02070174 (2) ITY OF
C
BUILDING DIIVC,ISIONVOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19191 PHIL LN 02070174
OWNER'S NAME: APPLICATION UB DA
KAM CHU 07/26/2002
pp PHONE: SANITARY NO. CONTROL NO.
O o ARCHRECTIENGINEER: BUILDING PERMIT INFO
FF BLDG ELECT PLUMB MECH
L= U
Z y= LICENSED CONTRACTOR'S DECLARATION Job Description
Z 1 hereby aff nn that 1 am licensed under provisions of Chapter 9(commencing
O
O<Z E with Section]000)of Division 3 of the Bu'mess end Professions Cade, it my license GEN L ELt�T G}AL
Y y m< Lin fy I(ecce andakct. �I -
eco�6 Dee Clms {••/ Ltizz Cic.M t
D�
O ARCHITECr'S OEEB[ ,#-J'
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ta x nxa n pa rams �
6 0 o teen
s OWNER-BUILDER DECLARATION
I hereby affmm that 1 am exempt tram the Contractor's License Law for the --- _
I:Z< owing reason.(Section 7031.5.Business and Professions Code:Any city or county $6000
I F❑ which rcquirts a permit m conawn,eller.improvq demolish,or rtpeir any swctum
3 ..p or ora--,a
ance,al ortquhesNeappl a......
fo s hp mut bileatigrcdamxm m
[hatit5 is licpn9ed punuanll¢thb pmvlsfan of N<ContrecmrY Licenx lsw(Chepmr9 '•', Valuation
(commenup8>with sec,jon,j000) fOivision Sof the 8us�neppa'nd Pwaasmms code) �b,j�t'k 3YTL]�f�+V" A• .�aki1:":1 7.3.,
at Nat fie Is exempt therefrom and the breis for the elle$nd ckemp,ion.Any viehtion
-of am.9031.5 by any applicant ter a permit subjects the ti heves bad.,pang ,�Ta,a�n{a P Y TYP
.nr nnemore,han five lam dollars 15500). 304 APNAbIff7f{ ELECTRI L""" : `O Occu ane e
O 1,n owner of the pmpors,ur my employees with wages as their sole compensation, 501 - FINAL ELECTRI
"waime:thead Pim.ars, gi Neme:Theure Contractor's nocimended Lice a eredLaw for salenot(SeCapply to an - '- - - �,t,-�,-I-
ownerss end Any Who b Code The vestheLicense Law dos m[apply tom 505 - FINAL EL$@{Pii eJ[IQils�eenons
owner of property Who builds or improves thereon,and who encs such work himself
or
m inmugh his awn employ re provided ilial such improvements enot intended or
-[offered for isle.If.howaver.th,wilding or improvement is sold wnhm aria Yeer or
completion,the owner-Wilder will have the burden of proving that he did not build m `
improve for purpose of sale.).
ormarrcttWmjw the pmpcny,am excBusiness
and ntrdnisi-withCode:)The,
oninguto nt'I'; q ".: ". tett
concis the Project(Sec.)014,Business and Profession CodoO The vesMe o, , e F I. '3 •'l.l d. P
Licene Law ems,wt apply wan ounce of a.property who builds or improver Merton.
_red.whitr`,Liatla.for suchaw. , roia[s.wiN.11 1. torts).Iicensed.Wraumtwtne_.._.__ .._. ____..._..__ .. ..__._ _..._._.._.__._._.... ..._i.._._....._.—..........
—..___...___.__._...
131 an extra
License Isw. ._
- - ❑lam<umpt usdcrsx.�, �� .., ',(B'&Acfor Nis rearm
Ower" ``Date ..
WORKER'S COMPENSATION DECLARATION
I hereby atlinn under pemlry of perjury one of[he fallowing declarations:
0 1 have'and'will maintain i Ceiuficate of Consent w self-insure for Worker's
Compena,I... . provided far by Section 3700�or Ne labor cone:for Ne
atde of ad woh for which this permit is iss
perfonnued.,
- 01 have and will miamisin R'drkei's Compensation Insurance,u required by Swim
9700 ofW Labor Cafe for the perf.magic.of the work'for which this pemut I,
issued.-bWark,es C pc von las. artier and Policy nuirdia e:
am eTFi4'T-vI .. ((". POI cygY (�. ( s`- s, 1 ! \ i'.;1
'rCERGFICATION OF EXEM N FROM W4 !'_
RANCEIO
OMPENSATN INSU
.. _ .. ':..v. . ,H,...- .....__. .._... __. . . __ ."_,_._..... _..._._ .__ ._..�.,...,.....
(This section need not be completed if the permit is for am hundred dollen s yC. ^•a , s )i-'1P.. ., a,
,
(5100)or less.)
'I cbtify'thu m the perfo'rmrde itFhe ark fm wNch th is is,mut is
shall,Ant employ-my Person in any manner w as in become subject to the Workers
Compenadon Laws of C.1ifnmia.Dam,
N CETOAao dae ,H,agermaking tiit thisCertificateof Exemption.youu mum , .
become mbjeci y the suchdmrrx
pr C'mpensathis permit shalt
me Labbr Cade,you must
cc (onhwiN comply with such provisions m this permit shall be dame-rcva-
�- CONSTRUCTION LENDING AGENCY " ' '"�•
a > !h mby affimn that Mere is a construction lending agency for the performance -
L Q of me wank for which this - -permit (Sec.3097 C)_",
Lenders .Cn .` _.__.�
Name--.--+.— [rs,ssud:...__... ..,._ .. a'.v':-..::-..i, ...._.._....__...__. _. _. _ _ ...__...... .__.. _
Z Lenders Atltliess".,.. •. . . ..
h1 cenify Had I have read Nis application and state Nat Ne above mfomwion is t
ILi[r corieei bagree arcomply with site ind county ordinances and state laws relating
- (7._r, t convection.aid hereby rout msrnd,ives of this ciry as entcrupan
Gt) _epw ntionedpropestyfo^nx on puryoxs..
agnx to saw. keep ion
harm),ache Cni of Cupertino against
liebili,ies, udg nine
ros penx. wheA may,in any way xcrve against said s..�
' U Ci -uence of Ing of s penniL "' n �JV�
PL A ER A.- AND COMPL WITHALLNON. INT i
u cE a AT v Issued by: Date
o - nose .: - _ .. Dab Re-roofs
US MATERIAIS DISCLOSURE ,'
W de-ppl ret a fumrt wild ng ace pmt store m harWe material ..')Type Of Roof.. .... .. ..... ..� y�.-._....,..,..
las deli by Ne C pervno Municipal a Chapter 9 I7 d the Health end Safety f _ i +s• t.• S
Cad ot:us3ua , ar ... , -gr ' ' IV r. " 1 i.' t . tl 4f 'air�•'
All roofs shall,be mspected.prior.to_any_roofirig,material being.ins,talled.,,_
will wit peen an,or future Wild vent tau q .pm t device,whim If a roof is installed'without first obtaining an'inspecnon'4 agree tdremove
emir bessid s air coma,mtwms as& by Ne Bay Arta Ali Qualtry Management
Drink,a all new materials for inspection. Applicant understands and will comply with
p „ _ all non-point source regulations-
it
have iced Ac'hanrdoui 'els rtquiremrnti under Chapierr5.95 of the
Cdifo in Hcahh&Safety Code05,35533 and 25534.I understand that
i0 1 it cunen a am,thati[ismyresponsibilitym..,i%Me
rep of tIt - qa meats m s he met poor to issuance f a Cenflf. of
.. ^
Oce
"Al Signature of Applicant Date
6,z; _. _ ..
„ All roof coverings to be Class"B"or better ,
- - _. . . ..