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02100108 (2) CITY OF CUPERTINO M;, " " "'"' •+ BUILDING DIVISION PERMIT CONTRACTORR• IINNFORMATIOO NM Y BU If1D(�:QI9&Es2OLBY AV PERMITNO2100108 IAMEWA- S . CHEN APPLICATII)Vt4((B1n4TY2002 PHONE: SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �00 LICENSED CONTRACTOR'S UECLARA'1'ION hpp� Cygy�� cer I hereby affirm that l am licensed under provisions of Chapter 9(commencing REV I S I ON--IN H�O SG G US IJ''n ONLY with Semioh 70)(B of Division 3 of one Businessand mofcssiom Cork,end my,license is t.00r in mumrceandeffect. NO NEW PERMIT ISSUED, ORIG. 402040143 -czq= License Class Lica —Z Dam Connector F=pp'y ARCHFIECI'S DECLARATION K< I understand my piens shall be used m public retards Licensed Pmlcssional S OWNER-BUII.Dfr DECLARATION 900 1 hereby affirm that 1 L. exempt from the Cuninanls License Law medic �'-00 followwhich acquires Permit t 7I13L9.Businessandmpr improve. de mill Crvor:Any cityorcnunty $� which requires a permit to consuum,alma infinwe,demolish,or repair any structure $100000 m,2< that hos is canned purse reto the thprovisions offor Contrasuch ctor's tilt a signed Ca¢mcm pssthommencanwJpumuan70kEofDvsion3omCunusiness LittmcLaw orsCm1mr9 Sq. Ft. Floor Area Valuation yF� (cat he xempwith here Section of pivisionroRM Business and Professionslationof 31629043 . 00 robot he is exempt therefrom end the basis for the alleged exemption.Any violation of Section T031.5 by any applicant for a permit subjects Jm applicant to a civil penalty of APN Number Occupancy T 1 not mom man Eve hundred delta.(sson). 101 - FOUNDATION P y yPe y ❑ I,m owner of dm property,or my employees with wages a tbeir sole compensation, will do the work,and the maceoo is not intended or offered for sale(Sec.7144,Business and Prafe samr,Code:The Conuactm's Lt..Law does not apply to an owner of 10! - UFER Required Inspections property who builds or improves diametrical who does such work himself or through his !; own employees,provided mal such improvements arc not intended oroRered!orale.If, 104 — REBAR however,the Wilding or improvement is sold within one war of completion,the owner. 105 — ANCHOR BOLTS Fbuilder will have tM burden of proving than he did not build or improve for purpose of ale')' 106 - SEWER & WATER �\ 01,as owner of the property,am exclusively contneting with licensed Columbus it) 202 - UNDERFLOOR PLUMBING consumer project(Sec.7(H4,Business and Professions CoJi The Contractors Lt can=Law does not apply to an owner of property who bunds or improves thereon,and. 203 - UNDERFLOOR MECHANICAL who contacts for such projects with a conuactorod licensed pursuant to the Contnctore 204 - UNDERFLOOR FRAME License Law. O l an exempt under Sec. .B&P C far lhisreman 205 - UNDERFLOOR INSULATION her pada 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER I hereby alarm under penalty of perjury ane of the following declarations: 303 — ROUGH MECHANICAL ❑ 1have and will maintain 4CeniEcneofConsent oself-insure for Worker's Camper- nation,m provided for by Section 37M of me labor Code,for the performance of the work lin which this permit is issued 305 — FRAME ❑ I hale and will maintain Worker's Compensation Insurance,in required by Section 306 - HOLDOWNS 37011 of But Inbar Cod.,for the performance of the work for which this permit is issued. My Worker'Compenaatian Insurance carrier and Policy number am: 307 - INSULATION Carrier: Policy No.: 308 - SHEETROCK CERTIFICATE COMPEN COMPENSATION RAANCPTION FROMEORKERS 309 - EXTERIOR LATH (Thissectionneed ratbeCompletedKIM permit isfnins bmndreddollan($100) 310 - INTERIOR LATH "`leas') 311 - SCRATCH COAT 1 ci ify that in the perfanmr.of the work far which Nis pertain is issued,l shell nal 313 - ROOF NAIL employ any person in any mannerso as at become subject to the Workers'Compensation Laws of California.pate 501 - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT:ll;after making this Cenilicare of Exemption,you sbnuW 502 - FINAL PLUMBING ENERGY become subject n the Worker's Compensation provisions of the Labor Cade,yam mea 503 - FINAL MECHANICAL ENERGY OO forthwith comply with such provisions or this Permit M deemed revoked. z504 - FINAL BUILDING ENERGY r NCONSTRUCTION LENDING AGENCY—t Iherebyunionbad them isacorstrur5ionlending agency lieOut perfmrmere.of 505 - FINAL ELECTRICAL 1:4 thewarkfor which(his Permit isissued(Sce.3097,ON.C.) 506 - GAS TEST W0 lender's Name, a z LendcraAdd.. 507 - FINAL PLUMBING U 0 1 certify than I nave read this application and aam that the shave information is 508 - FINAL MECHANICAL U Fcorrect.I agree to comply with all city and county ordinances and some laws relating to 5 FINAL GRADE Wilding construction.and hereby mutationurc a presen slisea of this city to enter upon the Wabove-mentioned property for inspection purposes. O — FIN I G (We,)agroc to save,indemnify and keep harmless the City of Cupertino against h liabilities,judgments,costs and expenses which may in any wayaccecagainstmidCity 5 N LI WORKS U Z in consequence of the granting of this permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by- Date all(X--) SOURCE REGULATIONS, Re-roofs Signature of ApplicaRDO Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle Health mdSafrmaterial m define)by the Cupertino Municipal Code.Chapter 9.12,and the Hcalnh end Safety e.Section 25532(')? - ❑res ON. All roofs shall be inspected prior to any roofing material being installed. Will the applicant Lir future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove car[formations air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 0 N 1 have real the McNnus materials regoimmcnts under Chapter 6.95 of the Califor- nis Haulm I Safety Cook,Sectors 25505.35533 and 25534.1 undersand the if do building fres not cimen0y have a knots.that it is my responsibility to ramify[be occupant of the requirements which must be met prior to issuance of a CaNEcate of Occupancy. Signature Of Applicant Date Owner or aathorircd agent Dae All roof coverings to be Class aBa Or better