03040068 (2) CITY OFCUPERTINO
BUILDING DIVISION PERMIT N15
a" IN NF TION
BUILT�O)RW CREST DR CHAM KIT M AND NG SAU L PFxMIT No.03040068
D "`KIT M AND NG SAU L � �M 04 11/2003
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITEMENGINEER:
BO ELECT PLUM O
i0o LICENSED CONTRACTOR'S DECLARATION lob Description
1 hortby affum that 1 un IlaruM under provisions of Chapter 9(eammeaing
withSection'l 3 of Dlviaton 3 or the Bupneax and profeadona code,and my Iimmat is
mfull to.and afloatREVISION--IN HOUSE USE ONLY
License Clea Lie.0
Dale
cnnlmM, NO NEW PERMIT, ORIG. #02110081
0 ARCHITECTS DECLARATION
u
1 understand my planhell he used as public mcords
5
s u0 Licensed RufeWonal Dg OWNER-BUILDER DECLARATION (\
20 f 1 hereby.(Smi that I 1 exempt from the f ssio nCo e:Any
Law for the \v\
o O following meson.(Saito 70315,I3,Buainea&and Profession dicenna Cade:AnY shy or county
$ which=quirts a permit m rob sten,plop Impmw,hPermitt t or mash any amant
toctura
PaonnWisauencc,atsumquiruthe apPlicamfor such permilrofileeatgncdNlcment S Ft,Floor Area Valuation
<
that he is licensed Pon um un the provisionsofthe ContraeeriLicense Law(Chapter 9 q•
(commencing with Section 7000)or Division 3 of the Business and Nofesdam Coda)or
a Nal he la exempt Ihemrmm and ale basis far Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for A Pump abJects the Applicant to s civil penalty of APN Number Occupancy Type
not mom dun Ow humsead dollars(5500).
O1,as owner of Om property,or my employ=with voter a their main campenaao4 35626016 . 00
will do t ewor4 sod the suunum 4notintended mortared Metals,(See.IDN.Bualrm Required Inspections
and ProfeWom de:CoThe Consomme,Liam Law d=not Apply to an owner of 101 - FOUNDATION
p ropeny who builds or i m w
prol Ihemon,end who does s uch work hlmsel f or through his
ownempsy=.provided thm such lmimwments ase not lowered moRered fmwe.If. 102 — PIERS
howewr,the building or Impmwment Is sold within one you of completion.the owner-
Wilder will haw arm burden of proving that he did rat wild ear Marrow fm Purpose of 103 — UFER
.M) 104 - REBAR
❑I,u Weer of the property,am exelumwly contracting with licenacd mnaanon in
contract the pmject(Sec.7W,Business and Profusions COM:)The Onuacefs U. 105 — ANCHOR BOLTS
awe Lew d=not apply to anawner or property who Wilde or improm demon,and, 1O6 — SEWER & WATER
who contras for such projects with A contra mor(s)licensed pursuant to ate Conusetofe
License Law. 202 - UNDERFLOOR PLUMBING
�I
an exempt under Sec. .B&PC for lids Mason 203 - UNDERFLOOR MECHANICAL
/` °ie 204 - UNDERFLOOR FRAME
- E M SATONDECLARAT
-by apq.ry.rPdcr penalty of perjury am:of the felloirtddalwlam: 205 - UNDERFLOOR INSULATION
❑Thew and wi(Ime'Inuina CertlBcaearConant to selfdnaum for WorYeM1Compen- 301 — ROUGH PLUMBING
Bunn,as provided for by Section 3700 of the labor Code,for the Performance of the 302 - TUB & OR SHOWER
wort far which'his permit iaissued. 303 - ROUGH' MECHANICAL
❑1 haw and will maintain WaRee's Compensation Imunna,as remitted by Section
3700 of the Labor coat.for the performance of the wart for which this pmmil is issued. 304 — ROUGH ELECTRICAL
My Wereoes Compensation Tnaunnca carrier and Policy number art: 305 — FRAME
Cartier. Policy No.:
CERTIFIGTE OF EXEMPT ION PROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE 307 - INSULATION
CI)rb swum need notWwmplewdlithe Permit is roma hundred dollars(SIM) 308 — SHEETROCK
arks') 309 - EXTERIOR LATH
I coldly that In ttt11��a perfnrme of the work fa which this Permit a issued,I&lull not
employ anyperwdip)ryi m r me subject to see wohcn•Compenunan 310 = INTERIOR LATH
Lwmarahroml 311 SCRATCH COAT
A{1Qplleqq�n4
N come subject
APPLICANT:If,Compensation o nthis Cenin,of th Lab rtio d,y u mull 313 - ROOF NAI L
hecome h comp ro the Worker's sorthi pmvimom of the mcd Cade,you muse
O'j. forthwith comply with such provisions or this per=il shall Waamca mroted. 501 — FINAL ELECTRICAL ENE Y '
?,_0 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENER
[To-. IWrchy am.ch.laertkacomwninnkndingelerrryfor awpcmes
wortrformo( 503 - FINAL MECHANICAL ENE
I>r> thefarwhichthispermhharm
Issued
Lender'&Nune 504 - FINAL BUILDING ENERG
Ig1 Q
7.Z Leneer'eAadm.. 505 - FINAL .ELECTRICAL
U O I canify Net 1 lmw mad this application madame......e a nw,Infomulun h 506 - GAS TEST
0 conept.I&gree to comply hor all city and county ntathes of and s We law r upon
m /
abovengeanonedpmand for Imeulhorimteoses. res orrola shy to eaterupon tW FIN PLUMB G //
W shove-(Wtlo agree
to rty(wlmnify an Purposes. G
Ly, (We)is me a an.Indemnify anti hapMay
I.harmless tW City of Cupertino against 08 FI L
Ur in coivAmotmenueeoauanding Orpeuuurn. mryin any nyaceme against ales Clty 5
U APPLICANT
of UNDERSTANDS
Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NOV-POINT Issued by:5 ING
sgy{ 3
cegecp}.AnpOs.n � / Re-roofs 4 NAL PUBLIC WORKS
'llsi���nature of Ajipp�plicennwConfractor DAM
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant start Or handle hmrdous material
as dented by ase Cupertino Municipal Code.Chapter 9.17.and tiro Health and Safety
/ -
Code.Saaon75537(a)? All roofs shall be inspected prior to any roofing material being installed.
A ❑YuNo
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardous air contaminants as defined by the Bey Arca Air Quality Management all new materials for inspection.
Distinct?
ea I�Nu
I h.. Rd the lwA=�mumaenalsachommenu underChapter G95ofam Califor.
dies Heald&Spay Cade.amenthen it
amalhillY-Ocmmw ase lime Wilding
d=not cu coll,s.1cl hew A tenant Net II. 55 3.,125 34.1 m nnafY me oats 'a
=palm a whi tat, lemUpriormiuuenaalesCcnifiatea[ cup�arrjc Signature of Applicant Date
ILXI All roof coverings to be Class "B"or better
Owner or Autho ands em Data