01120068 (2) CITY DrsDVSONO
ILIiiNPERMIT CONTRACTOR INFORMATION: -
.BUILDING ADDRESS: PERMIT NO.
10069 OAKLEAF PL 01120068
"ONLM6"THEN/CHUNG Y SHIH APPLICATION
2/18S/2001
DAM
A� iONEE:N _ SANITARY NO. CONTROL NO.
M'ac 2, ARCHITEC(ENGINEER: . . .. ... .. .. :. _... .. ....' : .. --.: .....: BUILDING PERMIT INFO ._......
ti le- BL EL' P UMB M I
W, IL-.1 L 1
w:Gd
N LICENSED CONTRACTOR'S DECLARATION IO Descriptio
hereby Brian Ilan l am licensed under provisions of Chapter 9(commencing,
w;thsectpinn)Puumroivnron3anneBasmeasanapn,m>amnsn,de.ammyhcense KITCHEN REMODEL
n force and effecL.
Lkenne Class Li,a
a a O Dom Convaaor
,
ARCHITECT'S DECLARATION
Lilo; ra ups�etFumA;my;Pl:m.v shall mused as public irmrdz
le.
C o L fen J R sf>�etbtal. IL ., .. ... ... _ ` .
' 'OUFCR❑UILDLR DCCLARAT16N " •- � � � '
uxs 1 hereby anion that 1 an exempt from the Contractor's License Low for the
F Z hollowing reason.(Section)031.5.Business and Professions Cade:Any city w county $25000
-
C,�❑ 'which mquires a permit nm em"me'.cher,improve,demolish,m hepar any awaure
a3� ,pnu t L 'also 9 'rc m PPlic tf hpcnnu fl .'g al smmmenL .... ..-_ _._.
ma he.Ice sedp uocmm"U airon rth C L noraL In, lClmme 9' - -
(comme,c'nawtnsect n]000)arD.,i 3 of
Bashes. dP rsnn.ende) l'•„L3$� 6�JI3S[.bQyq 1tr:"j: Valuation
m mm be
is exempt
therefromand Lhe box
is rot he
allege(Client inh.Any violation -
•uf5mivn)031
5 by any applicant
for v permit subjects the appliCan,m a civil petarlry
afoot mart limn five hundred dollars M(sh. 101�PN tfvlT1[1113JDATION " ” Occupancy Type
T1as owner lir the property.or my employees with wages as their sole compensation, 102 PIERS
do the Work,and the atmaorris nor intended or offered to,sale(see.)(w, 10 3 - UFER Required Inspections
owner Buserss and Professw
Propositions Code:The Contractor's License Law does not apply to an y p
sew of property Who Builds or improves thereon,and who docs such work himself 104 - REBAR
or through his own however t provided that such improvements me not intended
year Or ._
offered!forI' Ir however meWilding p t la to held or - - 105 - ANCHOR BOLTS ' 'completion,then Idc 'll have thburden prayingfthat hdid Lbuild or
nap rpm.: r l 1. 106 - SEWER & WATER ,
X "PLUi (Lhe prti meaew.vly untracting withlicensed contractors to - 202 - UNDERFLOOR
MBING
itinvet th project(Sec7u44 Business ondProfessions cad ITB Contractor 1 203 — UNDERFLOOR MECHANICAL
License Low does a.t apply in as owner of P openY IsM10 Wilds or P <s thereon,
aid ho contracts for such pmlaas.With a Coloss fa)licensed panoan to the - 2 04 -'— UNDERFLOOR- FRAME
Contractors Liccnse Law
01Waexempt a Stt. 10 B&PC for his Ana 205 - UNDERFLOOR 'INSULATION
ow�ar C �. Date 1 /2--/e-J/ 301 - ROUGH PLUMBING
WORKER'S COMPENSATON DECLARATION ,302 - TUB & OR SHOWER
I hereby afrounder pentary of fa Jary one of the fauawing deemmnoaa: 303 - ROUGH MECHANICAL
a. c�f;no�y'anp;win;mamLain ;ce�m�aebr cn�(enrt�self-inane tar workers 3 04 _ ROUGH ELECTRICAL
tape s i n, 'as.,provided for by-Secuon 3700.lir the Ial,or Code, tar the .. - .... .. .. . ..
'air arra.ser the work for Which this Permit is tsmed. 3 05 FRAME ..
❑1 have and will maintain Worker's Compenmrion Insurance,as required by Section 3 06 - HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this permit,is 307 - INSULATION
issued.My Worker's Compensation Insurance carrier and Policy number arc: —
308 ::_ ' SHEETROCK..
DO Icy
Caner ' sCl'RTIFICATIONOFF-%EMPTIONFROM,WORKERS' '- t ' r L 3O9�1f-''EXTERIOR -LATH t
COMPENSATION INSURANCE • ' °
--3"10 ,-7 INTERIOR-LATH--
(Thisiectionneed;orbecompletedif[heper it is for one hundreddollan 311' - 'SCRATCH COAT
If 100)or IessJ
` Benny ma.in he rmroirnee of he Work for Which this m,i
i:pet is ismsJ:1 ROOF NAIL
shall not employ any person in any manner so as w become subject to the Workers 501 - FINAL ELECTRICAL"ENERGY
Compcnaanan laws or California.D01C
Applicata 502 - FINAL PLUMBING ENERGY
- ...
-
.NOTICE TO APPLICANT.If.afar making this Certificate of Exemption,you should 503 - FINAL MECHANICAL "ENERGY
O pbecome subject to the Worker's Compensation provisions of the Labor Cade,you must
forthwith comply with such provisions or this permit shall be deemed revoked, 504 - FINAL BUILDING ENERGY
F-I,) ' CONSTRUCTION LENDING AGENCY 505' - FINAL -ELECTRICAL '
m > Iherebyannorthattheseisacomwctionlendingagencyforanepermedmance 506 - GAS TEST
r of the work for which this permit is issued(Sec.3090.Civ.C.):
ti q Under'sName' 507 - FINAL PLUMBING.
o z Lenders Address
r'.) O Iecnifymatlhave lend this applicationand statethrottleaboveinrrmaionix 508 - FINAL MECHANICAL
IL'F.r •coarser.1 agree to comply with all city and county ordinances and stain Taws relating 509 - FINAL GRADE
O p to buildingmmwciion:and hembytONCr6mrepresentatives Ofthis City to enter upon 510 - FINAL PLANNING
t>a the above-mentioned property for inspection purposes.
IS '(Wel agreetosave,indemnifyandkeephamuess'heCityofCupertinOagvinst -
h liabilities,judgments,costs and expenses which may in eery way accrue against said 514 FINAL PUB IC WORKS
U Z' City in conserpience'Of the gmnring Of tbispermn.., >
SPPLicA oo FU RSSTANDSAND WILL'COMPLY WITH ALL NON NT' ]SSUed by: D3Ie /`
ig afore lir APPlinnAate : Re-roofs
HAZARDOUS MATERIALS DIS OSURE
Wilt the pp.fa to futbrcbu(ding L L ser handle Health and Safety ..Type Of ROOF. . . _ - .. - --- - - -. -
'as dc:S.by me cuMnm Mu pal C'
pL 9 1 i,and theHealth and Safety
Cod Sm n 25537(e)
°Yoh " No All roofs shall be inspected poor to,any roofing material being installed.
Will the applicant or forms Wilda cupant use equipment or devices Which If a roof is installed without first obtaining an inspection,? agree to remove
.mit hazardomus air Co o nsois as def by rhe(day Area Air Goal,Management
ka,ricn all new materials for inspection. Applicant understands and will comply with
°Ycx "a- - all non-point source regulations:
1 have read me noted.,marcid,requirements under Chante,6.95 of the
California Health&Safety Cada Sections 25505.25533 and 75534.1 understand that
if be building does not contently have v moat,mat it is try rcspnnsihiliny era notify the
xcupanL of the requirements which must h<met prior to issutntt or a Cenifiote of
Signature of Applicant - Date _
nerpr•authorized agcut - - - Date All roof coverings to be Class "B" or better
- - OFFICE -