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06010037 (2) CITY OF CUPERTINO ? + - BUILDING DIVISION PERMIT �C,ONTRAGTORINFORMATION BUILDING ADDRESS: PRO ROOTER PERMTTNo.06010037 OWNER'S NAME: PERMIT ISSUE DATE WILSON CHIN 2306 AMERICA AVE #7 01/06/2006 ONE: SANITARY NO. CONTROL NO. (510) 670-1115 RCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH .00 LICENSED CONTRACTOR'S DECLARATION O O O O w,F I Mmby affirm Nal 1 am licensed under provisioro of Chapter 9(commencing Job Description `uj with Section 7")ofDivision J of the Business and ProfessionsC de.and my license is in full force and affect, t 'q? Licence Claes I-m. 3 REPLACE -SEWER MAIN (60 f DamTS DE W HII�gl ARCHITECTS DECLARATION ARATION I undersand my plans aM1a11 W used a public rtenrOs �yU JAN ;Q3 Licensed professional JAN 200(v OWNER-BUILDER DECLARATION ll a�0 0 I Wraso affirm That 11. exempt Business an the Concocrors e:A License Law for the ( fs i pe D following reason,Strom that I am exemptnand Professions Code:cense L of county {Jq Pt� �''y <m which requires a permit w construct.alter,improve,demolWs,or repair any structure �`� f a r )t t1_j' 'tf .i � $4800 LZi prior to its issuarme.arm rcquims the applicant for Such permit to File SwImod satemem < that hr is lionsed pursuant to the provisions or the Commutori License Law(Chapter 9 Sq.Ft. Floor AreaY€� — `�U 'V('✓ L;t Valuation(commencing with Section 7000)of Division of Oc Business and Professions Code)or a .- that be u esempl thertrom and the basis for the alleged smemptom.Any violadan of \1 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofOCCU araC not more Nan Five hundred dollars(SA)(B. r Occupancy Type 1,as owner of the property,or my employers with wages as theh mm compensation, will do the work,and the strremm is not intended or offered for sale(Sec.7W,Business and Pmfassimu Code:The Conuacmrs License law does not apply to en owner of Required Inspections property who Wilds mireprovesthereon,sand who doessuch work himself orthrough his Own employeea,provided Nat such improvements ere not intended moffered for ale.If, however,the building or improvement is mid within one year of completion.the owner builder will have the burden of proving that W did not Wild or improve for purpose of Sam.).e.). O 1,as Owner of the property,am exclusively contracting with liecrued contractors to - comwct the project(Sec.7044,Businam and Profusions Code:)The Contractor's Li. crude law docs not apply to an owner of pmpeny.who Wilds or improves themon,and who concocts for such projects with a contractor(a)licensed pursuant to the Contractors Lceude law. ❑1 am eaempt under Sea ,B Jr P C for this reason Owner Dam WORKER S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Cutircate of Centers o self-insure for WmkeruCompen- 1C11111, on,as provided for by Section 3700 of dm IaWr Code.for the performance Of the rk for which this Permit u issued. 1 have and will maintain Worker's Compensation Insurance,a required by Section 0 of Oc labor Code,for Ne performance of the work for which this permit is issued. Workers Commisamm mm.rsrn�cte carrnier�1�apnd Policy number am: ier. G,taENR�N +r'Jyarlr4dNsyNO.: ox& Oa.�9 7,52 CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE most action need not be completed if the permit is forme hundred dollars($100) or less.) I terrify that in the performance of me work for which this permit is issued.l shall not employ any person in any mamnerSu as to become subject o She Worked CO s,ammOom Laws of Califoroia.Date Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should Weome subject to the Woracra Come cation previsions of the labor Code,you must .J z forthwith comply with Such provisions or this permit shall W deemed revoked. zO CCONSTRUCTION LENDING AGENCY ,L Ihereby affirm that then is a construction lending agency for the performance of CYi the work for which this permit is issued(Sec.3097,Civ.C.) fA Lender's Nater IY lender's Address :)z rJ Q 1 cenify that 1 have read this application and sum Nat the above information is W F correct 1 agree to comply with all city and county ordinances and state laws relating to O V Wilding construction.and hereby authorise repreanutivu Of Nis city to enter upon me U aWveomendnnod Property for inspection pmpmma (Wc)agreeto ave,indemnify and keep harmless wyacof Cupertino against Zt,i in f ts,the granting expeaof Oil psroll. may in any wry eccmc eCemst aid City C)z m APPLICANT of me UNDERSTANDS of this Pe WI APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULADate �— 6 l TI S / n� 06/0 Re-roofs �f� Signature ofA manUC . r ontractor D v HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fmum Wilding o¢upant umc or baddle harardom material as darned by do Cupertino Municipal Code.Chapter 9.12.and Or Health and Safety Cwle.Section 25333(x)? All roofs shall be inspected prior to an roofing material being El Yet �,t P P � Y g g installed. Will the applicant or future Wilding occuPam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hamolous air comarpormu as defined by Oc Bay Area Air Quality Management all new materials for inspection. s Tin? 0Yes �L I hale mad the haandous materials requiremennt under Chapter 6.95 ofthe Califor- niaHeal"Saretycode,Seedos25515,25533 and 25574.1 undersand that it the Wilding docs not currently have a We. We'"ism responsibility m unify the cormUm of the regal¢ nu whichmuzbe tpdrrwi ancenfacerireamora Signature of Applicant Date owner mar rri,edagco ate All roof coverings to be Class "B"or better Community Development ��, J 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEI�TINO Building Department JOB ADDRESS: PERMIT # 0390 5T5q1jV6 610.. e ' OWNER'S NAME: wrbgp C�I PHONE # W71953a7 GENERAL CONTRACTOR: PAO P,0jq6C IWC. FAX # 5 a N-45liz I am not using any subcontractors:� &722te� p p Signature Daie Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ��IzM � 0 0606 Owner/Contractor Signature ate CITY OF CUPERTINO 3 aieo' REPIPE/SEWERS/MAIN SERVICE D al CUPEkTINO PERMIT APPLICATION FORM APN # 7J- Z Date: Na 6 D6 Building Address: Q Q `, / 1G Q� cvpm��- �"j Phone Owner's Name: UV,r�a� CAT-11) e T� Y 09 —7lq5307 Contractor: )9RD � Phone: (51 /D7) /)5 Jcen e#: /3�Sa Contact: Phone: Cupertino Business License#: T 5/O 750-Oc?�6 Building Permit Info: Bldg ❑ Elect ❑ Plumb e Job Description: "U0 VITA :D15T.Au fROPAXW cyE 5e� COPAN007 Rz5l?� (f/ytrT-OF sFeET IXEIV Ice 5- vy Residential Commercial ❑ Cost of Project: LKV Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS I Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING