01100003i�
" OF CUPERTINO
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.CITY
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
' BUILDING ADDRESS:
PERMIT NO.
10200 VICKSBURG DR
WATER SYSTEMS PLUMBING
01100003
OWNER'S NAME:
APPLICATION SUB DATE
DU XIAOLIN AND YANG HAI-LIAN
3844 HEPPNER LN
10/01/2001
PHONE:
(408)266-8222
SANITARY NO. CONTROL N0.
zo ARCHITECT/ENGINEER:
BUILDWGPERMITI 0
BLDG ELECT PLU MECH
O LJ I.
LICENSED CONTRACTOR'S DECLARATION-
DCSC IIOn
I hembyaffirm Nm l am licensed under provisionsof Chapter 9(commeming
wilM1 Senion ]011 Donmm, 3.2 the Business aW Profusions Cody(and my heens
n
is in full tope d TV,
.1017
REPIPE & MAIN LINE.
u License Class ` Lic. 6 /
,
Date Contractor
h ARCH] I LCT'S DECLA AT]ON
_I 1 understand my plans shall W uttJ as public re curd,
OLicensed Pndusiowl
LL OWNER -BUILDER DECLARATION
11 1 hemby alfinn that I am exempt from the Contractor's License Law for the
fallowing mumon. (Section 7831.5. Business and Professions Code: Any city or county
$4000
C which mquims a permit to construct, aver, improve, demolish, or repair any structum
prmrt 't mmua¢e, alsoreq'm th applicant for suchpcmnlmlleasgnwdnamn m.
- Ihoth 1Rmadputsu4rmloNep smfuse n,3of,eBusinesLcemeLaxon,C 9
(comm [ N Salo ]880) f Dimurn, 3 of the Business and ProfAnys Code)
q�p,�t�q_T..y�y�-
CJ; Y -t 3�S YC/;2-,tJ-••V`V-�,-�.f
Valuation
is Any violation
s ex Nemfiom anJ the barns for the cts ekeicant
or Natio ¢ ea1.5
3 s,9'�r3,�
_
b the t
of Semina ]031.5 by any applicant for a permit subjects the applicant to a civil penally -
ofnot mom than fiehundred dollars (s5D().
202fiPNPtKt $FLOOR PL
BING" Occupancy Type
° I, ..,vow of Ne Property, or any employees with wages m tiermile compensation,
1
will do the work, and the structum is not intended or ofimd for sale ISm. 70W,-
Business und`Pmfesdons Code: T o, Contractor's License Law does not apply to an
I
502 - FINAL PRtdBdiNG 3pi1RN@ 3GY'
..as, of psap rty Who Wilds or tmpmres thereon, send who does such work himself
507 - FINAL PLUMBING
or through his own employees. provided that such improvements are not intended or
offered for mal If, how Ih building ' or mprovermin s sold within one year of
./ - -
. i', ycompletion.
the cerAw Ida II h not bodkin of proving that he did Iwl Wild or
(�
improve1.f p :p e nrsale.).
e�j
Q—I. f the prnpeny. "elusively wnovu ng wlh licensed contractors 1°�--
:, consumer the pmjecl (Sm.. ]UW. Business and Professions Code.) The Contractor's
/ / / a q , , , r t r •,
' License Law does not apply to an owner of property who Wilds or improves thereon.
and.who cmntmets.for, such.projects with a emilmcloom licensed putsuanl to the.
..... __ ..... — _O�/ / ...t___. ._.... ._ _..._...., _. _.._ ...... __ ....
/O
' Commcmr's License law.
° l am exempt under See. - 't ;R&PCfonbis:eaxpn
Y 1, 1
/, } 1 -•. Ildl'r::
Owner " Dwe
_
'n WORKER' S COMPENSATION DECLARATION
I hereby aWon under penally of perjury one of the following dcclmm ions,
,
1 have and will maintain'a Cenifcam of Conseil to self-immot for Worker's
Compensation, as, provided for by Section 37M of the Labor Code, for the
Performance of the work for which.his permit is issued.
have and will maintain Worker's Compcnrmion Insura«c, as regoirtv by Stein
3700 of he Lobo Cod for 'N perfoma a of the work for eti. penal'.
sued M Wah Co I I survwe am r oli y be
r a
••
_ _
C1m J- Policy No.
rw jsq.s if' 1. {..+ ,.�{, r4:.'. �d.lt^.'D
', CERTIFlCATION OF E%EMPr10N FROM�WORKEI{S
ft• �,
sedbonncecl,am bectinplemd if the permit is fm one hundmd dollars
ISI0)) m lea.)
r
c , f M ' M1 roe which thisct t tssucd 11
sJ [ nd.j
(
an perste,he
in
shall not employ any pe n n any mannm as m become subject m the Workcia
ComApplicial ion Lows of California: Dam' " ""
• TO APPLICANT: Nis Cisions eof Exnmptiode. ns
Compenmr s
becnCE
thelsWrCodkell- mull
bcdmrc subjecttothe Work ti you
the Wrioc?s Compensation tion pconnil
shall
fonhwieTdomply with such provisions or Nis pCrrlil shall he deemed rtvokN.
po
CONSTRUCTION LENDING AGENCY '
t
I hemby affirms hit, hemi, akoomtmenri lending agency for the performance
o:
of ]lie work forwhich this permit is unwed (See. 307. Civ, C.)
-Lender's Name'-. .....s ... .. ..... .:.
-... ..
Leader's Address�...li•.
,
1 certify that 1 have mad this application and mate that the above infomtullon is
..
cones. 1 agree to comply with all city and coumy,ordourn es and slam laws relating
to Wilding cunmpmiW: and hxMby omhuroe mprciedldtiJcs of Nis city in enter upon ,
V the above-mentioned pm nY for inspection pugnoas.
k. (We)agrce to see ;indemnify Jkcep harmleci the Chyof Cupertino againm
O liabilities, jud n, ms end nam which may,w any way income against said
City in cam « theg n of.hol permit
'APP ST D. A MPLY WITH ALC ON INT'
Issued b Date
Y
SO c r oN'
slgnaorco APprcamfiCWmcmr .. r'-.: I' Date
Re -roofs
HAZARDOUS M IALS DISCLOSURE t
'
,' WIINcepplixrsm fI bind' p it handlehaiasdousmamnal
Type of Roof. - - --_-.......
as d f d bylhe Cupenmo Municipal Code Ch pt 9.12.ad he Health and Safety
Cmide Sect
_ y s ), b) _ t ,
0'-'m t Jh .
W 25n532(a) t.
°r t.' - t �°
i
All roofs shall.be.inspected prior to any -roofing material being installed__ _-
W II Ne Pplic mor 61is Id' g pat mecgwpme t ra ce5 wbich
If a roof is iilsialled'without first obtaining a i inspection; 7lagree;to remove
cmnhazardous a contaminants defned by theBay Area AQuality htanagemenl
I Norio
all new materials for inspection. Applicant understands and will, comply With
[I
' Yet "t I -.
-
all non -point source regulations.
I have read Ne h rind 'i maiadals requlremem i and Chapter 6.95 of the
Culifdmi5 HeaIN & S I Coda S cti0ns 25505; 25533 and 25534. I undersmnd Nm'
if NeW 10 s dy veemn I N t I t vrtspubltybnotify the
_
- -
rxcupam o m n1 /0 ch must Ire m t p to issu a nnB[ne of
o
Signature of Applicant Date
All roof coverings to be Class "B" orbetter
dreg tData
.. OFFICE- '