03020113 (2) CITY OF CUPERTINO �� "' �E,•"
BUILDING DIVISION PERMIT r. 0Wd l (G' t1•�L I U"MA" I� l
BUILDING ADDRESS: PERMIT NO.
10121 PHAR LAP DR 03020113
ov(NI?_ NA&E SHARON HOO PERMIT ISSUE
04/09/2003
Itl) SANITARY NO. CONTROL NO.
ARCHITECIYENGINEER: - _ BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
300 LICENSED CONTRACTOR'S DECLARATION Job Description
1 thereby M.Net 1 am licensed under provincesfir Chapter 9(...,Oct.$ p
with Section 70f r)of Division Sof the Business ard Profeadons Code.and my license LL
^< in full force and erml
jgzLicense Class Le.9 ADD 300
[to SQ. FT. /KIT.' REMODE
Dem r
ARCHITEC`rSDECLARATION
�=99MA,Ra®
' Iundersaused u nd my plans shall be upublic rmooh,
0Mto
LicensedPoressional SEP
1] 2 a1 �o o�
i OWNER-BUILDER DECLARATION JCP<m I hereby affirmthar I em exempt frum tie Conumctol's License Lew for the
Lao following resume.(Section 703 1.5,Business and Professons Code:Any city or county
3m which requires,permit On construct.alter,Improve,demolish,Or repair any structure R. II /�
prior be is boosted,also requires IM applicant for such permit to rile a xigned statement
<
met heislicensed pmsuenttothe provieionsOfthe Connector'WscnrcLaw(Chapter 9 Sq.Ft.Floor Area VIIInaIi n
a (commenting with Section 7000)of Division J of the Busineusnd Poorm ns Code)or 90000
f R R that he Is exempt shcmfmm and the huts for the alleged exemption.Any violation of
Search 7071.5 by any applicant for a permit objects On,applicant to a civil Faculty of _y §n1,jr, 0 0 Occupancy Type
not more man five hundred dollars(55(10). 3z617i
❑1,u owner of the property,w my employees wish wages as heir sole compcnsstlon,
will do me work,and me atm<tum H ons Intended or offered for salt(See.7044,Business
and Profealons Cade:The Curvatures License law da,not Apply to an owner of 101 - FOUNDA79lbO Inspections
property who builds or improves demand whodoenuch work hlmselfortheough his 102 — PIERS
own employees,provided that tech Imprewermu ate not Intended or offered(male.If.
however,the building or improvement is sola within one year ofeempletion.the owner. 103 UFER
builder will haw the burden of proving that he did not build or improve for purpose of
me). 104 REBAR -
1,as owner of the property.am exclusively contracting with licensed contractor to 105 — ANCHOR BOLTS
construct he project(Sm'7044,Business and Pmfeseiom Code:)The Conmmor's U 1O6 — SEWER & WATER
come law docs not apply m an owner of property who build,or improves thereon,and
who contractsfor such projects with a contractor(s)licensed pursuant to the,Contractor's 202 - .UNDERFLOOR PLUMBING
Licence taw. exof he" ttrh er ea B&Pe hA.M.,much 203 - UNDERFLOOR MECHANICAL
Own oa 03 204 '.r UNDERFLOOR FRAME
ORKER'S OMPENSATIONDFALARATIDA 205 - UNDERFLOOR INSULATION
I hereby Niro under mostly of perjury one of the f ng declarations: 301 - ROUGH • PLUMBING
yaw and will maintains CCnir1CAteof COnsenL 1.seIN....fo Worka's Compete 302 TUB & OR SHOWER
`;'kiorwes pmom:farmiii"ssued.3700.17 ft Laborcnee.mrthe parrma rrflhr 303. ROUGH MECHANICAL.
❑1 have and will maintain Worker,Compensation Insurance,as inquired by section 304 — ROUGH ELECTRICAL
1700 of the labor code.for me perronnnce of the work for which this pormlt LL issued. 305 - FRAME
My WOrkeea Chmpenestion Insurance envier and Policy number art:
Grier: Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION .
COMPENSATION INSURANCE
(Thls,oction need mule completed i(IM remit 1,throne hundrtddNlan(5101B 308 — SHEETROCK
.1c..) 309 - EXTERIOR LATH
T mmry that in the pax Ince of me wok for which this Permit sauces,I m.n net 310 - INTERIOR LATH
employ any person It ^Ironer.umM eat to lM Worked Compe0 lion
Lev'Or California.Dam �•X"��Y"�a, 311 - SCRATCH COAT
0z 313 - ROOF NAIL
NOIC APPLICANT. form Ing this ceninate of Exemption.you should
bar bjeclloth,Worka'.Compensulonprovide..(melaborCode,youroust 501 — FINAL ELECTRICAL ENERGY
'O forthwith comply with such provisions o this Permhehai Mem
deed revelam. SO2 — FINAL PLUMBING ENERGY
�^ CONSTRUCTION LENDING AGENCY 503 - FINAL MEC HANICA NERGY
1 therebyallirm that mere Is a connrearthm lending agency for the performance of
x> me workmrwhich this permhLLiuncd(Sm.3097.CN.C.) 504 - FINAL BUILDIN t Y
M Lender:Name 505 - FINAL ELECTRI
Z Lcnise,Aadress
p p 1 certify
Dat 1 have mad this,pplioumn and mm that the above information is 506 - GAS TEST
Fcorrect.1 agree to comply with all city and county on inances and hate laws relating to 5 7 — FINAL NAL PLUMB I
C.) building convection.and hereby authorize representatives of NLL city to Color ulen the
ehova-mentioned propcny for Inspection purposes. 0 "FI L MEC ICAL
y (We)agree m save,indemnify and kap hrtmlers the City of Cupertino against 9 Ilabilides,Judgments,costs end expenses which may In any way acme againstsaid CityZ In eonsequenee of dm granting of tispermi. /1APPLICANT UNDERSTAND 'AND WILL COMPLY WITH ALL NON-POINT Issued by. 5NGDate
RCER L Ns. Nc11,91.'3Re-roofs
Sign.tureot Ap nVCon nor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building oceupanta ice,or handle heardeus material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.sans..25532(.)7
❑Yes Nu All roofs shall be inspected prior to any roofing material being installed.
10 Will ma applicant or future building occupant use equipment or devims which If a roof is installed without first obtaining an inspection,I agree to remove
L'bihes. to eIt contaminants as defined by the Bey Area Air Quality Management all new materials for inspection.
C17
Dyes �QNu
I he,.reed the haeaNnusmeterldsrcquimments under Chepter6.95 of thc Califon
ri4Hwlmipg
5,25511ana 511.lundematdthatlftim building
duct nott Is my mePonsl m notify the acupanl N the
caI m n issuance or Consr `yr,anjy.. Signature of Applicant - Date
Owner or autho'ed ep, �/ Dam All roof coverings to be Class nBn or better