00070034 (2) CITY OF CUPFRTINO
0O°' Y1"0ftK. V ILLIRFiRMIT CONTRACTOR INFORMATION: 00070034
BUILDING ADDRESS: I'ERIVIT NO,
HSIEH, FU—SUNG 07/10/2000
OWNER'S NAME: - APPLICATION NOR DATE
PHONE: SANITARY NO. CONTROL.NO.
C O ARCHITECDEFGINHER; BUILDIN .PERNII'f INFO
_ 61.IR1 ELECT PLUMB MECH
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1.IC1:hatIaCONTRACTOR'sDECLARAnoN ADD WINDOW 1;RS BATH
O z= I Many affirm irvi 1 am Ileenc B under nal provisions,i lis apter Code9lcommI mvc
with Saetlorel(ddefnivi.ion9of the❑ndne,.and Pruldxtonx Code,and mylianse
6 is in full force and effect.
a d S L'lm Class Co a
o u nam S Drt Lcr
ARCIJIT3 G ka—hell C' U 5 DIiCLblic do olid
ON
1 undecatmd my Plnn,,hall M used m Dublic rcwrd, '
at in O O Licermd 11 1...iord
a. OWNER BUILDER DECLARATION
m I hcrchv:JLnt,,hit I:un exempt from the Contmcmr's License Law for the
F.Z r following mood.(Section 7011.5.Business and Professions Code:Any city or county
which refire,a permtoi It,onenno.oler.huprt)ve.nemt)lid,or,epmr any orncture $500
prior to its issuance.also mriren theapflicam for such permit it,file asigned.taamcm '
mar he i,Nerved p....cut to lM pm,i......ofd,a Ct)mmtors Licrn.e Law'Chapmr`) Sq. Ft. Floor Area Valuation
(enmmencing with Section 7180)of Divot on 3 of he B.,inew.and Profession,Code)
in nut he is exen,pr thenfron and the Wv,lotr-tbc ullcgcd excn,ption.Any viol.ilioll r00
of r o cion 7011.5 by any applicant for a pem,it.ubjmnx the applicant ma civil penalty
Fir not ncre man Fine Wndma dular(S500). APN Number Occupancy Type
❑1,zo owner f the property.or my employee,with"ago as[lie it sole cotnpenuGon. I —
will do the wok,and the mucmrc is not ime led Fir otfercd for cdc see.70414,
Endne,x and PmF.dnn.Code:The Commem,,License Law does nm appy In an 102 — P I EfPSquired Inspections.
r of property wilt)build%or improve, ere.....and who dor,xuch work himself
owner
m
rough his own mnphryce..pronded that such improvement,are not intended or 103 — UFER
offered for,ale.If.however.ole building Fir imryovemenr ,sold within one year of
ionipletion,the owner-builder will hen of proving he did not mild or 104 — REBAR
ave me burdg m
nnprovc for purpose or ale.). 105 — ANCHOR BOLTS
❑1,as owner of the proPcny,am exclusively enntmcnng with Iiecu,ed contractors in
n%met it,,porcet(Sec.7044.Bus and Prnfu. s Codef The C,mtricmr's 1.06 — SEWER & WATER
Licere Low does not apply m an owner property wnolbuilds or improves Fluor,
ord wilt) (me(,Int xa.h asicer,win,a cortmrmns>Incexcd pursuant It)me 2202 — UNDERFLOOR PLUMBING
01 am Sec 203 — UNDERFLOOR MECHANICAL
❑Ian,oiLi undar sue. .li h FIC Yoe tilt,ren.,,..
owner Date 204 — UNDERFLOOR FRAME
WORKERS COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
I hereby ifrrt),Linder peadyofperimyt)ox..f the follnwingdeclamtinn.: 301 — ROUGH PLUMBING
�iC
1 have and will mainmin a Certlrcme M Couwui to xeR-I..wa for Worker'` 302 — TUB & OR SHOWER
nmpemmmir as provided for by Section 3700 of the "001 Code. for the
Kifirmaue dobe work for"bids this permit ix i.,ned. 303 — ROUGH MECHANICAL_
❑1 have and will maintain Worker',Compensation insurance.as required by Section . 304 — ROUGH ELECTRICAL
37x1 of the Labor Cute,for the performance of the work lin which this permit is
surd.My Worker,Cmnpen.aaanlommice carrier and Policy numMr are 305 — FRAME
Carrier. PrOeyNo.: 306 — HOLDOWNS
CIiR'IIPICA'1'ION 01'EXEMI'I'ION FROM WORKERS'
COSIPENsn-ION INSURANCE 307 — INSULATION
(Thiaeciion need not he completed ifrhe Permit is for one hundred dollars 308 — SHEETROCK
309 — EXTERIOR LATH
I eerily that in the n in any
of the work lot which fink ct nnir a Woke,I
.hall..m coni..y u..y person in:toy atnnnrr...a,m pompe mnjrr m the Wt)rker< 310 — INTERIOR LATH
Codficma inn[sawst)fcahfnmiaDu1c 311 — SCRATCH COAT
Appliaunr -
NOTICETQ,l ,,i Work,faflCrmrkinioninCio,no t heI-nEsentption.ynushnuld
ow 313 — ROOF NAIL
Meona subject y the rich pr ,ourro moon pro,nermilohall the ceded Code,you mnq
O n,nhwhhet)rpywhhxnrhprovi,v�nsrmixprnnit.nanMaearr�aant)ked' 501.. — FINAL ELECTRICAL ENERGY
CONSTRUCTION[.ENDING AGENCY
I hereby afro Fal them a construction lending agency lot the perl'ormunce 502 — FINAL PLUMBING ENERGY
Z nnhe yank for lieh I...penun i. (See,3097,Civ C.) 503 — FINAL MECHANICAL ENERGY
Lender's Name
z [<we',Adress 504 — FINAL BUILDING ENERGY
U O 1 aenoy Fm I have read this upplianinn and stile that the above iulinnr't'ionin 505 — FINAL ELECTRICAL
I,. Est correct.1 agree to comply wi,b all city and county ordinance.and.mate law.aiming
O U lin Wilding contuuetinn.and hemhv outhmi.e mprewmaves nn hi.my5,,enter anon 506 — GAS TEST
ry
meabove.n"i ioncal propcny for in'
pecuou purrnncs.(We)aSmeor.ave.indemnify and keep nannis,, heCity ofCepemenagninsr. 507 — FINAL PLUMBING
rG liubilltics,judgments,c(ss and expenses which may In any any aced,against ,aid
Uz relue
ly innoetninonegroom,ofthi.permit. 508 — FINAL MECHANICAL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH'ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Sign:;mm ofnpplieanvcontmmm Date Re-roofs 510 — FINAL PLANNING
HAZARDOUS MAI'IiR1ALS DISCLOSURE
Wil the applicant or mrtme budding ouettpan lure or handle ha,amnn,material Type of Roof 514 — FINAL PUBLIC WORKS
a,deGnW by the Cupenino hinumipal Code.Chapter 9.12,and the Ilealth and Selely
Calc.Scoff to 25532(n)7
❑Yea 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant mfuture building occupant use nuipmentorder veswhich If a roof is installed without first obtaining an inspection, I agree to remove
crit hamcia,air omandeam ax defined by Ibe Be,Arca Air Qadny Mi c,cm
District? all new materials for inspection. Applicant understands and will comply with
Oyer ONo all non-point source regulations.
I have mad the hua thous mammas requirements under Chapter 6.95 al'he
California Ilealth dm S;dc,y Code.Section,255115.25533 and 25531.1 tmdemtand that
if the Wilding docs nor turmnny have a meant, but it is my rcvpomibiliry ro doily the
occupant of the mq,,mnanta which nn be nal prior m Ixwtu¢c of u Ccni E.am nl
°CCOp°"`y Signature of Applicant Date
��D.oZoo
Deane mammoth:mage [lata All roof coverings to be Class "B"or better