03050150 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT sCUNT',hXgTUR INFORMA"CIUN "
BUILDING ADDRESS: LIANG .LEE PP'IMITNO'03050150
1070A q TANTATT AIM
'S NAME: 24010 PRINCESS ELENA ,CT p ""m"`B19"f 19/2003
FRED & MONICA WONG
PHONE' (650) 917=9666 SANITARY NO. CONTROL NO.
ARCHITEC IEf4GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30p LICENSED CONTRACMR'SDECLARATION IbDescri Description
iI I hereby affirm Out I am liceme l under provisions of Cho
Chapter 9(commencing p
with Section 7000)of Dlvislon 3 of dm Bumnsand Pmfeasions Code,and my license es
A, infull tome and effect. REVISION--IN HOUSE USE ONLY
Dem Contractor aenanu
Clau e.R NO NEW PERMIT ISSUED, ORIG. 401080045 D
? ARCHITECTS DECLARATION
s 1 undcutend my plans shall he used u public mentals
dud
Licensed Profndonal �
3
y Oat I am exempt
fo DECLARATION \
y 1 hereby.farm that 11. exempt from the Contractor's License Law for the
p o following maean.permit
t ROId.Business and improve.
de Profession Cade:Any city structure county
which mqulms•permit m emumct,alder,Improve,de ermit t m repair any taement C
_Z<
prior oits iensedP Potsdam
to the loo,ismc or for such C.Ounche.U file Law statement
£ that(cmmcnigwi Purcilon7 )ofDiviio n(NCCanulm Lisnsclaw(Chapter Sq.Ft. Floor Area UBCIO
y 9 than els exe pttSemlon]0ndDivision3 mf sheeged evandon.Anyaru Crek)art 0
CIE— shar k V exempt thertRom and Bembuss for the alleged exemption.Any violation of
Seedon 7031.5 by any applicant for a permit subjects me applicant to a civil penally of APN Number Occupancy Type
test mom than five hundred dollars($500).
❑I,uownuarshe property,fir der employes wide wages u themao"eomNmdon, 37537003 . 00
will do the work and ueawnure is not imerded orafrered fouale(SecJO",Business gg�eGG tilos eCt1005
and Professlou Code:The Contractors Listue Law don tot apply m M owmer or 101 - F0UNDARTey8fY p
property who builds,or improves doxxx and who doesouchwaghimselforthrough his,
own employs.provided mal such Improvements an,notinunded oroRered forule.If. 102 — PIERS
however,me building or improvement is gold within ode Year of compledon.Ne owns.
builder will hero the burden or Proving mat he did not build a improve fee purpose of 103 — UFER
ale')' 104 - REBAR
❑1,as owner of the property.am exclusively contracting wish licensed contractors m 105 — ANCHOR. BOLTS
coutmct One project(Sec.7W.Business and Professions Cade:)The Contractor's Lb
oerm Law does not appy to an owner ofpropery who Wilda or Improves thereon,and, 106 — SEWER & WATER
who contracts for such pmjccU with a contracmr(s)licensed pursuant in me Contractor.
License Law. 202 - UNDERFLOOR PLUMBING
❑lamexemplunder .Sec. .BkPCfathesmuon 203 - UNDERFLOOR MECHANICAL
Dam 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby affirm under petWty of perjury one,of the following decimations: 301 — ROUGH PLUMBING
1 he.and will nolmaln a CeNfisu of Covent o ulf-m um forWarleer.COmpcm
sedan,u provided for by Section 3700 of me labor Code,fa she puromxe
aof the 302 - TUB & OR SHOWER
work for which this Permit is used 303 - ROUGH MECHANICAL
❑1 have and will maintain Workrg Compensation Inmuans,as required by Section 3 O4 — ROUGH ELECTRICAL
3700 of the labor Coale.for the Performance of the works for hated.which mis Permit is Issd.
My Workers Compensation Insaans wrier and Policy numbcome: 305 — FRAME
Carrier. Policy No: 306 - HOLDOWNS
CERTIFICATE MPENSATION INSURANCEORKEas' 307 — INSULATION
(Toes section need lot W completed Kthe permit is forone hundred dollars 308 - SHEETROCK
ormes.) 309 - EXTERIOR LATH
1 certify that In the performance of me wars for which this Permit is issued.I shall not 310 - INTERIOR LATH
employ any person in any manner an u m beeomc subject to the Workers'Compensation
Laws of California.Date 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT:If,after mating this Certificase of Exemption,you should 313 - ROOF- NAIL
become subject to the Workers Compeuauon provisions of the labor Cade,you must 501 - FINAL ELECTRICAL ENERGY
Oforthwith comply with such provisions or this Permit shall be domed revoked.
,z., CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
)..4 IWrchyuR'amthatthereItsconatmctionlendingagencyfortheperforman:e 1 503 - FINAL MECHANICAL ENERGY
the work for which shes permit is issued(Sm.3097.Civ.C.) 504 - FINAL BUILDING ENERGY
W Q Lenders Namc
�Z
Lenders Add. 505 - FINAL ELECTRICAL
U O I certify that I have mad this application and guts Out the above information is 506 - GAS TEST
comet.I epee to comply with JI city and county ordinances and sum laws relating to
QU
Wilding construction,andhembymthorimrtpmxnutiveOfmescity ocnorupon the INAL PLUMBI Ghovcmcntioncd proPcnd farinspectionex repro. VF
FI L
(We)agree m save,indemnify and trop harmless the City ofCupertino againstrr Babilitin,judgments.costs and exponents which may in any way accrue against said CityIU'Z in consequence of me granting ofthis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: NG Date
SOURCE REGULATIONS, _
Re-roofs 602k,-ROOF PLYWOOD NAIL
Signmum of ApplinnVConuacta Dam
HAZARDOUS MATERIALS DISCLOSURE TypeofRcg)b3 - ROOF BATTENS
Will ft applicant or future Wilding Occupant mom or handle huardou material 604 - ROOF IN-PROGRESS
'•defined by the CupeNno Municipal Code.Chapter 9.12,and tide Health and Safely
Section 255320)7 All roofs shall be inspected prior to any roofing material em installed.
❑Yes ON.
Will the applicant or future building Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
cre t herafdous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ON.
Its
mad the WuNnusmatarlals requirements under ChePur6.95O(thc Califon
niaH altha�Safcty COac,Sccduu25505.25533md25534.1undc.ta thatifthc Wilding
does not currently have a tenure,that Is is my oup reshility to notify do Occupant of the
requirements which mum W met prior m issuance of a CeniOcau of Occupancy. Signature of Applicant Date
Owner or authorized agent Dam All roof coverings to be Class"B"or better