02030105 (3) CITY OF CUPERTINO -' - '" _. - '
BUnAING DIVISION PERMIT CONTRACTOR INFORMATIO.,
BUILDING ADDRESS: PERMIT NO.
20091 FOREST AV NGUYEN HAI T ET AL 02030105
OWNER'S NAME: APPLICATION SUB DATE
NGUYEN HAI T ET AL 03/21/2002
HONE: SANITARY NO. CONTROLNO.
a ZO ARCHITEC7f/ENGINEER: BUILDING PERMIT INFO
U F BLDG ELECT PLUMB MECH
rice I�
z H i 1 hereby effno in I i mNSED �ce sed underr Provisions of Chap er 9(commencing .lob Description
'vCLARATION
Z—,�u wish Section 7000)of Division 3 close Business and Professions Code,andmylicense KITCHEN REMODEL.
x 2 is in full forte and effect.
License Class Lic.4
1
0>. Dem Contactor
i is 5 o9�'s-B
O ARCHITECT'S DECLARATION
un 5 1 mukatend my plans shall be used as public records
6p�p Licensed Professior.] MAY ? 4 [UO2
u�et i OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
C Z following reason.(Section 7031.5.Business and Professions Code:Any city or county
f x O which requires a permit to construct,alar,improve.demolish,or repass any swaure 1 t 1 11�p I/� $10000
3� "Prior taiuiuuanc<,alsorequirsthe applicamfor suchpemdtsoflari.grr4 statement l/ F�[i INl'A
that ban licensed pursupm t.,W provisions ofine Contractor's License law fChep¢r9 ca g p Q,r@a
(commencing with Section 00D of Division 3 ohne BusimessaM Professions Coda) _ r., x•r3 SO 3'. Ir.:U,1/. -'... ., .3.'S•, Valuation
or that he is exempt thcmfrdm and the basis for the allegca ucimptio.Any violation -
-d5mtion]031 Bby any applicvm for a permit sobjecu fie applicam to a civil penalty ,
:of no, me than fse hundred dollars S500). 101A'PN qyd3DATI ON h Occupancy Type
1,os owner of the pmpeny.u my employees with wages es theirmle compensation, _
will dd the work,'and the structure is not intended a offered for sale(Sec.71 . -
Bhsindas'ana Profession.Coda:The Cnntamor'a License Law docs nor appy to an 103 - UFER Required Inspections'
owner of progeny who builds or improves thereon,and w.W does such work himself 10 4 - REBAR
or throwgh his own employees,provided that such improvements are not intended or
,,Or
fol sale.IChowev<r,the Wilding ar imProvcmcnt is said'within one you of
�complcson,the owner-Wilder will have the burden of proving Nm In,did nm Wild or 105 - ANCHOR BOLTS
imp roveforpurposeofaale.). 106 - SEWER & WATER
61 wetimg with lcened cuntracmrs m 2UNDERFLOOR PLUMBING
" -02 -- —-- ----- - - --
meteoritics that,pmjmt(Sec.704x,Business and Professions Code:)The Connor's
License law does not apply to mmowner of pmpany who Wilds or Improves meraom, 203 - UNDERFLOOR MECHANICAL
_and.who.contacts for.such projecra with a.conulicensedrsan
actor(s) puut.to the
ContrutOls License Law.. -- -- -204" =' UNDERFLOOR--FRAME-
❑l am exempt un ac. -' B&P C forthis reason
r ' 205 - UNDERFLOOR INSULATION
orr�r r D;te 2i' 2/�OZ '' 301 - ROUGH PLUMBING
'WORT R'S COMPENSATION ECLARATION
302 - TUB & OR SHOWER
Inerbyamrm nneq penalty o(pe joy one of the mnowimg amlaason:: 303 - ROUGH MECHANICAL
❑ 1 haJe'eiid'will hainuin a C<rti0cate-of Conant to self-insar for Wmkus 304 - ROUGH ELECTRICAL
. v Compensation. as provided for by Section 37W-of the Labor Code, for the
performance of the work for which this permit is issued_, 305 — FRAME
❑I have and wilrmain am Worker's Compensation Insurance,as required by s«tion 306 - HOEDOWNS
3700 of the'Labor Code;for the performmce of Ne work for which this permit is
issnea.My workara compcnsatiov luuama eatrierem Polley number aR:. 307 - INSULATION
cad I a 'ka< r Policy Nor , 3s08 :;SHEETROCK
7 :CERTIFICATION OF EXEMPTION FROM WORKERS - - " •• , `it
...,mMPENgnnaN INsuRANCE"- . .. ' ...,
" ''309• =` 'EXTERIOR�LATH•
-,-..- ,- -.- ,...r-_,_,-..-__.....__....
�::• - -,:, 3"10-,"-_-'-.INTERIOR"'OATH-_-...__:::,:: ._.....(rni:uniddxd[aKbrl><edmplamHtnepemdtisfor one Wnardaon,a 311 - SCRATCH COAT
(sIW)or less.) . . .
,„T fcriyfl mine performanceof bewrk for' h'ch thio permn res r'smua1 ' �'3T3 -ROOF NAIL' '. ”" " : •• . . _.-., _,
mhaB t ploy nypersom try anmy:ro ggqbbbmmm esublestrotnework 501 - FINAL ELECTRICAL"ENERGY
Compc I. V's o Cel f rya Date 1 fG 2
AOTIC �s '_ f M_arc i �� iffy_ _.. 502 -- "FINAL PLUMBING ENERGY
NOTICB'TPAPPL 1/,aftermakmginsc ionsofi 'th xabor ode,Y byre 503 - FINAL MECHANICAL 'ENERGY
Z become auomply it cl,prCompeuNon Permit
thd erred Code,you must
0 � foMwith comply with sucfi provisions or this permit shell be deemed rvokW.
y� _---. .._. "_-..S.._-.-__..__. .._.. . GE ...... . . .. .. ..._ ._... 504. ,- .FINAL_BUILDING. ENERGY't- .._ ..--
a „y CONSTRUCTION LENDINGAGENCY.f "" -- --- —
.� •f`^n rhfior'which this there conswniori lensing agency for the perfoimindc — ELECTRICAL
hay of th'e work for'which this is issued(Sec.309],Civ.CJ EL
505 FINALE CAL
wt _. .... a... .... .....:.. .... . GAS TEST
p:y It(rm'anparesm -" 507 - FINAL PLUMBING ._.. . ._. .. _._. -. .. __ - .
U-P ,.,- :,Icesufy'that l line read'tlsx application Ina stare that theibove Informatioo lis 508 — FINAL MECHANICAL
P
w'F coil I agree to m-Ply.with aallcicityand county Ordinances and sure laws.].,at, 509 - FINAL GRADEii[) to Wilding consuuaion,end hereby euthodu representatives Of this city to enter upon
pattheaWve-mmtmn
aed,properymrinspection pnpore
L..9 ty.t (W)agree m sae mm
nd if}•arra hNi k ep arthe City of Ctipem o against
510 - FINAL PLANNING
Lh rA liabil u 3udg °u,come sod peau wn h may n any way true as nst aced 514 - FINAL P I C WORKS
UZ City sequence of the graining of ij,pc as"7
APPLICANT UNDERSTANDSAND WILL COMPLY WrrH Aft,NON PO NT /G �
so C'ERE n 3 t/a Issued by: Date /
_ - rgnaweofnppfe Contanor .: Re-roofs
D .....
f`„a `,'.NAL.RDOUS MATERIALS DISCLOSURE- - - °
wdI tlrc Is It niorfutvre duldrng'occnpant same or hm
dl<hemdoas material . ..Type of Roof. . _
u defined by,the CLpenice Municipal Code,Chapter 9,12.and the Health and Safery - — - - -
Cbde Smt v
yM
Y.:: 1 f771'Pq'0.t ` .e r '
All roofs shall be inspected-poo;to any roof ng material being tnstalled.
IW)1 theapp!not !urn mbuilding fend oc pant use equipmentsAo devices which If a roof is installed without fust obtaining an inspectiori;'I'agree to remove
t as"air join ants u defend by the Bay Arse Air Outlay Mmegement'
i. es all new materials.for inspection. Applicant understands and will comply with
all'id -point source regulations.
' n 1 Mvadad the'h d 'meu,reqs me a under Chaptei'695 of the '
Cllifwnn Health&Safety Code.S(ectipon�s 25505,8533 and 25534 1 ondersend Net
sb 1 y to °ti(Y the
W din dose nm cu ntly h vat a tenant that t 33 and 2
upant of the requ rtme e h h m v be mat Prior w usuance r a C n ate f'
upon ,� y „p .
.. L Signature of Applicant Dale
Own Non de ant _._ .. .._.
: s l s DGt-- All roof coverings to be Class "B"or better
.r. 1..R ". .. .
...
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