03070098 (5) CITY OF CUPERTINO
BUILDING DIVISION PERMIT • �CilN:•TRAGTCIRINFO
RMA�IQ
BUILDING ADDRESS: PERMIT NO0 3 0 7 0 0 9 8
NER'S NAME: PERMITISSUEDATE
YAO-CHENG SONG 2003
ONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.00 LICENSED CONTRACIUR'S DECLARATION
E U I wrtby affirm that 1 am li inacd under provisions of Chapter 9(commencing Job Description
With Seen..?")of Division 3.1'do Business and Professions Coda,and my license is
jZ,„
in full SKYLIGHT
License Class.Lic.P
DamCanmamof REVISION--${03080002 (ADD 1 MORE SKYLIGHT)
fARCHITECTS DECLARATION
1 understand my plans ahatl he sued as public meet&
ya
Licensed Professional
OWNER-BUILDER DECLARATION
C<I I hammy,(Sam on 70 1. exempt from d r Contractor',License Law for Ibe
pO following mason,Permit
to l.0.Businessand ve.ririnm Code:Any city or county
m�+ which tequima a permit m cores the tlma impmw,deermitt ore,sig any a(tucmm
S¢ thateo iuimusdpursuant to the prevision
of for such the Contetoilmmcnm Lawned
OOO
pS< (commincingudPurstion70bepmvislons 3ofthe nushelssU Profession
ChapmrY Sq. F[. Floor Area Valua @I
(commencing he Is ernintmhereirom And 00)of
Divtsianr n((beeged r.aand Prof cu vi Code)or
e 3� Blot be ts ezempt therefrom ane IM breis for Ne alleged eaempdon.Any violation or
Section 7071.5 by any applicant for a permit subjects Ne applicant to a civil penalty of CIO 0 Occupancy Type .
not snort Nan five hundred doll..($500). "
0 I,As owner Affirm property,CO my employees with wages As Chair sam compensation.
will do dC work.and the atmclure isnot intended noffemtl foraale(Sec.701/,Business Reou dIns ections
and Professions Code:The Commerce.License Law does not apply m an owner of 101 - FOUNDAT 1 V p
propeny who builds or Improver Nenem,and who doeuuch work himselfor through his
ovincmployees,provided that such improvements art not inmMed or offered for ale.If. 102 — PIERS
however,the building or improvement 1,mid within one year o(completion,the owner
builder will bare the burden of proving Nat he did not build or improve for purpose of 103 — UFER
104 - REBAR
I,arawnefofma Sec.7y,ameinessald ecurfaProfessional
withlicensedCoonlnemaa 105 — ANCHOR BOLTS
m Cmn Cbe pmjen(sec.70th,Business and Rofcailons code:)The Canmacmrs La-
m law does not apply man owner of property who wilds or improves themun,and, 106 — SEWER & WATER
who contracts for such pmjecu with a conCramor(s)licensed pursuant(o the Coni min'.
LimeroaLtw. 202 - UNDERFLOOR PLUMBING
O lam eXemPIY s'' .B k P C for this mmon 203 - UNDERFLOOR MECHANICAL
or, D' 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hemby afindon&,penalty of perjury..of the following declaration: 205 — UNDERFLOOR INSULATION .
I have and will maintain a Canm iOesof Consent m self-insure for Workcra Compcn. 301 — ROUGH PLUMBING
moon,u provided for by Section 5700 of the Laver Code.(or the,performance of the 3 02 — TUB & OR SHOWER
work(w which this permit is issued. 303 - ROUGH MECHANICAL
❑I have and will maintain WarkcA Compensation Insurance,as required by Section - 3 O4 — ROUGH ELECTRICAL
3700 of the laver Cadc.for the performance of the Weak for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number em: 305 — FRAME .
c mer: Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(Thus*Action need not the completed ifthe Pennh Is forane hundred dollen(5100) 308 - SHEETROCK
"`less') 309 - EXTERIOR LATH
I ceni(y the,in me performance of the work(or which this Permit is issued.I shall not 310 - INTERIOR LATH
employ any personm u m in any manor become subject the Worker' ns
Compeation
Laver of
nrcaliramia.Data - SCRATCH COAT
"W'Applicant
NOTICE TO APPLICANT:If.after making this Cenificam of Exemption,you should 313 - ROOF NAIL
Worme subject to me Workers Compensation prov.lons of dm Iawr Code,you mum
�z forthwith comply with such provisions of oris Permit 0411 be deemed mwkcd. 501 — FINAL ELECTRICAL ENERGY
ZO CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I hereby affirm ma tem is a construction lending agency fm be Performance of 503 - FINAL MECHANICAL ENERGY
xY Chnner'. urWhich lhlaPermit Bissucd(SrsJ097,CIv.C.) 504 - FINAL BUILDING ENERGY
31 Q L odors Name
jz Lndw1ceifers 505 - FINAL ELECTRICAL
;,I p I ttnee mat I marc with
this application y ordinance,rum that nd sumOlival informaiun it 5 0 6 - GAS TES T
U cunei(.I.gore Co comply beim all city ane mualy of and sore laws r upon
m
�O buileingconstme(ion,and hereby eutharim mprcaenutivca of Of,city menmruPon the FINA 'PLUMBI G
N W� .hove-memionetl propcny forinspcetion Purposes.
(Wa).gleetours,indemnify and keep harmless mQr
e City of Cupanino egeinsf 08 4IFL
:a y
liabilities,judgments,costs and expenses which may In any way accme against mid City 5 Z
J Z in cossegueuce of the imnling of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
SOURCE REGULATIONS. _
Re-roofs
Signature of ApplicandContracho Dem
HAZARDOUS MATERIALSOccupant
DISCLOSURE Type of Roof
Will the applicant or fuwre wildinggucmpant nom or handle ha'rartlaua mammal
An C r.Od by the CuPertln Municipal Coda Ch W'
9.12.and me Health and Safety
Baden 23512(.)? All roofs shall be inspected prior to any roofing material being installed.
OYes No
Will me applicant or Tulse wilding oecupant use eyuipmenC or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hasardous air contaminmts donned by the Bay Area Air Quality Management all new materials for inspection.
Wirt?
O Yes No
Ihaveroadmewmrdnam rialsmquimmenbunderCwpmr6.95ofthc Cati(or
nia HealthhSafmy Coen Sec6m25505.255330 25531.1undemantlthmifthewilding
docs not currently have a Count,ma it is my nesponsihitity to notify de oecuPAML of the
myuimmcnts which must be met priorw issuanccofa Ondfc pfOccuponcy. Signature of Applicant Date
owner oreuthonvcdagenm All roof coverings to be Class "B" or better