02050049 (3) CITYOF CUPERTINO
BUnAING DIVISION PERMIT ','CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
8056 PARK VILLA CL CHEN' S CONSTRUCTION 0 02050049
OWNER'S NAME: APPLICATION SUB DATE
MARIA CHAU 1271 WASHINGTON AVE 05/08/2002
PHONE:
SANITARY NO. CONTROL NO.
(510) 639-0853
ARCHITECf/ENGINEER: BUILDING PERMIT INTO
LEPLUMB MECH
yad 7 �.
.�y= LICENSED CONTRACTOR'S DECLARATION Job Description
S z m I hereby Rrthat l am licensed order provisions of chapter 9 mom osmaing
:=t:W with Sec,ion7000)ofDivision3oftheBusinessandprofessions rd and my license CHANGE WINDOW/KITCHEN REMODEL/
,a full force and e O\
ipos License ass
Licit— - KITCHEN KITCHEN CIRCUITS UPGRADE
S DECLAr F8�S B A n E
ARCHITECTS D meson 11�'1 �m
1 csst d my plans sba11 b<used as publi cw ,
i S5 p p Licemed professional JUN 1
, 1 hereby affirm the 1 OWNER-BUILDER
exempt Eform Eme CovacOtor's License Law for the• + ZOOZ
u��
h?< following reason.(Section 7031.5,Business and professions Cade:Any city w county
E F C which requires a permit o consweL alter,improve,demolish,or repair any structure
ud7 Ca.am prior to its issuance,also require mi
the applicant such pertnofile a signed statement
out he is licensed pu..an,an the previsions of the convectors ucem<Law(Chapter 9 jSq.!Ft. tlo��-fjea_:!:-=, aIUatlon
(commencing with Section]Oq))of Division 3 of the Business and PmfSss'nsCrd<)or Drat he is exempt mercfmm aid the basis for the alllged exersomit.Any violation -of Send..]031.5 by any...fictrd for a prnnirsubjects the ii,licom is a rnil pe.I,y 4 go
•or not marc than five hunched dollars(x5001. ALFN Number Occupancy Type
01,as owns of the property.m my Implores with wages as thdr sale ror,cout ion, I _
will do the work,and be svucturc is not intended or offered for sale(Sec.7 4.
Business and Professions Code:The Contractor'a License Law does m,apply to an 102 - PIERS Required Inspections
owner of prop my who builds or impmves thereon,and who does such work himself
or through his own employees.provided that such improvements are not mended or 10 3 - UFER
cReied for site If.ow however,the Wilding or improvement n sold et he did not year of - - - -` -
completion,N<own<r-Wilder will have the burden of proving that he did no,Wild or 104 - �REBAR
nprovefarpiirposeofsale.). 105 - ANCHOR_ BOLTS
01,as owner of the property,on exclusively contncting with licensed smarecmn to 106 - 'SEWER & WATER -
construct the project(Sec.]flee,Business and Professors eWe:)Tate Commnor'e 202 — UNDERFLOOR PLUMBING
License Law does not apply to an owner of property,who Wilds at improves thereon,
and who conosou for.sum projects with..cornmcmr(s)licensedpursuant to the 203 - UNDERFLOOR MECHANICAL
Contractors License Law.
0 l am ammpt under Ste. ,B&P C for this reason 204 - UNDERFLOOR FRAME
" " owner Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
.+ Ihereby affim,under penalty ofparlor,one ofthe following detonations: 302 - TUB & OR SHOWER
4 0 I have and will maintain a Certificate of Concert to self.insare for workers 303 - ROUGH MECHANICAL
Compensation,as provided for by section 3700 of the Labor Cod<, for the
performance of the wan far which this permit is indeed. 304 - ROUGH ELECTRICAL
01 have end will maintain Workers Compensation Insu..es required by Section 305 - FRAME
37W of,he Labor Code.for the prfommuce of the work for which this perm t is
My ark<fseJa^mpensa/dp�nlnsuranee'ear.,eana sir be arc: 306 - HOLDOWNS
c.rtier� Gtryi�ip=Lg-policy 30,7 ''INSULATION - -
CERTIFlCAT161l OFEXEMPI'IONFROM WORKBI(5' _ .308 - SHEETROCK'
COMPENSATION INSURANCE
_.
LATH--'-
mos(This section need not be completed if the permit is for one hundred dollata _.. _. .._....._._. ._
(aloo)on<ss.) 310 - INTERIOR LATH
I certify that in therm
perfaane ofthe work for which this permit is issued.) 311 - 'SCRATCH- COAT .. .
'shall not employ any person in any manner so as to become subject to th<Workers 313 - ROOF NAIL' '
Compensation Laws of California.Date313
- FINAL ELECTRICAL ENERGY
NOTICE TOAPo the Workers If.after Compensation
this visinsofthcate of Exemption.you,youmulst 502 - FINAL PLUMBING ENERGY
became subject y the Workers Compensation morrit oro of Ne Leber devot you must
O forthwith comply with m<n provisions or this.erma snmlWaecmed revoked. 503 - FINAL MECHANICAL ENERGY
t"t,r7 CONSTRUCTION LENDING AGENCY
(~ Ihereby afnrmthat them isacommotion lending agency for theandamwce 504 - FINAL BUILDING ENERGY
of the work for which this p.it itissued son.309].Civ.C.) 505 - FINAL ELECTRICAL
q UnAddress roder'sAamm
Z ' 506 - GAS TEST
LL Unider's
7
Icenifymat Ihave mad Nisapplicationand state that the above informationis 507 - FINAL PLUMBING
w p Correct.l agree to comply with all city and county ordinances and state laws relating 508 - FINAL MECHANICAL
O U to building constmamn,and hereby authorise opresenutive of this city to enter upon
W 1W Wm-moraed
.rpmpany far inspection purposes. 509 - FINAL GRADE
Pr fwe)agree t.mile.indemnify and keep harmless the Cily of eapcnino agvnn
WKYIC�W
' dgmenu,casts and ap:mes which may in any way edema it imr said 510 - FINAL PL
U 4aquence of the grams9pof this pemtit.
UNDERSTA,\'D"WE W ILL CO P ITH ALL NON IM' 514�- N G �/
a 7 .� Issued by: DA plica ammo. Date Re-roofs
HAZARDOU MATERIALS DISCLOSURE
,1l the applicant or furore Wilding occupant store or handle haralloas matadel Type of Roof _
ss defined by mc CuPeNm Municipal Co la.LTaper 9.12.and the Hcdth and Safety
Cade.Section 25532(.1] -
0Yes ONo All roofs,'shall be inspected.prior to any roofin teria]being installed. . ..
wmtbe,ppbesnt sir nature Wilding occupant use equipment or devices whish If a roof is installed.without fust obtaining an inspec I agree to remove
emit Industrious me air corrections;futu az defined by the Bay Area ip Quality or evicesManagmem
_N District! all new materials for ifispection. Applicant understands an 1 comply with
t( g °Ycs ON. all non-point source regulations_..
• 1 have Health
the hazardous ecd rials requirements under 4 1 un 6.95 of,he -
California Hedth x m ciy Code:recta um.m.0h t i,is and 25530.1 undersand that
occ a res not arecia y h most
or that iN,my pons of a to ratify the
occu t of the rcquircm<nu w ' must W sun prior,to' uancc of•C rx fladat f _
oe party' Signature of Applicant Date.
Cbasert;r flboriztdAccd Da, All roof coverings to be Class "B" or better
.. - OFFICE
CITY OF CUPERTINk,)
CITY OF IAI PPLICATION FORM
CUPETI .._......_/
Date:
Wing Address:
Owner's ame: Phone :
Contractor: License4:
Cont Pho #:
_ 02
Applicant/Contraptor:� Fax#:
Building Permit InfK
Bldg Ele t Plumb ech
tion "2"�-*I+` a,/ C I t(GC
Residenti f Commercial:
oor Area: $/Sq.Ft.:
Architect/Engineer: Valua '
YAft �
Type of Construction: OCCUPThcy Group:
Quantity Fee ID Fee Description Fee Group
APTFEE EACH STORY OVER 3
HOTELFEE EACH STORY OVER 3
OFFICEFEE EACH STORY OVER 3
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX hid/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A • ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
• BNEWMULTI New Multi-family Res ELECTRICAL
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