01010006 (2) C�7'Y OF CUPERTINO
WILDING DIVISION PERMIT CONTRACTOR INFORMATION:
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BUILDING ADDRESS: PI.R II'
21724 REGNART CT KENNETH CHENG 1"�fl@@06
OWNFIR S NAME APPLICATION SUH IN
KENNETH CHENG G WY\Q ( 01/02/2 01
ONE. SANITARY NO. CONTROL NO.
OrcZ1RCIII'I'EC'I 7ENGINEER: BUILDING Pi INFO
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Ii1.UG ELECT PLUMB MI?C11
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H z form that
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CORACTOR'S DECLARATION Job Description
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p Z ,� I hereby uniformfilm vin licensed order nrnvsmns of Cnupmr 9(sronmmncing
I-to with Section )of Division Jof thetlninca anJ Pn,(esinns Gtle.and my license REMODEL/ADDITION BATHROOM *DOUBLE FEES —
li
0 I�icenw in lull ,rcercc...send i CLss Lic.M
aW„ Date Contractor PERMIT*
ARCllfl'IitS DECIARA'I'ION
p.ori 1 undo round my plan.hall be used sex public reamk
W`p'paw.. �l
Licensed professional
OWNER-HUILD[H m the
Com ION
e u=m 1 nerdy(chem that tun cxrntnt Imo Inc k,inactm''s License law fm the
t_-z> followingmoot(Section Zu31 rabusinessand1'mfenion CdW, Anycity ser county
0 no.,
i t,I ave caverna)rociii me ober.b......c.acln..itt ore.o toy drnnurt
ce prior W ill ie used p alion, ,,the tha ap�Iie.nt for such ..it to ick s eLew Criperm
° •— (comm I,licensedwit Purvuam mlha PoDi...I til the Contractors License Lew Code) Sq. Ft. Floor Area Va a
or that a ix exempth t
theren7(NNbo thebsiso the
exandion.Any
Code)
✓
or thin p is 31.5 rany a,li l t the psis for the alleged a pliant to Any violation
of Scninn 7(U L5 by only dr d doll lis n ncrmit wM1,irt'tx the applicant lu a civil Pcnuny
nn�tint mom Ivan live hanumn dollars(isllq. APN Number y Type
9T1.m owner of the nmpmnn or my employees wait w.g,a,.ten sole cmnpcneliun. -
will it,,the work,and the vrulane is not intended or.11f and for sale(Sec.7(W. 356 �.
business and Pmfesshoa Ciae.'De cotmeli�,License Law does a,,,aid,u,an Required Inspections
nrvof property Who builds or impmvc,thereon.and who does such work himself
d nn..I his awn employees.Provided film.such improvements am not intended or
ofe ed H,r role.uL however.me nodding m impmecmcm is said within are rear of 101 — FOUNDATION
icompletion,the owner-hulmer will have the wooden of posing that he did not build or
mprove ro.pupae of miosis 102 — PIERS_ -
❑Las owner offne property,am exclusively contracting with licensed contractors t" 103 — UFER
onauel the immact(Sec.]HW,business and Profession Codi'the Conti-actor's
License Law does not apply toanox,ter ofproperty who builds nrimproves memon. 104 REBAR
sena who counters fit inch Jurpos wit a umrnnm(x1 livened par nam In the
Commemrs License taw. 105 — ANCHOR BOLTS
ClI a n,c�smsmf fanner 5ce .If&PC to,bele moron 106 - SEWER & WATER
ow,her(p�'+�^+ Doc 1.1 X01
WOIIKII -oM1u•I,NSNIION DECLARATION 202 — UNDERFLOOR PLUMBING
I hereby rd'rrm tinder penahynf perjury one(It the Hollowing dmlam0al,, 203- — UNDERFLOOR MECHANICAL
1 have and will maintain a CeniOcam of Consent to,elf-inam for Worker's 204 — UNDERFLOOR FRAME
Cmnpcmaron, a, provided for by section 37a) if tile whor Coact. for the 205 — UNDERFLOOR INSULATION
performance ofma and for which this permit is ism W.
❑1have and w111nhai,hlainwowiCompenxmionImam....as..aired fly senion 301 — ROUGH PLUMBING
37(x1 of the Labor Coils,for the petfnineurce of the work for which this haemo is 302 — TUB & OR SHOWER
i...ca.My Work,,I Coumenaaon Instance pure,mid Policy number are:
amier: roneynun,, 303 — ROUGH MECHANICAL
C17KIIFICAIION op EXEMPTION FROM WORKERS' 304 — ROUGH ELECTRICAL_
COMPENSATION INSURANCE
obi,.ecbnnneedhotbe,vnplemaifthepiisforihundreddollar. .i@5 — FRAME
($100)"i306 — HOLDOWNS
I.stay that in the performance of the work for which this permit is issued.1 307 — INSULATION
,hall not employ any person in any manic r an as in,we I,aah i Ii the Work,,,' — SHEET ROCK
Compensation laws of California.Date
Appl'¢,.n
NO[ICE TO APPLICAN'nIC after making this Cenilicam tit Laannnion.you should 309 — EXTERIOR LATH
p Cfemme subject..the W'orker's Compemutlon provisions of the Labor Code.you must
f mmill,comply wilt such pmvi,i...I,in nils permit shall bin dcemma.viked, 310 — INTERIOR LATH
F- In CONS IRUCI'ION LENDING AOCNGY 311 — SCRATCH COAT
oriI hereby am that them isconstruction pending iti Inv the pminmfxnce —
uROOF NAIL
I work for v affirm this pema tl ix issued(See.3097,Civ.C.) 313
yp Lsnder's Name
O z l,ndc,IAddres 5@1 — FINAL ELECTRICAL ENERGY
UO Ianiry(catlbase mad this annuaali.nti.d ,am that he til„em infnrmaenn i. 502 — FINAL PLUMBING ENERGY
w Fti I If In i with all city and county tedurances and state aw,re at 119
S@3 — FINAL MECHANICAL ENERGY
O U ..hula tg. I am dl M1y dor pre. flvn' fIll 1 'yt ter nnn
dthe aN is e....ennionednnrc for inspectionn pse 504 — FINAL BUILDING ENERGY
(We)ance III io,India 'fly andk 1I I. fit City fCP 1 ng''nf
m liabilities.judgments,cl d expenses nmy am ragainst.aid 5@5 — FINAL ELECTRICAL
L7 z Cay ma....voice-of the granting of(ci,"niii. _
SWRIC ANK%f1tATKlNZNn
�SAND WILT.COMPLY WIIIIAp.1.NON-
PO'
IMI' I\Sl12d I7yF@6 = GAS TEST D:IIC
Slgnmte�Appllcaooa,mra.m, Dale Re-roofs
HA,Z 11.bS MAT'IiR1ALS DISCLOSURIi 09178 — FINAL MECHANICAL
Will five apry+lican,.1 l'nmem nulAingdornier l olive or handle pmNoustnutiormi Type of ROT
as drained by bile Cupenlno ManicilsJ arae.Chapter 9.12,and the Health and safety 509 — FINAL GRADE
Code,Sonoma❑Yes 25532(a)I n
All roofs k51lk?-be-ins�1Fc :tA1pri(QLAM�d fi_vLg material being installed.
Will the application or future building occupant use equipment or devisee which Ira roof iyQtlllalled FqdENMIJ11rylPbffkihiIi Qg zW(BRK,6tion, I agree to remove
Emu naaatdom air containment,es di by the Ila,Arca Air Quality Management
isoniC10 yes r✓Nn all new materials for inspection. Applicant understands and will comply with.
all non-point source regulations.
1 have read the harmdous materials requiremmru tinder Chapter 6,95 if the
Callfnrnin Hradlh A Safety Code,Seaton,25505,'_55)3 and 25531 1 ondennnd thin
it the building does not currently have a Icnvnl,IPI iI 1,my a,t uu%ldi,y.notify the
sncuponl of the mquircmetns which must be met prior In issuance of a Centilicae til
(kcupnn°v Date
Signature of Applicant
ownsrm nJd�<dAden, - u.11e All roof coverings to be Class•B•' or better
OFFICE