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03050071 (2) CITY OF CUPERTINO ""'^` `"e { - s BUILDING DIVISION PERMIT �.CONTItACTORINFORMATI©N s;:. BUILDING ADDRESS: WATER SYSTEMS PLUMBING PERMIT N'03050071 OWNER'S NAME: 3844 HEPPNER LN PERMITk55{jPSD7 6/2003 U CHENG-CHIH NE: (408) 266-8222 SANITARY NO, CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH cpZ, LICENSED CONTRACTOR'S DECLARATION Job Description U C I lemby affirm that 1• iia d under provisions or Chapter 9(commmehiS p U wide Senion�BflB)ofDi,e f lBusircssarb Profestium Cade.and mYliccrue is �In aALED � N inmB fhh1�aa,,anile tete 028 REPIPE (2 BATHRMS) Z n Z Lkense.Crass 6 S Lk.0 nt•0 Da ARCHM FGo"RATIONr " MAY 2 7 2003 I undersand my plans shall b,used as public Iecn1W DyU 30 L Licensed Professional BUILDINGOW OWNER-BUILDER DECLARATION F1 I craby anion that I am exempt from the Contractor's License Law for the a p 0 following mason.(Sccuun 71D 1.5,Business and Profe cions Calc:Any city or county u B which rogoiros•permit W cmmlmcL site,improve,dcmalish,or repair any mruemm poor at its imam.also requires the applicant for such wrmiuo file a signed sutemcm �Zxx< that he is licensed pursuant o the pmArimn of be Cmarutofs License Law(Chapter 9 Sq. Ft. Floor Area $516ibietion e�sF$ (commencing with Section 7000)of Division J M the Business and Profusions Code)or �.- that he u exempt thmcf c m and the baso for the illegal uenpdm.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant W a civil penally of 3 A?N] h&&er0 0 Occupancy Type not port Nan five hundred dollars(S500). 1,As Owner of the property,or my employees with wages M their WIC compensation, will do the mark.and the stoncwm is not intended or offered for Sale(Sm.7064,Business 2U2 — """'V and Pmrusimu Cade:The Convenor"License Law does not apply W an owner of 301 — ROUGH B property who builds or improves thereon,and whodoessuch work himselfortluough his Own employees.provided that such improvements are not intended ora@ted foreal,If. 502 — FINAL PLUMBING ENERGY however,the building W improvement is sold within one Year of mmplm on,the ownan builder will have the burden of proving that he did wt Wild or improve for puryou of 507 - FINAL PLUMBING sale.). 1,As owner of the property.am exclusively contracting with licensed comandourra W comtroct the project(Sec.70,14,Business and Professions Cade:)The Contractors Li. certain law does not apply W an owner of property who Wilds or improv thereon.and who contracts for such projects with a convacum(s)licensed pursuant W the Convenor License Law. ❑1 am exempt under Sac. .B&P C for this rcuon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby aRrre under penalty of perjury one of the following declaration: I haus and will muntain a Certificate of Consent to self-insure for Workers Compem 13:700 ion,ss Provided for by Secdan 3700 of the LAW,Cade.for the Performace of the rk for which this permit is issued. 1 have and will maintain Workars Compensation buaance.as tequimd by Section of me fabar CodAs for Ne perto tete of Ne ch this pennon is issued. Wo d Com rasa I a Imm�nce crier Wd Policy n rr. 'SffA f �Vn N.Y CERTIFICA OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed if the permit Is formic hundred dollars(SIM) or Mss.) 1 certify that in the perfmmantt of the.,it for which this permit is issued.I shall not employ any person in any manner W As W become subject in the workers Com,ensadon Laws of Califonais.Doc Applicant NOTICE TO APPLICANT:If,after making this Ccnificatc of Exemption.you should ,atone subject W the Workers Compensation provisions of the Later Cod,you muse ,J O foMw ds comply wilt such pnivisic.or this permit shall W deemed nevokcd. z- CONSTRUCTION LENDING AGENCY 'T. 1 hereby affirm that Nem is a construed..lending agency for the pelf...of C 7 the work for which this permit Is issued(Sm.3097,Civ.C.) U 0 1 Leader's N..z Lender's Address U P 1 certify that 1 have mad this City And conn and sate as the above cos rA euun u U.0 U burtacL I agree m comply with ill city rd county nuuli wof and cute laws enter upon the pU buildingconstruction,and hcmbynify And lrcp lunutivof this city uPortiuponm( above-mcnuoned property,for insi moon purposes 6. es ji agree W ave,imd cmpcn And kith harmless the City of Cupcnst s id City Uro liabilities judgmcmn,cosnendcapenscswhich mayin any way eccmc against said City V z in omeguexe of RS1>gof mss per mit. Date PLICA N RSf 5 AND WILL COMPLY WITH ALL NON-POINT Issued by: O TI Re-roofs Si nawrc of Applicant/ onraclOI Dae of Roof HAZARDOUS ATERIALSDISCLOSURE Type Will the applicant of future Wilding occupant store or handle hvaNaus mateoal As dcrinod by the Cupertino Municipal Code.Chapter 9.13,and she Health and Safety code.Seedaa 255314)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu OO Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove it havallous air cooumim est As defined by the Bay Area Air Quality Managcmant all new materials for inspection. Dislrics7 ❑Yes "NO I have read be havaNtmrsmautrialsmquimmenu under Clupun6.95 of the Calif d, nia Hcalth&Safcry Calc vom25505.25533 and25534.1 undcrsWnd this ifthe Wilding docs not currently ho tenon at it u my respomibility W nuury the Occupant of the tore 1 1 nor is ceofacendficaneOfQc ancy/ Sig nature of Applicant Date S All roof coverings to be Class"B"or better Owner raw Oriacd agent CITY OF CUPERTINO ag,,K)l REPIPE/sEwRsiAIN SERVICE 03 �� $CUPERTINO PERMIT APPLICATION FORM APN # ' - 3 _ D 6 Dat Building Address: O I 36 Lh Owner's Name: Phone #: r 14 S L-1 R SS - / S Cent rac or: S Phone: 6 License#: W=11 Contac : r- Phone: Cupertino Business License #: kt � V'rw rf - D 94 Y, Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: F, Pr P t- Residential in Commercial ❑ Cost of Project: oa :4 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING