01080081 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7538 DE LA FARGE DR 01080081
OWNER'S NAME: APPLICATION SUB DATE
HSIANG CHEN WU 08/16/2001
PHONE: SANITARY NO. CONTROL NO.
1
oOO ARCHITECTENGINEER: BUILDING PERMIT INFO
r BLDG ELECT PLUMB MECH
y= LICENSED CONTRACTOR'S DECLARATION Job Description
i Z_0 1 hereby affirm that 1 am licenud under pruvi+inns (commencing:
of Chapter 9
m huj with Secrion7")of Division 3 ofrhe Btumas,und Professions Cwle.,hd my license ADD FUSE PANEL.
j m y� is in full force and effect.
:z C a Licmu Class S D p
i 3,o y
One Contractor
ARCHITECT'S DECLARATION
°—�O
r un� 1 demmnd my plans shall he used as puhlic rcmNs
I p o licenud Professional
S: OWNER BUILDER DECLARATION /
I hereby.affirm dmt 11. ,Business,
from the Gonion Co Liana Law co the
F Z g following fires a ISmion]O3L5,Business and improve.
elisions ., Any city mcounry O
�F C which anti res a pe hour to construct, her rmpmvc,demo)sit rtpa any vry ore
w 3C�,.pilo ro rs s I req the opPlicum fw such peon a fl gn a rot m m. ... ...._... _ _ _....._. .__._ �....
v — Mpt hd il'aiued pais Mt mth'Ph mos of dm Commctof V n Ia IChaprer9 SQ pL p1 p E O alU tion
(comrpe cng with Section 7000) f Division 3 of the Business andProfessions.Code) j'f 1;+J !,3 SJ'Zb(J'2 70rUaat l�,a,-( jt}a,
or Thal he is exempt metefm roand the basis for rhe alleged eaem carni Any violation
-of Section 10315 by any applicem for a permit strucets the applica t to a civil Penalty'
[of not from than five hundred dollars($500). PN Occupancy Type
❑L as owner of the norm employees with wit 30 - UCH ELECTRI AL"
Pd'th Y YonsP Y gas offend
role (Senution
will do The work, of the'strucT structure is not intended d or License Law foesnou appl ]06a, - 1.'. Sl'• -1'_'
come,of property Whorls Code:The Consmnoro , nd w Law Jas not apply m an 505 - FINAL EL�H!'i'17�i�"�PEc[IOh"s
owner of properly Who builds or improves thereon,improvements
who dos such worknded
of in.gh M own employees pmvNed tit t h p l art mended
siffercd f le If.however,the building i improvement Id within one year
cons improve
for pu xwnervbuilder will have Ne Which of proving that M did not build or 1'". !•Y C o
i improve for puryou of ale.2
r
s.wner of the
as with licensed characters to . Al I
consumer the prolem(Sec.7b6,Business d Professions Cad J The Contractor's I i I tf !I •RO
1 ,
"' Luenu co does not vpply man owner of p pony h bre Ids seimproves thereon.
andi Cl commas.forsuch projects with a conwmor(sj licensed Wrswnt m the
on Class
License
low.... r: ......: _ . .. __..... .. -. _._.._ .. .._ .i._..._-___.. ____._...-__. ._..__...__..
❑loin cal und<r t` fi6P�cf.r Nis rtason ...,. •'P!' !n0
'Owner etc' .J
- PENSATION DECLARATION
I heuby affirm under penalty of peijurypnc of t1.he following dMantions:
S 1 have and will'mainfain a Cenificete•of'Cdnsent•l'a scl6insom for Workers
.pmpenmtme, as provided for by Section 37M of the Labor Code. for the
doreforl of the work for which this pnmi.is issued..
_ ❑I have 5ntl will mai.,am Worker's compcnieiion lmur5nce,'6,ixpand by Sel
3700 of die Lalor Coke,far the performance of the work.foraffle,i 'thisrenit;is
stied IvyWal Cmireirlian8h Inumnis,conferred Pull,,...We of.
.
C3imer {i+ '.9lP iia.p'1,°V r Pafc
EM PITON FROM WORKERS 1•.'. 1, t .! _ 1. s.Y�f, 5.3.! 1. 1,h. .,
URN
ACE a 'a `
' ITh s union neral hot be con le _.-...,_,-_. \U �..__._. .__
CERTIFlCATION F F%
COMPENSATION INS
_.
lm;a 7hry Ila. t.7
P tedrhhc permit is f«nim hundred dollars - �•'�'I I' .i='•
ISIoO) 1 )
TI cent That in the to
f •bf titl work f which this penin i issued,I f.-L,
'.. L't�,9P•f'r
t, ori ren m an manor m as m become,, '`'" "
snall nix empbY Y R Y lyect-N'11 the W«keri i
PPS n.. , .,,
o t Laws of Ca mi Date
1
i 1NOTICE 10 APPLICANT.if after making thsCennicmeof Exemption.yoyahouldi � t
became su opply the such Provisions
or
this permit shall e d lybor Code;you must I
Q 0 forthwith comply tits such pro si or this ammt hall be deemed nevoked.
` nth rah b.t ct nkd f Ile1 /0n h teby R g g n Y perfoiinpnce
.'of the brk f ' hon tit P< t i tied(Sec tfW] C C) I I
U,O
I cm fy than 1 ha a rend tht upplica0on and swte Nat the ebose m(omraion is
fasc (co'ruct.I agree m mmply wnh all city 5ntl county ordinances anJ sole Inws miming
i 0.-� mbuilding ctinstrvnibn;end hereby outnoriio represcmativcs of thisdrymenmrupan,
�,f W 'the abovs-mendone0 properry for impectioo puryous.:
^:d I We)agra m svve:'indemnify and kttp harmless We CiiY o(Cupvtirio against
W liabilities,judgmm�ts,msm end apcnus which may in any way accrue agmina wid
V e� City'.conscqucnce ohne gra t ng of Ile pent t'' ' '
SOURCE
POINT''CANT UNDEk$TANDS ANb�VfdcC'0�3I LY•WITH A�.G NON:CE'REcuLATloNs/��.,�1 — Issued by: Date
Sign m of App er Date ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE ?' 1
Will due indictedo fire Inlding ocepn,on.o,handle onard noterfill .- .Type Of Roo - e: - _ (� �•9
eadefad by the CPcn noM ncpai[ode Chapter 9.12and the Heald iSfty' to r s41
Cade I]Y 25532(al ,{'SIO No ` ";U salvo V. w.!A'< ('tv; . h� :btJ i ',fJl a h 4, '
- ' ,. V �1 , R. p
II roofs s 1. a mspected,pnor to,any_roofing.material being installed,
I Wlll be applica t (mrehudtling c pontusecgepmem oroc io.whtrn - If a roof is installed without first obtainingaiilifis action;Iia ree,to`retnove
suit r_, stir rnm win. .1 def ed by thele yAreaA Quality M ge rat. p g
inn all new materials for inspection. Applicant understands and willcomply,with _
I ❑Na all non-point sourcereglations.., , •d 'l'`t'on6
�� r I h vx read'Ne id a mis innixriair requirements under Chsper.6.95'af rite
.Cebfdm!a Heellh&Safely 176de,Scnibns25505:35533 and 35536.IiurMerstur that j
"if the buildingJas nmcupen0y have am e t that tis my rep 'bilityto notify the
' dccupdm of tit
+, Occupancy r q i ire,mmmeiD 'mpn io issi u nee of a certificatee,a
;.
Signature of Applicant,_ _ ,_ . .. _ _ Date
aaunan m.g Dae'.' All roof coverings to be Class„`'Bre or better
wit 1 - -
y „Iw ) ; c OFFICE