00120001 (2) CITY OF CUPERTINO
BUILDING DIVISION - PERMIT CONTRACTOR INFORMATION:
RUILDING ADDRESS; PERMIT NO.
1, 1.0132 PRADO VISTA DR CHOLA, J. CHIA`& SWEF_ IN 001.20001.
yOWNER'S NAME: AI'I'LICATION SHE DATE
CHOK J. CH 1 A & SWEE CHIN 1'x'/01'/'=000
ZONE: SANITARY NO. CON'rROLNO.
n,a Z A RCHI'TECTIENGINEER: BUILDING PERMIT INFO
tom•w BLDG IiLEC'I' PLUMB MF.CH
1,U
5 N Z LICENSED CONTRAC'TOR'S DCCLARAOON Job Description
L= l leraby idron'hal l urn Ifecnsed under pmomiol,x of Chapter 9 ccononencmg
rrm�u withSecti-70)(h of Divfninn3of Om 13usinesn rind Pmlessimax Code.anA my licence
in fill force anad cOcet. SHINGLES TO TILES
d C K 6 License Clues Lic.IT
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x O ca U Dare Cunfmcror -
Tri 3 u y ARCHITECT'S IIECLARAI'ION -
u r 1 undervmnd m I 1 II ho uwd as' hlic rcconla vnanasaa pn
w
LiccnscA Pn'ofcaional
es
OWNER-BUILDER DECLARATION
a'�w= 1 hereby affrin:hal I um exempt I the Cnnlmdorc Licca,Lnw for The '
C Z following rcna,n.0s,,"ion 70315.Business and 1'ml'.,00a,Code:Any ctry nrenunry -
M O which rcqulres h permit to construct.Nmr,in,provc demnlieh,nr repair troy aaabna,
le pros t x to q Th pN If hpu iu fl 6 d wmacn
=- Ih:ln le : lh .van d ptintI Contactor',L : 1 (Chamer9 Sq. Ft. Floor Area Val 1 q
(e sm Th 5 'rl 701x3) 1l ..- T I m R ,esu d P w s Code) p }
n,r that ne'rs c,unpl Bmrctro ..,d he fawn ler he all,ed cxcmpli r Anv violaBnm
rStb�a°i�7031 5 by any applicam for a pernm.vunjecls the applicant w a civil penal,
nrnC-k+r' In fi,,handrcddolla,,($100). APN Number Occupancy Type
n1 p Ir r no-„ t -g asa l 1,axarnn. 34,:1.4094. 00
will do thek d the aonturenot intended Oen (See:9144.
Ramey and Plote,,ubs Code ThC bnEalLn,eroo,Law doesI apply Inn - Required Inspections
u� r Tit ro, Y Who Build.or in.pnrvcc Thn'con,and who docs such work hiraif 305 '- FRAME
ihr:a,h a,own enn,loyce....minlet nhal Sam:in,nob, enls arc bol handed or
ofr d to,nam.If,hoover, he hadd'rng nr ion,00eoco is add winhin a c year m' 307 —' INSULATION
nnrnrenorkneow...harld-will lune me lurdcn of..oris,than hedid nolhuild or _
pnoc R,r pblpnae nraale.). - 601 — ROOF TEAR OFF
El I.I,oarofthc Aeby.anoI,,1 .iWlye,nara,lo,with Gcansedcontractor,To 6022 — ROOF PLYWOOD NAIL
1,ivanvnct me pmjnn Lcce.9044.Bos s wad Pmaxsinns Code.) tire Conlmclor'.v
em
Law ,c and apply to ant eafprapony who holds or anpntherein, 603 — ROOF PATTENS
and who nmmmts fn,such Prclecls with a contmemr(s) hcensed Puoaanl In the
Cunt elnr.LieeirwLaw, E04 — ROOF IN—F'PaOGRE
O l um exempt under Se,. ,13&P C li,rnhie reason
lwncr� Dmc �..,.L/j I•// -
WORKF-R'S COMPENSATION DECLARATION /
1 ly'f1 1 -p 'l'y t'erjury one orte following dl I nc: -
11 I 'll r C (I 'l I C 11 :elf' Worker,
'asap n.-al P d l l by S l n 37001 f II LabC r for the
pert ron ovnl the work for wh eh This conno is ewcd,
01 have and will nronWin Worker's Compcnsnlion Instnowc.ws required by Seclien ,
3700 of the Lahor Cod,,for The perE...nan,,of the work for which this p<•nnH is
suet.My Worker's C'n o,ennmion Insvr:mce carrier and Pnllcy nnniaMr are:
Carrier: Policy No,
CERTHICA'IION OF EXEMM ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need non he completed if the permit is Fortino hundred dollarrt
o I00)or lcn,J
I acidly Thal in the perkarnanec oT the work for which Ihis permit is Toned.1
Shull nut wnploy any per, x m he,omc xnooct To the Wnrkorn'
Clant :my mrmnc•r To
Applicant caminn Lown of Cnlifnmin.Unw
NO11 ml -
Nf"on,?TOA To fla� N'EII:Omen-ai.IhisCioanl,)Iof Exanpliodyob.hndd
hcurrnc ar lanply the Workers Caiorsor los prnvrdona afeac Lanni Rooke . nmsl
O � rnnlawnn cnrnply w;Th xlTen provian,n,or nae parnaa shall adeemed mvnked.
z !^/� CONS'I'RUCI'ION LENDING AGENCY
aI hereby ofllrnn That There is it a,nxho,non lending ager,for the lrerformm..m
W VI In,work fin which min peonit is ie,uA1(Sec.3097,Ci,C.)
0. A Lendcr's Nrunc
Z) Z Lender's AAdres,
U O 1 cenody naal 1 lave read sore n:pprealion abs are mat the annoy inrnrrnall i nx
(L c nett.I agree ,,emb,ly will,all city and cuunTy ordinances and uarn laws rdanin, -
V Rr huilding cnnsnuclinn,and henehyaumn..... arcoonative,of to,oily he cncr no
� W the ab f I Pr lx tyor ao,,,,a,on p p -
r 6 IW ) b l :u d Ty I kcri,1 :IhcCp fC P ro aga'Ta .
nq 1 Inahil Tlcl, ud,n,riI c Iand rs,ni which I ay inany way ag na xaid
U Z City in colocc[ancoa, arm gointing(it this p ilJr
_APPLICANT UNDERS NDS AND WILL COMPLY WITH ALL NON POINT Issued b Dat
ti 5 URCFRFCUL y'
signamrc nr ph..:bUC.lws..nr D.aTe Re-roofs. -
IIAZARDOUS MATERIAI.9 D15CLQSGRC
Will the applicant or wtarchuildmg neeppro o0ocorhandlehvurdbns nnncrial Type of Roof -
as defmal by Ito Cupcnino Municipal Cod,,Chxpmr9,12,and The Ilenith and Snfmy -
C te.Section 2553260'
D Y,. ❑No All roofs shall be inspected prior to any roofing material being installed.
Wal mTare lauding nenrpdbr ase I,uipmem nr dr-,which If a roof is installed without first obtaining an inspection, I agree to remove
cnnit humNnux or conunniante a ddlned by the Bay Aran Air Qnulhy Mamr, car
vrldce all new materials for inspection. Applicant understands and will comply with
D Ye, 0 N all non-point source regulations.
I h" d d 1 d an ''I y ' t. d CI , O5 f bac
Calif H Il&Yf ly( d la t '255..5 titfl d25534.1understandThai
the .�e�a� '�✓`�� _
'nen n' ba _ T 1, la" l tn, rr r 1 'or1.0 lryme
nclpau of The 15tanenebs whah Ta he mel p-To'm ss nfl Crn'T etc of
'canpaboy, ` �I �61(t7 ignatur of Applicant � Date
✓"� Z/
r rnanhnr,eadagem F—, Date All roof coverings to be Class "B" or better ,
OFFICE