01040009 (2) CITY OF CUPERTINO - '
BUILDING DIVISION PERMIT CONTRACTOR,INFORMATION:
BUILDINGADDRESS: PERMIT NO.
21103 LAVINA CT. 01040009
OWNER'S NAME: APPLICATION SUB DATE
DENNIS WONG 04/03/2001
PHONE: SANITARY NO. CONTROL NO.
ZO ARCHITEC'/ENGINEER: BUILDING PERMIT INTO
ee u E BLDG ELECT PLUMB MECH
waoa CJ LJ I-1 L._I
Z 5 N Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z so 8 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
F=- with Section 7")of Division 3 of the Business and Professions Cod and my license
axe is in fail force ad erregl� .6 t 7 SFDWL, 4185 SQ.FT. LIVING SPACE,
ca O i License Sic.p
w 3¢,h Data c°"tm`1Of 2y��" 489 SQ. FT. GARAGE .
} RCHITECreDECLAR 1 o
1 understand my plans shall be used as public records 1)Q �' �®
w p O Licensed Pr°re,sionid .2 p Q
2 00
2
OWNER-BUILDER DECLARATION
1 hereby ulBrm that 1 am exempt from the Contractor's License Law for the
F Z< following reason.(Section 7031_5,Business and Professions Code:Any city or county JUN C L
et which ey 5 a perm,m construct.alter,improve,demolish or repair any sura m e
pliellis illIs reditilecl the applicant Tnrsoch pennit to file asigred tteric)t
h he 14 Int5flVitid111111L.ral , Ne la .moor the G,nlracl,r, La,,(Chapin9 SC.I1- EIOUT-Alea n�p, uation-.
a 'sums t 7WO) fD'.an 3ofheU-meS dr rs,on,Code) i-.43'b1=^.� : .l a, 4..�.7'r.sx-�_�9.'.i'it
4{5I3,
or that h Empi th f m d th empuon basis for the alleged exAny violation i Y}/ 2
of Section 7031.5 by any applicant for a Permit subjects the applicanuo a civil penalty
l or not more than five hundred dollars(S500). APN Number - 1, it Occupancy Type
❑1,as owner or me property,or my employees with wages as their sole compensation,
-w111do the'wblk,,-and'the armhole not intended.1 Ifirred for sale(see.lou; Required Inspections'"
'Business andprofessionsCode:The Contractor's License Law does not apply to an •' ` -
owner of property Who Wilds or impmves thereon,and who does such work himself s
°r through his own employees.provided Nm such improvements are not intended or 1 1 - FOUNDATION
--oReied for..E.IC fiowevcr,the building - ...._.__
or improvemem n sold within ons Wild
of -_---I -- - --completion,theoserifsuild'r will have the burden of pmvmg that the aid not buJd of 102 - PIERS
mprovemrPupo orale.). _10.3. . LIFER.._
c _ Oas --- .._.._.._ - - - - ---4----- - -- -- --
Las ownerofthe property,amusinessland Professions
CWensThe Commuter's
omcmrsto 104 - REBAR ,;
_ --
consumer theLaw
rowan(Sec.]to a.owner o and properly
w io b Code:)The les them n, E.l ,.
License law does not apply m an owner of property won buds,or improves thereon,
105 - ANCHOR BOLTS
_and who.contmcu s.wima for such prejectcontracams).licensed pursuant-to.de- _.. _ -_ _ .. _. . .—
c°""a °`aL"`"m106 - SEWER & WATER„dt ;,,,
❑lam exempt under Seca' ,B&PC,(or this mason (1
oma « phti . 202 - UNDERFLOOR PLUMBING
WORKERSCOMPENSATION DECLARATION 203 - UNDERFLOOR MECHANICAL
I herebyafrm d_ pnaltyifpLrluynnGofmglznowmgaeemrattnn,: 204 - UNDERFLOOR FRAME
>, """ and w,irmaintnin a'c Adleme of Consent to self.msom for Worker's 2 05 - UNDERFLOOR INSULATION
Compensation:-as provided for by-section 37W of the Labor Code. for me
performance of the work,to which dtisge,mitis i„a'd.l 301 - ROUGH PLUMBING
❑In mJ did t Wo
rk Crat,broillim . ecoiled bySbflma 302 - TUB & OR SHOWER
3700 f the"Ihcr'C& f Ili perfo' f the work f which this'red,i 'is
MY WorkjjPaCn d Icon n naP1y brare: 30.3. ROUGH MECHANICAL...-...... __._... _ _._._ .__. _ ....
Ca eSfiA.TR!,C(.�lvl e.Pu cY _... O s•
�}.,.pF'� _ - /0-0S'304 -ROUGHi;ELECTRICAL
rt;iiIM N OF.EXEMPTION FROM WORKERS tt- + -
.y.. .. COMPENSATION INSURANCE- .;.„-. FRAME_-.
' s'
•' '”, mis saaiitin Aced not be completed if the permit is for one hundred do_Ilars 3 0 6 5,1-" HOLDOWNS '''- " `' "`'''t'"' . .
'(8100)mlusd
.3&7 - INSULATION-..._..:i._.
i,� I c ndY,that in the pert mance of the work foi wM1 ch di-pe,mit is issued,l Iv, {,�
shall not employ any,person in any manner so as to become subject m me'WorkeK 3 08 - SHEETROCK
Com ,.ah Laws of Califomla:Date.' -'
APPIa'r-°" . _.EXTERIOR_LATH' ...-.--- -
z ^ ;NOTICE TOAPPLICANT;If,after makin this Certificate ofExemtion,youshould RCOAT --- .I- ,
necomesub3ecn theta rke! C penvg provisions of thLabor Cod,you must 310 - INTERIOR '
O form th reply ithsuch p ism ns or the Pmol hall be deemed tea. ....311._- SCRATCH _
5 CONSTRUCTION LENDING AGENCY i -
7 1 h reby affim that'he.is.construction lending ag cy far the perfmamme 313 - ROOF NAIL ,
W
of the for which mxp mil is issued(s3ro7 em.c)
Lendeders Name _ _ __..,501: - . F.INAL_ ELECTRICAL -ENERGY.
N • -.. (See _. ... - e. -
Q-Z lad Add"` 502 - FINAL PLUMBINGnENERGY
V-0 1 rectify that I hao,leadthis applicationd site that me above information is - 503 - FINAL MECHANICAL ENERGY
Tar-F.t
correcting
o ct 1 grt to comply. th It city and county ordinances and state laws belong
O_V tobuilJingmns,rection:hndherebyawhrdizeiepresenmtivesnnniicirymeme upon 504 - FINAL BUILDING ENERGY
the above-memlomJ proPeny for,inspection purp°,es. ,_
Imnu (We)agmeinsave.mdamniryaadkeepharmlesstheCity ufCupertiv, gam, 505 - FINAL ELECTRICAL
j udl ems mv5 d ncpense which y in any way accrue again,,said
V Ccome
o q -earth
. Rhe gr,tng Of th mit 506 - S T T
_ PLICANT,UNDERSfAM1DSAN1) OMP WITH AL -POINT Issued Date
S URCLREGULA71(3NS 'l`
2
.Sign ur btAppicant)Cont st Q - ,pate-, Re-roAO - FINAL MECHANICAL
Will theapplicant HAZA us fv1AlFR1Als DISCLOSURE " .d .I Type o6 A�3f- FINAL GRADE
" o I m b Idi,g ,pantshandle ... _ _
°i 'h rd° _
as re'n'd by the Cupertino Municipal Code,Chapter 9,12.and the Health and Safety
cos seahon253 u I t r f F� , X510°I'=: FINRli�;PLANNING
❑vet.- , No , , d+1 � " eta - _Atl rocggis4al!_belt11 RT.9d.POBlpjoy Woftgnaterial being installed.-,__---_
Will the applicant future bddmant use equipment or devices which
!
emit mocardims
air conta to'defined by the Day Arca Air Quality ManagementIf a rod'knsalRl *optfy.%gb i Uspection, Iagree to remove
Distrct all ne%T ijerLiIs*6&pp � . Micant understands and will complywnh
ovaIP all non- Tt sou p�1 n.
n` I hova read',th haaaN us materials requirements under Chapter6.95 of the 4 - ��P' N-PROGRESS' •tl' '
CaliforniaHealth&Safety Carde.Sections 25505.25533 and M534I understand tear
if the all Iding Jas not cnrre have S tebhni:tea ius my msponsibiliry to notify Ne -
anpam of the require is r ich must h t met prior.,issvnace of a Certificate of
Occupancy., .r. / . .
Signature of Applicant _. —._. ._ .._. _ . Date_ .. . .
Gwne,orp n xe 'm All roof coverings to be Class"B" or better
. ,
._ '-.�;. .. . ,: ._._ ....... ..--- • -'- -._ r -- OFFICE
t ..