Bay Area An Quality Management
District, all new materials for inspection. Applicant understands and will comply with
l Oyes .r, o .'•, - all non-point source regulations.
I have ,ad the hazardous mammals mefdr=m=ms uad.,'Chapin,6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a[ennui.that it is my responsible]isy to notify the ,
ofcupeor of the requ immonts which must he met prior to ixrva ce of a Cenificam of
actpaP
Signature of_Applicant Date
owner r vmEi cd% Dam , All roof coverings to be Class "B" or better
l
,- •• .... � t': ._ - - OFFICE