04110169 Permit CITY OF CUPERTINO
BUILDING olvlsoN PERMIT. 9CONTIAOTOR INFORMATION �z
.
BUILDING ADDRESS: YANG GENERAL PERMIT NO04110169
ER'S NAME: PERMIT ISSUE DATE
ELIZABETH CHIN & CHINN CHIN 3234 RIDDLE RD 11130/20Q4
PHONE: SANITARY NO. CONTROL NO.
(408) 398-4209
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION
F❑ I kmby.from de
in., am licensed anr Provisions of Chapmf 9 caommmcing lob Description
�<W with Sevin.NyXB Or Division 3 ofon,BusinesaaM Proressinns Cmis,md my licca is
.may
in full
�mmaannerra'.
e u�? Lf Clea Lic.N ADD 2ND FL. BATHRM W/SKYLITE
°rc Dam Cmrtractor REMODEL (E) BATHRM (2ND FL. ) /REVISION--#0501010
fn wj ARCHITECTS DECLARATION Ty Q 5 10 1 rJ 1
a 1 understand my plans shall he used as public records 4
you
N Liccnscd Pmfcssional
7 g
OWNER-BUILDER DECLARATION /
2 0 0 1 hereby affirm that 1 ore exempt from dr Contractors C License Law county L
e O followhich re massa.secPoch t 703 I.S.Business and improve.
demolish.
Coda;Any coy or county
3- which its requires issuance,cels to mors die alms import,demolish,fia sign d urnmrm
_Z� pnonn s Iea also rcquime lnovisio s Of for such Permit file crow Law(Cha mem
-zitthmbelsccgwithSmmnuothe 00)ofDimsion3OftheButhe aaurindProfeaw(Code)or Sq. Ft. Floor Area adB ❑
est-$ (commencing with Section7000)and the
Division f r nfthceged ct and Professions Any
Calc?tar
That k is caempt dmrefrom and the baso for Ik alleged cacmption.Any violation of Q L 0 0 0 0
Section 7031.5 by any applicant for a permit subjects Be applicant to a civil Penalty of APN Number Occupancy Type
inot from Eve hundred dist...($50(E.
as owner of the property,or my employees with wages ss Indo sole compensation,
i do Ne work,and the swclurt is notimcndcd or offered for Sale(see7044.Business
and Professions Code:The Conmctor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who docs such work himsclfor through his
own employees,provided Oat such improvements are not intended or offered for sale.If. -
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of pmving that he did not Wild or improve for purpose of
sale.)
I.as owner of the propcny,em aclusively contracting with licenaed eonoaetOr"to
wm the project(Sec.]Obit.Business and Professions Codc:)The Contractor.Li-
cersm law does not apply to an owner of property,who Wilds or improves thereon,and.
who contracts for such projects with a emoractor(s)licensed pursuant to the Convectors
Liao law.
[D1 am nempl under Sec. .B&P C for this mason
cr ( _ Data -26- C
WORK ER'S MPENSATION UECIARATION
I hereby affirm under penally of perjury an of the following declarations:
❑I have and will maintain a Ce tifcam of Cmucnl to xlf-insure for Workers Cont
sation,u provided for by Section 37M of the,labor Code,for the Performance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as acquired by Sectio
3700 of the Labor Code,for the performance of She work for which this Permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Curicr. Policy No.:
CERTIFICATE OF EXEM NITON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nut to completed if Bc Permit is fornnc hundred dollars($100)
or cas.)
I certify that in the perro m ince of the work for which this Permit is isved.I shall not
employ any person in any manner an as m become subject to the Worker:Compensation
Lawsaf California. - _
Applicata
NOTICE TO APPLICXNT:If.o r making this Ccniri me of E,,option,y9 should
become svbjat to the Workcr's Pco,i.n provisions of one labor CNet you..at
�Q forthwith comply with such provisions or this permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
1 hereby arms that There is a construction lending agency for the performance of
x the work fur which Nis permit is issued(Secs 3007.C.S.C.)
17 0 lenders Name
z Lender's Addreas
zm);)P I ccnee that 1 have mad This city
and coon and site Nn Ik shout ws relating is /
U bunco I agree to comply with all city and county ordinances and sole lawn relating e
Ea 21imengemionedtlon.and hereby awhonpreprescmativewf this City to enter upon lite
Ea ca, ahovo(We) N I.savc for indmnify an keep
i a
(We)agree to save,indemnify es keep hay in an Ik City or Cupertino.chitty
jN in
jNgmcnhemating cs this Permit. rosyinanywayaccmc against Said City /
J z A APPLICANT
or UNDERSTANDS
Sthis Permit — '7 6
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale C
SOUR EGULATIONS_
_z(e-o Re-roofs
Signawrc Appbc okfientoactor A�
HAZARDOUS MATERIALS DISCLOSURE Dam 'type of Roof
Will the applicant tar future Wilding occupant store or handle haeardous material
as darned by the Cupeni Municipal Code,Chapmr 9.13,and the Health and Safety
dc.Section 25532(a)? All roofs shall be inspected nor to an roofing material belt
❑Yes p p y g g installed.
Win theapplic IorfuI buildingoccupantuse equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove
emitha amaosairmnu uo dcfnNhy z Bay Area Air Quality Management all hew materials for inspection.
District) n
[D Yet ❑
I have mad the hazardous materials requirements under Chapter 6,95 of the Calif.,
ilia Health&Safety Code.Sections 155115,25533 and 25534,1 undersund that it to Wilding
0..1 currently have a tenam,that it IS my respumi hilly m nnufy Ik occupant of the
requirements whichmusl he met prior it)issuance or a Cenlfcam of Occupancy. Signature of Applicant Dale
—0
owarar aamnrleed.gen Dam All roof coverings to be Class "B" or better
CI TY OF CUPERTINO
BUILDING DIVISION PERMIT CONT RACTORINFORMATION
BUILDING ADDRESS: PERMIT NO0 4 11 0 1 6 9
10266 BEARDON DR
OWNER'S NAME: PERMIT ISSUE DATE
ELIZABETH CHIN & CHINN CHI
E:
SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
nOp LICENSED CON'TRACTOR'S DECLARATION IOb Description
w❑ I Mreby affirm that 1 Am licenced under provisions of Chapter 9(commencing p
zW with Sation 70(p)of Division 3 ofthe Business Cod Frofessi s Code.and my license is
in fun form and effect. ADD 2ND FL. BATHRM W/SKYLITE
5 v�2 License0.'1855 oM
DamWContractor REMODEL (E) BATHRM (2ND FL. )
ARCHITECTS DECLARATION
w� IUMcnanJ my plans shall beused As While rtcnNsA.
L
30� Licensed Professional { / /!
3 Oe I a BUILDER DECLARATION
y 1 hereby arm don oro exempt from the Contractors License Law for fC•/Y-\J
](131.3.Business and Prom Code:Any city or county
E❑O following mason.(Sued..w(L which rectums A permit to chnvmct,alter,improve,demuli h,or.pair any 0whire
prio to its issuance.also requires the applicant forauch Permit to Gleasignedslawaro t
t�< ttulheis licensed pursuanttothe provisions offtCommon's lisase Law(Chapter 9 Sq.Ft. Floor Area Valu$49000
Wr$ (commencing with Section 70100)of Division 3 of the Business and Profcssiors Code)or
Net he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any Applicant for A Permitatbjects the applicant o a civil penalty of APN Number Occupancy Type
.at mom Nan two bandied della.($500):
32633013 . 00
01,uawna of the Proprrty,amY employca with wagnulhevsolc compewtion,
will do tie walk end the manure is mKinmMed Clattered(orsole(Sec.7014,Business
.it Professions Code:The Confiscates License Lew does oat apply to an owner of Required Inspections
property who builds or improves Ihemon,and whodoes suchwark himself or through his
can employees,provided that such improvements arc not intended orotterW formic.IL
however,the building or improvement is sold within ane Year of completion,Ne owner.
Guilder will haw the burden of proving door he did nm build or improve(a,purpose of
.e.).
'1,as owner of the pm,huny,am exclusively contracting with licensed contractors to
cohmoua the project(Sec.7044.Business and Professions Code:)The Contractor's Li. _
case Law docs not apply to an owner of property who builds or improves thereon,and
wkho co aactsforw. such projects with A cantracmr(a)licensed pursuant at the Cmurwmr'a
I
Lezcmptypda Sec B& for Nis moon
0 11-3D 4- .
WORKER'S O1 PENSATIONDECLAR ION
I hereby affirm under penalty of perjury am of th Ilowing theantions:
:w and will maintain A CadR®m of Consent self-insure for Wortrls Comam- '
n,ss provided for by Section 3700 of the labor Code,for the pcdarmance of Ne
walk for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,n required by Section -
3700 of the Labe,Code,for the
performance of the work for which thia permit is issued.
My We".,
Compensation Inwnna carie,and Policy numkr vee
Cartier. Policy No.:
CERTIFICATE OF EXEM PDON FROM WORKERS'
COMPENSATION INSURANCE
CThu union need not becompleaid i0the permit is foronc hundreddolim(3100)
or less.)
I cam y that in be performance of the work for which this Permit is issued.I shall not
employ any pecan in any manner m As in become subject o the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this CeniBnm of Esemption.you should
become subject at the worker's Compensation previsions of the Latour Code,you most
.,7, foMwith comply with such provisions or this Permit shall the deemed revoked.
z CONSTRUCTION LENDING AGENCY
HIhereby affirm that there is a construction lending agency for the Performance of '
E
the work fur which Nu permit is issued(Sec.3097,Civ.C.)
Lenders Name
z Under's Address
V C) I certify Net I have mad this application and sale that the show information is
,y fes' wreck 1 agree to comply with all city and county ordinances and sate laws relating to
OU building construction,and hereby mdonve rcpreseulativra of this city to chair upon the
W above-mentioned property for Insisicaoa purposes.
(We)agree to saw.hadminify
d keep
nless
City of
rtino
F'
liabilities,judgments.casts and expenses which may in any way accrue against said City
C.)z AConsequence of the gaining t
LICANTUNDERSTADS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
'SOU CE REGULATIONS. ,
Re-roofs
Caro of ApplicanVCo ter D
H OUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant stone or handle hmallous mammal
As defined by Ne Captain.Municipal Code.Chapter 9.12,and the Health and Safety _
Code,Section 35532(.)? All roofs shall be inspected prior to an roofing material beim
Dyes 1„! p p y g being installed.
14 Will thea applicant future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Pp g P^^ &Air n
her Nous air contaminants a dcOncJ by tk Bay Ama Air Quality Management all new materials for inspection.
a?
Q Yes �1GC
1 hew real the hanalous materials requirements under Chapter 6.95 of the Califor-
nu Ha550
lla Js SafetyCode.Sonots 25.25533 Audi MM.l understand Nm if the building
EJOGS net currently haw a Lett.that it IS my aspJrolbillly w nadfy Lcc
IC Oap to Of dot
mquiremens which must the met prior w amawc of a Certificate of Occupancy. Signature Of Applicant Date
All roof coverings to be Class "B"or better
.I5-��mqfbviacdagFat Dam
CITY 01'CUPERTINO - <
Bu1;jjo,OIVISION PER*r C®NTRACTnR INFOR ION
a. , . 1 NEO
BUILDING ADDRESS: - ' YANG GENERAL PERMIT N004110169
ER's NAME: - PERNITISSUEDATE
ELIZABETH CHIN CHINN CHI 1 323.4 RIDDLE RD 11 /30/2004
PHONE SANITARY NO. CONTROL NO.
408) 398-4209
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lOp LICENSED CONTRACTOR'S DECLARATION Ib Description
w 1 bare ry affirm that 1 am licensed under provisions of Chapter 9(commencing OCSCFI P
ca with Section? MRor Division 3 oflhe Business and Professions Code,and my license is
±.N mmnroneanaerrec`' ADD 2ND FL. BATHRM W/SKYLITE
a,EZ License Class Lie.,
;rp Dam Contractor REMODEL (E) BATHRM (2ND FL . ) /REVISION--40501010
ARCHITECTS DECLARATION
8 lvneeramne my plans ah,u he ootid as pnnhe reenraa #05010151
ad'
Pd
C,
u Licensed Professional -
g OWNER-BUILDER DECLARATION
a1 hereby offirm that I not exempt from the Contractor's License Law for the
p O following reason.(Section)1131.5.Business and Professions Code:Any city or county
m which requires a Permit to construct,alter,improve,demolish,or repair any structure
u2i prior to its issuance.also inquires the applicant forsuch nermitm file asignedslatement -
< that he is licensed porsocal to the previsions(if the Contractor i LiccnW Low(Chapter 9 Sq. FL Floor Area Valuation
4 (Commencing with Section](MMI)of Division 3ofthe Business and Professions Code)or $10000
°,;$ Nal he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 9011.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not
than five hundred dollars(S5B0).
as [rorthe pmpeny.o my employees with wages as thelr.sole compensation.
i do the work.and the stnctum is not immnticdoroffered for sale(S¢.70,14,Business
RC Ulred Inspections
and Pmressihns Code:no Contractor's License Law dors not apply tp an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees.Provided that such improvements arc not intended or offered far to.If.
however,the building or improvement is sold within one year of completion,the.-no,-
builder will have the burden of proving that he did not build or improve for purpose of
sato.)
1,as owner of the property.am exclusively Contracting with licensed contractors to
nova the pobject(Sec.7044,Business and Pm@esloes Code:)The Character's Li-
se Law docs not apply to an owner of property who Wilds or improves Ihemun,and
who contracts for such projects with a centracmr(a)licensed pursuant to the Conranor's
LKea.L.
of
am exempt under See ,Bh PCrorlhism
( --\ Data _2-6- ono
WORKER'S MPENS ATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following declarations:
❑I have and will maintain a Ccnificmeof Conscnl to self-insum rte Whrkeri Compcn-
nation,as provided for by Section 3900 of the labor Code.for me performance or the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,az required by section
37W of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS"
COMPENSATION INSURANCE
(Thisione ina need notM completed it tbe permit is fm hoc hundred dollars(SIOB)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any Person in any manner an as to become subject m the WorYcri Compensation
Laws of California.
AppBcanl_ — f
NCmCETO APPLIC :If,a r making this Cerincmc of Eumption,y9 should
become subject to the Workcr'a p mantlim provisions of the Labor Coca,you most
�z forthwith comply with such provisions or this pereml shall be deemed revoked. .
0;; CONSTRUCTION LENDING AGENCY
I hereby affirm that mere is a construction lending agency for performance of
3.'? me work fur which this permit is issued(Sec.3(hi Civ.C.) -
i7 Q Lender's Name
z Tendert Address
J p I artily that 1 have read this application and slam that one above information rmmiun to ,a
I'^ bonen.1 agree to Comply with all coy and county utaiv ordinances and cram laws relating to S
U building construction,andhereby inaNchortmrpose,ntslivcs of this city to enter often the
a
above mcmion agree
to save.
for emnify an keep ha -
(We)agree m save,indemnify and keep harmless the City of Cupertino against
-' Z fi.bilfilin
nconsequnce ofthe granting(if
bf thisa,nPermit,
APPLICANT
may inanyway accmcagainstsaidCity / —
J Z AcPLICA T of the Fronting hf this permit. '7 l{/_7
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C
Of
SOUR EGULATIONS-
,/�.�� Re-roofs
SignatumMApplicidevEmalmol Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building uceupanismre or handle hanrhous material
defined by the Cupeni MM m Pol,Cock,Chapter 9.13.and the Health and Safety
m.Sarden 15513(.)7 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yeap P P Y g g
Will the applicarrLLI or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha'mrdoes sI,wmarB4 nqs u as defined by the Bay Arca Air Quality Management all new materials for inspection.
Distribt? '
oyes ❑
I have read me hzaardous materials requirements under Chapter695 tithe Califor-
niaHcalmksafctyCalc,Sccdons255115.15511 and 255ld.l unJcrsmnU thutifthc bottom,
does nm amently lave a tenant,mat h is my responsibility to nmily the txbupant of the
requirements which most no me,prior toissuance ofaCbnlficamorOccupancy. Signature of Applicant Date
'Z -D
Owner or autiMH,rd a,cn Date All roof coverings to be Class"B"or better