00060183 (2) CITY OF CUPERTINO Q /_ >
InALDING DIVISION PERMIT CONTRACTOR INFORMATION: O l c(Ll b 3
BUILDING ADDRESS; 1•17RMI I'NO.
T all Ave. � �ob1FI+J
OWNER'S Ahf " I V APPLICATION SUB O 1C
D 4v
PHONE 4 SANITARYN'tl, CON IROLNO.
- 2y — Los 5 � SD�,2
M O O ARCHITILC(ENGINEER: BUILDING PERNIIT IN'T'O
V I
cw _ ^/ _ 19BLDG ELECT PLUhIN MLCfI
a 7 E I o U �`� -1 1
¢y
h-
LICENSEDCONnsed anOR'Swwor,ar chaN Job DeSCI'Ipilon
- u- I harchv affirm that 1 um licensed ander pmvisinns nr Cluplery(commencing
M1-w will,Seetion]0110)offcrixion3ofineBusiness and Profosions , e.andlayliceroe G1NP
is in fullfoneanJeffe, ��� �z � �iµJ✓� ext5nN�i 2. LkvQ of t�UoF �2 LAMex3
z s 5 Lieenm ClorIsers{-fC—{a Liea. ,p 1 1 I
O c e Dan_JI I)V CtoitClwr �Q�/��1�.���
SoILLn luV nuCHrrecT'SDI:cLARAI N�t"•" '"'�j IN51 -1,L 1�6n1 ,c� �`iTM 1� �-U•���-
u O 3 1 understand my plan, hall he used-puhlic recruit,
••ur
ate-',C O I.icenveJ Ihnfesnional /�. aq( /LC 9 RAi'r S IH�rZL4
n. oWNIiRNU1LD1iR D[CLARATION L/�L 'CAI K /'1,J/ 1f••"I VI 1./
vl n 1 hereby affirm that I an exempt one the Contractor's License Law for the
L S following reason.Need 1 71315,Basi and 1'roresn is Coda:An,city nr ..my
S❑ wh,,h nqu res mn
a petit ,,venw ¢I,alter xiinprove.detallish.or rcpaa any%uncture -
leprier to it,i...ance.alsorequites the upplicunt mrsuch Parnham file ao,aiRlwammem
a. mat be is licensed parnantcc)the provionnsnf the Comecmr..Limns,Law tchamery Sq' Ft. Floor Area uy Valuation
aomnrcnciag w;m Sectinn 7000)of Di.i.ion 3 ofhe Bonus,mad Pred—inns Code) 2 q l s 5,a 11/ t
.,,hat he is c%empt therefrom vad the husk fur the allege]csenquill.Any violation LL l V V
lit
ar Section 703I.5 by any ap,dem,far a perinit oubjaeu the applicant m a civil penalty
ormntat,ndmnroe handedAoparv(S501c) APNNo er Occupancy Type
[ILasnwnernrthe prnpcny.or any employe®with wages v.mcir sole c ruscmotlen, 1— � 2--3 �, t5t � .
will do the work.and the%tmcmm is not intended or eBereJ for.ale(Sec.7x94.
Business and Prore%sinnr Code:The Contractor•,Lmen.e Law Jren not apply a)an . Required Inspections
owner of prope ly Who hail]%Ely improver thenen.and who does such work himself
or through his own employees.provided that%uoh intrinsical are nut intended or
oRercd Ibr sae,If,nnwuvet,the building or improvement I%Doli w'nhin one year m'
imtplcl r.the Owner-hander ill have 11,c,a hvrtf-of proving had Ire did Dat build nr
iw
mprove tar puH,osu of
❑Las owner of the pmpc.7 am exdiness a contracting with McCaw]contmanrsto
rs
mm.t t thep ) t(Sec.]to a Business I e professions C% IThC nthencons
L'cen 11 I does t apply t nl property ry lin build improves manna
- a of 111.1 clantlaot,r M1 p mat. 10 a t ls)liwea,vd moran to the
Con i :L - I,Lw.
n a -
❑I a se,tpt nm,.rsee. .n&I c r mi.Dass
Owner Date
WORKER'S COMPENSATION DECLARATION
I hcrcby ahon.,.'ler penalty or",iury one ofine Int nw.ng dee L,rationa:
❑ I have and will maintain a Cenilicate of Consent m wli-insure for Worker's
Compensation, a% providedfar by Selina 3700 of the Whir Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Co narmation Insurance,as required by Section _
3]t 9 m me Labor Code, or the perfnnoaae, A tire wbtk Ins which this lint nit is
ironed,NVlr/.yWorit rs.ttC•f)o1�m�rsl,re�nnmion Immanle`am•io''rand policy 11
Zen,_F t'Gr�' Policy NoVV70000 IGCJ�
CERTIPICA'I'If)N OF F,%ENIM[ON FROM WORKERS'
COMPENSATION INSURANCE
(I'hi..ecrmm acd n 1 le amtplcwal it the permit is lbv one hundred dodlnm
0101)or less.)
I certify that in he ferfammnce niche work for which his permit is issued.I
shall moa employ any Renin in any manner m as to berome subject m the Workers' ,
Componmtion Laos of Culifnrnia.Date -
NOI'ICE'I()APPLICAN1",ILufmrmaking this Ccnl5chre of Iixramd c,you should
bannswbpv,Inthe Workers Conon,minnpanislorrot the i,nho
:m Cale,yu must - -
Olimhwith comply with such provisions or this pemtit%hull be deemed wended.
F` .tea CONSTRUCTION LENDING AGENCY
herebyeffirm which that there iss construction(Selending agency for the perlimtmnm
of the work Iris which this Penna is IswmJ(Seas 3097,Civ.C.)
Q Lender's
Name
C) I,cnJcr'I AJJ)that
Z--3 /,
7 -3 /e 'l
U I certify the 1 Moe real this application and surto that the chore laws mini is C// L 111
LL Utonecn I acne tr comply pith all city and county ordinances and state loos elating
(� the aioingcnnntinedla:nd M1erchyspecti irenpmsenmdven of thisairy memm�tpnn
mu nbn(We)ction to one.
for inspection onpnga,ses.
F d
(We)ngr,crosnvc.inJcmnify mal keep hnmdcss me City of Cupenino uguinnt ,
y liahilitics,judgment.,cows and capenms which may in any wary accrue car t said l - O O
U Z City in consequence of[lie granting of this pemtit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-MINT Issued by: Date
SOURCE REGULATIONS. y'
Slgnaaue of AppliaanuContruumr Lam Re-roofs
IIA%ARDOUS MNI'URIALS DISCLOSURE
Will the applicant er fume btak ing avert name in,hmodle h reankaw ntatemil Type of Roof
us Jc9nN by the Cupenino Municipal Cole.Chapter 9.12,and the Health and Safety
Cole.Section 25532(x1".
❑Ye. , All roofs shall be inspected prior to any roofing material being installed.
Will Ilan apphcwtor a:tm ndl]ingn Lament use equipontn erdeoieen wars, If a roof is installed without first obtaining an inspection, I agree to remove
mit haterfuun air contaminants as dellnal by she Bay All Al r Qa:do,"a rem
`)iwriet] Mmaterialsor inspection. Applicant understands and will comply with
Id 0 Yes /'No e regulations.
I have
reuit the haemnloss materials reyuimenems lander CMp, M195 of he
California health&Sulcry Code,Sections 25505,25533 and 2"" I m ®mnJ max �)
if me htrddingdoil in really havca en, hat al 'any on, Y,
miry', �UU
sonar I of the mr, linens which ratio be met prior to Lonnme of a Cern"o,of
oecnpaney. Date
cant
Owner or authorized agent Daae AII.roof coverings to be Cla. ' r'B"or better
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR; chrietya
;
Sec: Twp: Rng: Sub: Blk: Lot:35931023.00
INVOICE DATE......: 06/30/2000
REFERENCE ID q ...: 00060183
SITE ADDRESS . . .., : 1157 KENTWOOD AV
SUBDIVISION . . . ... ,
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ....... . . . . . : HUANG/CHEN, AMY 6 GENHONG
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5838
CONTRACTOR LIC k
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ --------.__
BPERMFEE P 230.60 0.00 230.60
BSEISMICRE P 0.65 0.00 0.65
231.25 0.00 231.25
ID . DESCRIPTION VOICE Ip,. -____. DESCRIPTION-
.. ..... ............ ... -------- ---
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYNOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS