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02040035 (3)CITY OF CUPERTINO ,-� O Q Z O I:. f, m L Za - - - - - BUILDING DIVISION PERMIT -CONTRACTORINF.ORMATION: BUILDING ADDRESS: PERMIT NO. 20091 FOREST AV NGUYEN HAI T ET AL 02040035 OWNER'S NAME: APPLICATION SUB DATE NGUYEN HAI T ET AL 04/08/2002 PHONE: SANITARY NO. CONTROL NO. zo ARCHITECT/ENGINEER: BUILDING PERMIT INTO F. BLDG ELECT PLUMB MECH i LICENSED CONTRACTOR'S DECLARATION 1 hereby offum that I am licensed under provisions of Chapter 9 (commencing Job Description p w with Section7")ofDlsiston3nnheBarmessandProfessionsCode.andmyE«nse j Is In full force orad effect. � NEW SUBPANEL FOR KITCHEN. U License Class Lic.p Data Contracmr ARCHITECT S DECLARATION g I understand my plans shall be used as public eecards II— B�YI /i�[F.CO p Lensed Professional OWNER us 1 hr M. exemptBUILDER m the CoATION License Law for the 1 am exempt from the Cantos MAY 1 4 2002 aso on 7031.5. Business and Professions Cmc: Any, city or county o a following rcama permit t O which requirts a permit to conarva, ober, improve. demolish, or repair any structures $800 m . prior to its issuance. atm requires,he applicant for such period to file a signed statement - that hats licemed pursuant to the provisions of the Contractors License Law (Chipmr9 (cbmmencing with Seetion]00o)of DivisionJof,he Bsyiness end P.rpf<ssions Code) SQ, - ��I� A•�• t, - - - Valuation or that he is exempt therefrom and, ,he basis far ,he alldgcd ea onslumm Any violation ,.I. 31tl-TiT'7�-QC .' ' of Swim 703 IS by tiny applica sufma permit subjects the: to a civil pcwhy of not Five •app 10Y"a'�P DATION Occupancy Type Lidernnthad Ofthehundrcedmlyeeplovir. or my employees wages their sole compensation. h as owner of the and '°vittdo the the is intended d a, swaure not endM1 a e offered for sale apply to nessa Professions License now apply to an Cme: The Coes 103 - UFER Required Inspections ownBuser of pro erty Who theins who s such owner of property Who builds or improves thereon, and who encs such work intended °r,heo°gn own employees, or ,or mpb improvements are no, onendm °r 104 REBAR sol t building improsreardne a sold within one year of .oRem1 for sole. If, a, -Wil r. the tibase the compinion, the mwner-Wilder will hovc,he burden of proving that he did not build or - 105 .-.. " ' - ANCHOR BOLTS improve for purpose of sale.). - ... . .. 106 - SEWER & WATER I, es owner hophe property, am exclmenadPromlag diha with iiprnsea pnn,;adors m ionswct ,he project (Sec. ],10.1, Business and Professions CmcO The Contractor .. ..... . _ � 202 .. _- ...... - _ - UNDERFLOOR PLUMBING ' ima.Lawit=notapplytoanownerofpropertywhoWildsorimprovestheted, . and who contracts for such projmu with a eonuaemefs) licenscd.pursuem ed the'2 203 - UNDERFLOOR MECHANICAL " Conuactor's License Luw. O4 -.. _... _.. .. ...._.... ... .-. -'-UNDERFLOOR 'FRAME "" ❑lame an peg. B@P C for this 205 - UNDERFLOOR' INSULATION }(¢/y''pI ``rr..�{{ .. 9ole779� Owner-✓^ WO R'S�C0 PENSATIO DEC RATION 301 - ROUGH PLUMBING Ithereby alremaMet Penalty orp<1jmymennhefau°wingdppl.ra,mns: 302 - TUB & OR SHOWER I have and will a Cay If Coastal ,t Ifinsurefor Worker*a 303 - ROUGH MECHANICAL Compensation. roiled Septi for by Section 3700 of the Ismr Code, for ,h< 304 - ROUGH ELECTRICAL Performancehe .Afair .1 he work for which ,his permit is issuN. 305 - FRAME . ❑ 1 have and will minimum Worker's Compensation Insuream es requirtd by Section metier,helaWrcme.rnr,Wperrnrmanpear,newodso%whichthispermitis 3 06 - HOEDOWNS issued. My Workers Compensation Insurance [artier end Policy number art: 307 - INSULATION Carrier.. � t � � .. Policy No.: "' 308,=;.SHEETROCK • CERTIFlCATION OF EXEMMONTEOMSURANC WORKER. i - .... -, ... mMPENsnnoNwsuaANCE �. ., ' a 309 ' - EXTERIOR LATH . '(This xaion need Turd W completed if the permit is far one hunerm dollars .INTERIOR...LATH 51001°''`rs') 311 - SCRATCH COAT 1 Certify that In ,he perfnrtnance Of the work for which this permit is issaed. I , . ... 313 - ROOF NAIL - .. ... - . shall not employ any person in any mender to an m became subject to the Worked' Compensationof Cala. Due `LX:. 501 - FINAL ELECTRICAL ENERGY Applicant t "502 - FINAL PLUMBING ENERGY-' NOTICE TO APP ICANT. . after making ,hrs Le ¢mc of Eaem , should NOTICsubjauo,hd terrEtabort lancome Workers Compensation provisions youmuo forthwith comply with such pm%kions or permit shall te deemed mvoked. 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY CONSemUCnoNLENDwn AGENCY I hereby this Chert mss construction(Sc.lending agency for the perfomiantt 505 - FINAL ELECTRICAL which oldie work for which Nip permit is issued (stip. 3097. Civ. C.) Lender's Name .. 5 0 6 - GAS TEST LendcrsAdder..506 507 - FINAL PLUMBING 1purifythisIhave readalthis rndlainancesaabove ilaw'mi°ng 508 - FINAL MECHANICAL ityandapplication to ,o building cons,rvnion, and hereby authorize rtprtsrnarives of this city to corer upon ildct I conter tocomply d hhencityartaere or nmatims and state law'missingI'd 509 - FINAL GRADE` -- he above-mentimmilPINdy far inspection mrpos (We)"me m save. indemnify and keep hamdessme City of Cupedino'againsi 510 - FINAL PLANNING liabilities. j illons s, ensu .ad exp ns« which may in any way accrve agamic said City in consequence of the granting of dims 514 - FINAL PU I C WORKS lamina. APPLICA L:C�RSTA.\'pp4or- hC SOURCE U ATIO LCO.ILY r Issued by: akeI\'ITHALLM1'pN.pO1 %/�/ �'/J{((/V'(a/./ Date Stgnamrc AppbcHAZARDOU '—�- tp " HAZARDOUS MATERIALS DISCLOSURE' Re -roofs pa WIbyte Cupertino tenure Municipal Cgocc hapt mortwhad the Health and ss defined by ,he Cupertino Municipal Cme. chapter 9.12, and the Hca1N and Safely Type of Roof Coro. Semon 25532(a)' '. oyes oN°'r Will fumesbuildingbytheBayAeaAirQualityment All roofs, shall be inspected prior to any roofing material being installed. us airoiintmecasurn emit hazardous air conuminan¢ u defined by Bay Area Air Quality Manegemem onagees tint If a roof is installed without first obtaining an inspection, I agree to remove istn`t? ❑Yea 0No all new materials for inspection. Applicant understands and will comply with all non-p❑Ppint source regulations. 1 have read the hazardous mamrials requirements under Chapter of the California Health 3 Safety Cme, Sections 25505. 25533 and 2553a.luna 6.95 othat standtify if,he Wilding docs not cunemly have a ¢mart,, drat iris my responsibility1untie no @e u xhich tax, be met prior m issuance of/a Cenif ate G/Tq y✓a Y of --v Aculanm,.1dui �_/— V Signature of Applicant Dateo All roof coverings to be Class "B" or better agrn, /� D — OFFICE • • • APR -08-2002 .1 ; 03 AM 510.8, 8. 6. 7. 5. 9, 54P) SUBMITTAL 1 fOOA 60A M4i470retkP/1_ � r rr , t w/3 r ' r 4P,A .Z dA 16 AYS 15108867595 • r�i s P, 02 -5" OA ;ORDANCE WITH THt l.{I + 0�, a I(Nr OL'.Q AND JDL: AN',.S .his sel aa', cations MUST be kep, r 1t1 yes and it is on lwlui to is : or alterations n some :e mission from e to, d n; ';upertino. rm n no specifications Pe mir .r to be an S�6 ny provisions �o,S/�a.CeS /,� G'ircui7.S RPP l�' U S C on I y III APR 0 8 2002