03030001 (2)CITY OF CUPERTINOa
'GTOR N, TTION,,,
4,
BUILDING DIVISION pER TCONT
F� _
BUILDING ADDRESS:
PERMIT NO,
11238 TERRA BELLA DR
03030001
NAME:
PERMIT OUE DATE
5R'S
CHING CHENG CHAI'
03/03/2003
PH ONE: _
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
ON
Lm that I DCONTRACnORS &,pmvisl.m, I hap
1 hereby affirm that 1 em If under of Chanter 9 (commencing
Job Description
p
d ftfuss
With SmtionAnd of of ecDivialon 3 of NC Buainw arM Proraulnm Code, and my license 4
ON Bt
mrmlfomeandcfrem. -
Class Lic.A
REVISION --IN
NO NEW PERMIT
- -
HOUSE USE ONLYLiceL
ISSUED, ORIG. #%9298yvozr V OI J
Deunse
ARCHITECTS DECLARATION
1 understand my plans Nail he wed u public recouls
RELOCATE SHOWER
Licensed Professional
• OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt form the Comrmmra License Law for the
-
following mason. (Suction 70313, Business and Professions Code: Any city or county
which requires a permit to construct, alar, harrow, demolish, or repair any structure
'
poor In its issuance. aim mquires,M applicant formals permit to file align of atstement
that he is licensed purm.m to the previsions of the connector's License Law (Charter 9
- Sq. Ft. Floor Area Valuation -
(commencing with Section 7000) of Division 3 of the Buonus m l Professions Code) or
DLit he is exempt therefrom and gte basis for the alleged exemption. Any violation of
APN Number OCcu Type
p y 'TryJ p
Section 7031.5 by soy eppliesnt for a permit subjects Ne Applicant to a civil penalty of
not mart Nan five hundred dollar (53( L
❑ I,uownermfthepmpcny,mmyemployemwiffimpsutiulrmlacompewtion.
will do IN work. and the structure is not Intended oro0ertd forule(Sec. 7044, Business
And Professions Cade: The Convector's Liam. Law does not apply to an owner of
Required Inspections
q p
property who bulldsor improves thereon, and who doessuch work himselfor through his
own employees, provided that such lmpmwmmu sn ore intended ora@red for We. It.
_ 1a1 —
FOUNDATIONS
however, Ne building or Improvement Is within one year ofcompl,don. the owner.
102 —
PIERS
builder will have tin burden of proving dear he did not build ars Improve for purpose of
Asia.).
103 -
UFER
❑ 1, as owner of the Property, am emlwively competing with licensed mnnacbn In
104 -
RE BAR
construct the project (Sec. 7044. Business and Proletarians Code:) The Commerors U.
sue Law data not pply to an owner of property who builds or improma thereon.rod,
105 —
ANCHOR BOLTS
who cmmracu for such projects with a com uctor(O licensed pursuant to Na Connecta,
106 —
SEWER _&' WATER, '
License Lew.
am exAmpwnderSec. B&PC for thiso mss
202 -
UNDERFLOOR. PLUMBING
r Data
203--
204 -
UNDERFLOOR MECHANICAL
UNDERFLOOR FRAME -
WORKER'S COMPENSATION DECLARATION
IherebyAfnmtmderpenaltyofperjuryone of the mnowingdecl.rations
205 -
UNDERFLOOR INSULATION
❑Lluve and will meloid. A Certlficsteof Comet to self -swum fm worker, Comeau.
301 —
ROUGH PLUMBING
ution, u provided for by Section 3700 of the labor Code. for Ne performance of me
_
workforwhichthisPeroithilaand.
302 -
TUB & OR SHOWER
❑ 1 nave and will maintain Worker's Compensation Warm¢, u required by Section
303 —
ROUGH MECHANICAL
7700 of NA labor Code, for Ne performance of the work for which Nis permit is issued.
MyWorkcrgcnmpensauonWunncecarierandPoncynumberam:
304 —
-
ROUGH..ELECTRICAL -
Carrier. Policy No.:
305 -
FRAME
CERTIFICATE OF MEMPTION FROM WORKERS' -
306 —
HOEDOWNS
COMPENSATION INSURANCE
--
(Thlameticancumnot ccomplutedlfdeepermitisforms,hundmddnllan(SIM)
307 -
INSULATION
miass')
308 -
SHEETROCK -
I certify that in the performance of AN ..,it ser which NIA perm, is Issued, 10.11 not
309 '—
_
EXTERIOR LATH
employ any person in my manner an u m become subject to IN Workers! Compensation
Laws of Celifomla. Data
310" —.
INTERIOR LATH'
Applies.,
311 —,,SCRATCH
r COAT, -
NOTICE TO APPLICANT.If. after making this CertlOceu or Exemption, you should
become subject m Ne Workers Compmutlmn previsions of IN Labor code. you muss
313 —
ROOF NAIL
forthwith comply wide such Provisions or this permit shall be deemed revoked.
501 -
FINAL ELECTRICAL ENERGY
1, cushy afl,m thalal ft. NSTRUCTION Lia connnmctinol lending LENING agency for Ne parromurceuf
502 —
FINAL PLUMBING ENERGY -
dwwork for which this permit tsissued (Sm.3097. Civ. C.)
Lender's theme
503 -
504 -
FINAL MECHANICAL ENERGY
FINAL BUILDING ENERGY
fenders Address
I unify that l have rod this Application and suss that the shove bar..line Is
505' —
FINAL ,ELECTRICAL
contact. I agree m comply with all city end county ordinance, and data laws relating to
.'%6 -GAS
'TES T
building convection, and hereby authorise representative, of this city u color upon the-
above -m nfloned Property for inspection purposes
FIN PLUMB G(We)
agree u Live, Indemnify and kmp harmless the City of CupeNno against11militles,
juegments, costs and expenses which mag in my way accmc agaiw said City
I C ICAL
in eoneequmec of Na granting of Nis permlt
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
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Issued by:
Date
SOURCE REGULATIONS.
Re -roofs 514
,.
Type Of ROOF
INAL PUBLIC WORKS
Slgnuum al ApplicaAZAR Dau
HAZARDOUS MATERIALS DISCLOSURE I u
H
building rccupmt nomm anodic
Willy eCupertino
Muni
sal de0eCupertino Munlclpal Coda. ChaPur 9.12. end tin HuIN end Ssldy
Health and
'
Secure 25
0Ys 35532(a)?
❑Yes, C] No
All roofs shall be inspected
prior to any roofing material being installed.
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the Applicant or future building occupant use equipment or devices which
emit hanrdow air contaminants u defined by tis Bay Area Air Quality Management
all new materials for inspection. -
Dlmict?
-
❑Yes (:I No
I ban mad the hannlnus materials requirements undo, Chapter 6.95 or the cables.
A le Health& Safety Code, Secuou 25505,25533 and 25534.1 understand that KIN building
docs not currently haw a um.4 that It is my responsibility in Audi the occupant of the
requirements which mon N met prions issuance of a Comficate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owmr arantharved seem now