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01050198 CInuoFGurvESIONaNSIPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 11631 UPLAND WAY 01050198 OWNER'S NAME: APPLICATION SUB DATE ROGER WANG 05/30/2001 PHONE: SANITARY N0, CONTROL NO. noO ARCHTTECTIENGINEER: BUILDING PERMIT INTO c 40 BLDG ELECT PLUMB MECH N Ua b CJ L_.0 1_-7 GJ - H LICENSED CONTRACTOR'S DECLARATION >Z I hereby eRirm that l am licrnxd under provisions of Chap¢r 9(commencing Job Description ,rte withSeelm.7000)of Division 3ofthe Businessand Professions Code,andmylicense LIVING AREA 8 , 073 GARAGE 460 SFDWL S�G is in full force and effect. K License Class Lic.a o u Date Contractor Pr r)al _,Azs qS a0 N ARCHITE.CT'S DECLARATION �-" t to g 1 understand my plans shall N used as public records i rap 0 Licensed Professional 1 h 2003 OWNER-BUILDER DECLARATION eto to 1 herebyreser .Section 7031.5, 1 1. ,Bump,fron the Conwcmrod :Any c law for the C?a following reason.(Section]x31.5,Business andProfessionsvetdeli Code:Any city or county $900000 I O Pwhichro" ts permit toconstrict.aha.Improve,h parm,h r repair any structure �a�,eay,,1t '�� p i p�G (commencing q PP � tofileast�hint me,- - � - ._ NLJILI,I�V�ICa.. _ Pro".I also rcu sthea applicant lm such .._ ............ .... .. .... _. u Ih t h it e rs gats th p f Division i oto n 3 o the smr9 L cense law ICs pt 9 r' a• _ Valuation I g with Section]OfN1) f Dry b on 3 of the B ;nada and Prof sons Cad) 1 t t [ ,'3 68:0 U;(;:L,;JI�'p�rk�'1.S t lw. or In.,he Is exempt therefrom and,he basis for the all ged exempubd ray violation i of Section 703M by any applicant for a pcmdt subjecut the applicant in a civil penalty of notm han IO,ehundrcddllars/5500). 101APN�gVfJ flATION �' Occupancy Type ;;asownaof the propenur ymy,mplayees with wages u lhd " r solecommmi.n. _ PIERS will do the work,and the 6tructum is not intended im offered for..]a Sim.7004,' Business and Prdfebsmn9 Coke:The Ci m,aetor9 Liscnx law does not apply m an 103 — UFER Required Inspections •• owner of property Who builds or improvxs themon,and who does such work hictulf not intended or or through his own employees,provided -105 _110 4 - REBAR Nat such improvern,m6 are oRcred for-sale.If,howevea,he Wilding or improvement is sold within one year of O C, _ ANCHOR BOLTS 1 - completion,the owncrbuildcr will trove the When of proving that he did not Wild or impmveformrpabenfm1c.). 106 - SEWER & WATER Cl 1;as owner of the progeny.em Business y d Profting with licensed Contrars,o 202 UNDERFLOOR PLUMBING anbwm thepros no(sec.rod,,owner o sokerty who crde:)The conthmad, 203 - UNDERFLOOR MECHANICAL " I: - License Law does not apply loan owner with property who builds se improves thereon, and who contracts for each projecu with a commnorts).licensed pursuant in Ina - 2 04 - - UNDERFLOOR FRAME Conuacrore Lic'"-Law.1. , Ol am exempt an a sec. - ,B&PC for thinrtason 205 - UNDERFLOOR INSULATION Ownil ala a79�� ../ 301 - ROUGH PLUMBING RKER'S COMPENSATION ECLARATION 302 - TUB & OR SHOWER I hereby affirm ander penally of perj.ry one artist:folowing demasmmns: 3 03 — ROUGH MECHANICAL ❑ I have sea will maiotal. a Certificate'-!Consent to atif-maim, far worker's 304 — ROUGH ELECTRICAL Compensation, a9 provided for by section 37M of the Labor Code, for the 305 — FRAME performance of Ne work for which Nssu is permit is ied. ❑I have and will'maiomm Worker',Compensation Insurance,ai requimd by Sation 306 - HOLDOWNS 3700 of The labor Code.Tar the performance of the work far which his pemdt is 307 — INSULATION issued My W rk is Compensation Insurance earner and Pol ry be - ,- cuner t E 3'. l:, l Policy+No f,. n -F,A308 I ,'SHEETROCK .... y....t , _. CERTIITION P.XEMPTION FROM WORKERtS i " '•f 1.x309 is��EXTERIOR =LATH^- (This section imed not be completed i wepRANee .." ...-._....-.-...-310-}.-*-•.INTERIOR`LATH ""I'... , _... .. COMPENSATIo If the permit is fair ON hundred dollars 311 - SCRATCH COAT (5100)or leas.) � I ramify,that in theperformnce ofap work f4schich m t -313 - •ROOF NAIL , sicill is ct to tis issued,1 compensation ow,ofperson inanymannvsouto'bccomervbjanothe Warken' 501 - FINAL ELECTRICAL'-IBNERGY Compcnxuon laws of California.CData Applicant - -. .. 502 - FINAL PLUMBING ENERGY NOTICETOAPPLICANT.If,after making this Certificate ofEscmption,you should 503 - FINAL MECHANICAL ENERGY ' became subject to the Workers Compensation pribvisiom of the Labor Code,you must O p forthwith comply nnsuch provisions a this pertnnshall bea edxvpkM. 50.4. -..FINAL BUILDING ENERGY _ �. 505 _ FINAL ELECTRICAL F CONSTRUCTION LENDING AGENCY .ai thereby affirm that th<rctlst`consl'nI lending agency forthe To Cj06 GAS TEST _ L7a of the o k forwhich this pe issued See,3037Civ.C) . ' O ame Lender'saANdd 507 FINAL PLUMBING V1 mfy Nal I have W this applicm on arW scom that the abs e information i9 508 - FINAL MECHAN I CAL cortt I 1 agree to c ply with all city and county auditoriums and ern, laws relating 509 - FINAL GRADE O T,J 0,WJdmgconswnio andh by ead,orim mprt actives mfthisc,yl ,toes upon r.� the above-mentioned property for inspection purposes. 510 — FINAL PLANNING M. (We)agree to have,indemnify and keep harmless Ne City of Cupertino against -tin liebililies,judgments,costs end expenxs which may in anyway acerae against said 514 - FINAL PUB I C WORKS tJ rZ�. :try in consequence of the grbming or this permit, 602 0 F NAI L APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT SOU E UCATIONS" ' Issued I�OP. Date OGr P�$yo/ si mane, pprcantContractor Re-roofs - ROOF IN-PROGRESS HAZARDOUS MATERIALS DISCLOSUREi'r,�+ Data ' _Wdl the applira,t or anise bonding oavWt store ar handle luiamcm mamn.di Type of Roof L,_� - . •. .. —l -O` ©. as defined by the Cupertino Municipal Code,Chapmr.9.12.ud Ne Heahh tib Safety v Code,Section OYefi 255320,17:;" ,❑No: . ,.I,,,'R.i'. t. �..tw 1 i.. ( : 1'. t'. j' �:.';'..L y'%•l. ,. �. .. t. l t ' All.roofs shall.be.inspected prior to any roofing,material being,installed....._. . Will the applicant or future building Occupant use equipment ordevices which If a roof is installed without first obtaining an inspection;I agree to remove Will ham lm,air cont ms as defined by die Bay Are.Ail Quality Management Dib'aet7 all new materials for inspection, Applicant understands and„will comply with ❑vpb„ o No all non-point source regulations. 5 I have read the Wood..,material. quiremcros unaeg Chapter 6.95 of the California Health&Safety Code.Sectmos,25505,25533 and 25534.l understand that if the building does nal currently have.lactim,that it is mm y responsibility notify the ' accustom of the cacao,mea.which must be met prior to issuance of a Cardfiam of a p.ney. _ Signature of Applicant. Date v m.u; zed again rate All roof coverings to be Class"B”or better •' '',: ,. OFFICE ._ . .