03080002 (3) CITY OF CUPERT
FIN.
O ,r. ,�
BUILDINGDIVISION PERMIT • � �tACTnR NkORMATIO+$
BUILDING AnDRE35: PER'"'NOD 3 0 8 0 0 0 2
Ig
NER'S NAME: PERMIT ISSUE DATE
YAO-CHENG SONG 08/04/2003
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1Cp LICENSED CONTRACTOR'S DECLARATION' ,
lug I hereby affirm Nat I am licensed under provisions or Chapter 9(commencing Job Description
with Section 7")of Division 5 of Ne Business and Professions Code.and my license is
+ y imfell mmaamerre
License ice a Lk.N REVISION--IN HOUSE USE ONLY
j�On
Dam COntracmr NO NEW PERMIT ISSUED/ORIG. #03070098
ARCHITECTS DECLARATION ADD 1 MORE SKYLIGHT
` 1 understand my plans¢hall he used m public records
y�i1
e� Licensed Profcsamtril
OWNER-BUILDER DECLARATION
CO E I hafchy.(Tore that 1 I.S.exempt from the Contractor's Co e:Any c Law for the
❑D following mann.Permit
t 703 LBusiness and ve de nm Code:Any city structure county
5$ which da issu a permit m construct,elms improve,dem rift fi repair ed of y
tpoor hat he iv censed p.elso uant to res the
ovisio antsof for such Permit b file L W rtsmmenl
< That mencingwitPurseant70th)ofDivinuoftheComm�ess Lkrnselaw(C addle)9 Sq.Ft.Floor Area Valuation
y�S
that
iexem withSection700r)of hands for
of the
eged axe andon.Any
Csade)of $2000
y� Net he V exempt thertfrom and Ire but far dm alk{cd Gumption.Any violation of 9
Section 7031.5 by any epleic.ntfm•permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not tort than fin hundred dollen(5500).
❑I,u owner ofthe property,in my employees with wage,As their sole compensation, 32653046 . 00
will do the work.and the structure is not Intended or offered for sale(Sec. Butiness Required Inspections
and Profession e Code:The Convector's License law does not apply to an owner of q
property,who builds orimprows themrn.and who docs¢uch work himself or through his
own employees,provided that such Improvements are not Intended oroRemd for Asia,If. 101 — FOUNDATION
however.the building or improvement is sold within one you of completion.The owner
builder will have the burden of proving that he did not build or Improve for puryom of 102 — PIERS
tele) 103 - UFER
❑I.es owner of the property,am exclusively convecting with licensed ronvacton be 104 — REBAR
construct ft project(Sec.7014.Business and Profesaians Code:)The Contracted,'.Li
Gema law than;not pply an an owner of Primary who builds or barroom thereon,and 105 - ANCHOR BOLTS
who contracts for such projects wide a convenor(!)Resume pursuant to the Conuatoe.
Lic,nse Law. 106 - SEWER & WATER
0 l ameaemptunder Sec. .B&PCfor Nbmuon 202 - UNDERFLOOR PLUMBING
ter Dam 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
I hereby ammt under Penalty of perjury one of to following declarations: 204 — UNDERFLOOR FRAME
I hew and will ro.madn a Ccnifieo¢of Consent 1.self-Maur,for woker'.Comfort. 205 — UNDERFLOOR INSULATION ,
IMy
u provided for by Section 37M of Ne labor Code.for Ne performance of the 3 01 - ROUGH PLUMBINGkforwhiehth,permniaissued. 302 — TUB & OR SHOWER
1 haw and will maintain Writer's Compensation Imuran,m required by Section3O3 — ROUGH MECHANICAL
0 of Ne labor Code,for Ne performance of the wok for which Nis rmit Is issued.Workers Compensation Insurance carrier end Policy number ere: 304 — ROUGH ELECTRICAL
Grtier. Policy No.: 305 — FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 306 - HOLDOWNS
(Thisunitm road nuthecrmplemJ HOW permit is for one hundred dollars(SIM) 307 - INSULATION
tole¢`) 308 - SHEETROCK
I certify Not in the performance of Nc work for which this permit is insist,I shall not 309 - EXTERIOR LATH
employ any person in any manner x m m m become subject the Workers'Compeu
nnon
Lew,of California.Dedc 310 - INTERIOR LATH
Law. fApplicant
NOTICE TO APPLICANT:Ir,after making dab 00111Cam of EumPtion,you should 311 - SCRATCH COAT
become subject m the Workers ComPenmtion provisions of the fahm CSW,,you muss
Z forthwith comply with such powitinm or Nis Permit Hall An dwmcd ranted, - 313 — ROOF NAIL
z 0
CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
I herehyafirre that there its omeonxtinn lendinpgercy for the ,(.,..A 502 - FINAL PLUMBING ENERGY
Ya> Lft ard, oOrwhichthkpertnittsissued(Sec.309'1,Civ.C.) 503 - FINAL MECHANICAL ENERGY
:s1 A Lentos N.mc
j z <nderaAddre,a 504 - FINAL BUILDING ENERGY
J O I certify diet 1 hive read this application end nam that N,above mformatiun 1. 505 - FINAL ELECTRICAL
:L E. correct,l agree to comply with all city and county ordinances and stat lam mi.tol,to
�U building convection,and hereby amhorixe opresematiws of Nit city m corer upon the GAS
N G ehova(We) S.Property rindmnifyAd keephi. 07 FI
.w (We) need m sew,indemnify end keep humleu Ne City of Cupertino against
y
liabilities,judgments,corer and expenses which may in any my Accost,against mid City 5 CAC
J,'2,' in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
SOURCE REGULATIONS. _
Re-roofs 5]�4 INAL PUBLIC WORKS
Signature of Applicmx
UContrmm r De
HAZARDOUS MATERIAL.DISCLOSURE Type of Roo
WIII theapplicantm returnbuildingCode,
Chapter
rtor handle h Health
and
as tanned by the Cupertino Municipal Codc.Chapter 9.11,and Ne HaIN end Safety
c,saurian 15531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea ONO
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit hmamrua air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Or istict7
❑Ycs ONO
I haw road dmh mundbos materiels requirements under ChaPmr 6,95 of the Califor.
nia Health&Safety Code,Suvtas 25505.15533 and 15534.1 understand that ifthe building
docs not currently haw a mnanx dud it u my respomihility x nmiry th,occupant of dm
mquimmanm which must k met poorm iuuanro of.C,rdncam of Decupxry. Signature Of Applicant Dale.
Owner ur awhoraad agent Dam All roof coverings to be Class "B" or better