02080079 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMTlGONTRACTORINFORMATION
B UILDING ADDRESS: ' PERMITNO02080079
OWNER'S NAME: PERMITL UEDATE
JOSEPH CHEN
WE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERM
rT INFO
BLDG ELECT PLUMB MECIi
�Oo
LICENSED CONIRACI'OR'SDECLARATION� Job Description
m❑ 1 orcbyl that 1 am Ifaa¢tl under provisions of ChapteoescrIp
Charlie, (commencing 6W with Section of of Division Sarthc Business and Pmfcssinns Code.add is
in full force and effect.
License Lic.N ADD 1005 SQ. FT. LIVING SPACE
�0
= o Dam Contractor 139 SQ:FT. GARAGE INALED
C Wj ARCHITECTS DECLARATION
C K< 1 understand my plans shall W used as public records
5a� MAR 1 9 2004
u.o G Licensed Professional
S OWNER-BUILDER DECLARATION
y a
V. 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 1B ^1s�/L\A'
00 following reason.(Section 7031.5,Business and Professional Code:Any city or county � �
<m which requires a permm it construct,after,improve,demolish,or repair any am
truure Y
°i0 poor to its issuance,also requires the applicant for such Permit to file a signed somment
< that he islicensed pursuant tothe provisions id'the Contractor's Late am Law(Chapter it Sq. Ft. Floor Area Valuation
yam$ (cam mcncing with Scction7000)of Division 3 of the Business and Professions Code)nt
that he is exempt thcmfrom and she basis for me alleged exemption.Any violation of 118000
Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not mora thn r hundred dollars($5W). Occupancy TYpe
I,as Owner of the ptopertY or my employees with wages as their sole compensation, 3 1630055 . 00
will do Ne work.and me structure is not intended or offered for sale(Sec.1(W1,Business
and Pmfcssinns Code:The Contractor's License Law does not apply to an worm,or Required Inspections,
property who huilds or improves thereon,and who doessuch wink himself or through his
own employees.provided that such improvements are not intended or offered for sale.If. 101 — FOUNDATION
however,the building or improvement is sold within one year of completion,the owner-
builder will have me burden of proving that he did not Wild or improve for purpose of 102 — PIERS
1e')' 103 — UFER
coreas owns of the pec.70a amusine sivnd confessions with loaned contractors i
compact the pmjen(Sea 7044,Business and Professions Cude:)'Ihe Contractor's Li" 104 — REBAR ,
come law does not apply to an owner of property who Wilda or improves msmon.arid. 105 — ANCHOR BOLTS
who contacts for such projects with a eontracsor(q licensed pursuant to the Contractofa
License Law. 106 — SEWER & WATER
❑I sm eacmpt under Sm j B A,P C for this reason
202 — UNDERFLOOR PLUMBING
owneWOVE,SCOM ENSAn NDECLARATTION 203 — UNDERFLOOR MECHANICAL
I hereby am Penalty of Perjury am of the fnBowing declarations: 204 _ UNDERFLOOR FRAME
:ax and will maintain a Cmificmmof Consent to rel Wasare for Workers Compere 205 UNDERFLOOR INSULATION
1307M
.at pmaded far by Section 371X1 of the Labor code,tar the retf.....of the 3 01 — ROUGH PLUMBING
for which this permit is issued"
has and will maintain Workers Compensation Discusses.a 3 02 — TUB & OR SHOWER
or the tabor code.tar thc performance orthe work for whichN Marttisssued. 303 — ROUGH MECHANICALarkO'sCompcnanimInsurancecame, adPolicynumberme: 304 — ROUGH ELECTRICAL
e,.. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS' 3OS — FRAME '
COMPENSATION INSURANCE 306 — HOLDOWNS
Or (This section recd not te completed iftW permit is Corona hundred dollars($100) 307 INSULATION
less) 308 — SHEETROCK
Z certify that in men any mann of the work for which this permit is issued,1 shall not
employLaws
California.onmanymannersnum become subjauotW Workers'Compensation 309 — EXTERIOR LATH
Daws or calaaD'¢Applint 310 — INTERIOR LATH
NOTICEafter
NcameTO APP the Worker
s Compensation this Genucom of Exemption,YOU you
311 — SCRATCH COAT
became h coSubject y Inc Workers Compensation provisions of the laud Code,you must
UZ Forthwith comply with such provisions or this permit shall he deemed revoked. 313 — ROOF NAIL
?Z CONSTRUCTION LENDING AGENCY501 — FINAL ELECTRICAL ENERGY
1..
I hamby affirm East them is a canscraction knob ag agency for the Performance of 502 — FINAL PLUMBING ENERGY
z >
I-ek Name-
i which p mitiaiauedlSe3A .eiv.ea
dc503 — FINAL MECHANICAL ENERGY
W Q drew
z ,'s
ader'sAddress 504 — FINAL BUILDING ENERGY
U 0 . I certify mat I have read this application and sato Wat me move amoundatiun is 505 — FINAL ELECTRICAL
F^ correct.1 agree to comply with all city and county oNan
inscs and state laws relating to
O U building construction,and hereby muthorbe repre:emmiva of this city to enter upon4heGAS TEST -
above-mentioned property for impaction purposes. lirtN
HC (We-)agree in sax,indemnify and keep harmless the City or Cupertino against 0 7 FI
N liabilitiesjudgments.costs and expenses which may in any way accme again t cid Cily
U z in cnnuqucncc of the gra 'ng of toot permi S ICAL
APPLICANT UNDE TA SAND COMPLY WITH ALL NON-POINT Issued by:5 Date
SOURCE REGULATIONS.
Re-roofs 54 INAL PUBLIC WORKS
wwrc of Applies nU actor Dale-
HA ARDOUS MATERIALS DISCLOSURE Type Of ROO
Will the applicant or(marc building r,Clrant smrc or handle Health a material "
u domed m the Cupertino Munirjpal Lode.Cnapur 9.13,and the Health and Safety
cWe,soden 25532(an All roofs shall be inspected prior to any roofing material being installed.
Yn u
Will the applicant or future building ucwpant 6.equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hvzrdaus air contaminan7fncd by the Bay Area Air Quality Management all new materials for inspection.
let
❑Yes
I have mad the hmmdoos materials requirements under Chapherei95 mare Calif n.
EMM
Codd.Sexanm 25511.25533 and 8534.1 undersuntl thatlithe Wilding
a a tenant.ma my ma umibility m analythe oceir mr of me
m met Ep u mafaCcnlfieatooOccaparcy. Signature of Applicant Dated gent I Date All roof coverings to be Class"B" or better