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04060264 (2) CITY OF CUPERTINO - 477777 7 77 BUILDING o1v1s1oN - P>;RM . C2.1N`TkZA.CT0R."INFC? MIA N . a ., .. BUILDING ADDRESS: CRW INDUSTRIES PERMIT N904060264 9927 TWII-TCMT CT OWNER'S NAME: PERMIT MUE DATE KUANG LAI SANITARY NO. ONE: CONTROL NO. (408) 378-1 2477 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB LARCH 0 0 0 0 u00 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description . with Section][gN))nf Oivision3oftheflusinessan943.f.kno Cmle,and my he...is I.fall a ndcffeew Cir) / r> y'oZ 6`4 WINDOW UPGRADE AAA Y Llccnyc a w S p F'� ra a� L fE Dam L^ Cannot�oor.�__._.' pA7 Y�Vfl'g'g(faga�@t ']tIp��ID" .Y ARCHITECTS Ds Pool C} N I understand my plans shall M1c used as pout cnrm+f ds �aU o Licensed Pmfcs¢ional r—(� OWNER-BUILDER DECLARATION s— 7 gm 1 hereby affirm that I mm exempt form the Contractors License Law for the ©L'ta O t7 ZUU4 E:20 followingreason.(Scetirtn](131.5,Business and ve de inns Codr.Anycity.county m which requires a permit m coouwcr alter,improve,demolish.narepair any swctum - m�" prior m its issuance,also mquims the applicant for such permit file a signed smmment t- -m that he is licensedpursuant to the provisions of the Cmumann's License LOW(Chapter 9 Sq.Ft. Floor Area hor a11on ea-� oommodemS with Section7")of Division 3 of the Bosinessand Profession¢Code)or W 5 that he is exempt therofrom and tM basis far the alleged cona,dom Any violation of Section 7031.5 by any applicant for a Permit subjects me applicant to a civil penalty of 3 3P&3VT Lffi I)er0 0 Occupancy Type oat mom than five hundred della.($508). ❑1,as owner ofthe property,or my employees with wages as their sale compensation, willdo the work and Ne ewcturc is not intended or offered forsalc(Sec.7094,Business and Pmfcssions Code:The Comraam's License Law does not apply to an owner of Required Inspections property who builds or improves Nenum,and who does such work himself orthrough his own employees,provided thm such improns merso and,not intended or offered foreale.IL however the building or improvement is sold within one year of completion,the owner- builder will have Ne burden of proving Nat he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors m conamtl the project(Sec.7044.Business and Professions Code:)The Contractors U. cense Law does not apply to an owner of property who Wilds or improves thereon.and. who convmeo for such projects with a cormamor(s)licensed pursuant m the Contractors License Law. ❑I am exempt under See. ,B&P C far this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of Perjuyrone of Ne following decimations: ']I have and will maintain a Cerdificmm of Consent m¢elf-i rum for Worker's Compere cation,as provided for by Section 3700 of the Labor Code,fur the performance of the work for which this permit is issued. ❑I have add will maintain Workers Compensation Insurance,as required by Section 3708 of the Mbar Code,for the performance of the work for which this permit is issued. My Workeyr�s -,�Compensation Insumnm carrier and Policy number M: Ca�S roytrl: �Mr) Policryy Nyy /OL39H `a'k'� CERTIFICATE OF EXEMPTIONPROM WORKERS' �/ COMPENSATION INSURANCE (This cation need not he completed if the permit is forms,hundred dollars($10d) or less.) 1 ecart,duet in the performance of the work for which Nis permit is issued,Isbell not employ,any person in any manner so as to becomo subject o the Workers'Cmmpedration Law.of California.Date Applicant NOTICE TO APPLICANT:IL after making No Cenificam of Exemption,you should become subject to Ne Worker's Compensation provisions of the Labor Code,you most .JO frrmwidh comply with such provisions orthia perm it shall he deemed revoked. . .Zi CONSTRUCTION LENDING AGENCY (r.�. I hereby affirm that there is a convection lending agency for the Performance of - Rai the work for which this permit is issued(Sec.3097,Cih,C.) W�Q Lender's Namc z Lento's Address U 0 I certify that I have read this application and stem(hat the above information is W H correct,I agree to comply With all city and county oNimmeas and state laws relating to 0 V building convection,and hereby authorise repreaen.dives of Nis city to enter upon the ;t.W above-mcmloned property for inspection purposes. % t (We)agree to save,indemnify and keep harmless the City of Cupertino again( F,, liabilities,judgments,costs and expencs which may in any way acrncagainst said City %+ U in consequence of the granting of this permit. r—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 D S=IONS. //�_ -- 66aLL Re-roofs Signa(ur of ApplicanUContracmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar future building e,Chapter marc ter handle hamsters mateety C de,Sed by the Cupertino Municipal Code,Chepmr 9.12,and the Health and Safety Code,Section zss3z(a)7 All roofs shall be inspected prior to an roofing material beim ❑v s �tNo P P Y g g installed. flWill the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mi(hazardous air contaminants as defined by doe Bay Area Air Quality Management all new materials for inspection. Distrio? C]Yet urN. 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SeloyCodc,Sections 25505,25533 and 25534.1 understand Nat if the building docs not currently have a tenant,that it is my responsibility m nod ly the Occupant of the colo mets h must be met poor to kdoncm or a Centficate 010ccuPncy. Signature of Applicant Date ire n c 2U --�---- � ru, J All roof coverings to be Class "B"or better 0 our authorize)agent Oa¢ • 84 x48 ge x4t Berl ` lar_ ob Z BCD 1 MssMe t 6FD RISC r 1 _ Zuo JL!N s pay CpllOF CU 8UPFRT/d� E1r�rnnoN 1CU'j/AV FPA1?TIWE1IT Qeo as (cnsz�ca�rrs � Cvue„� 64n6ss coKOWaNce� �IAU-. 6�F"M K4511M 6�<�VANIiy 3°x4" 3`YJ° garg4 gax4° 3°z4°- • loo x bo Dr r PPROVED lfcNr-W AKb FAmi+ y amm MAL D CE w E OF nave gayly �oKe CiV o�a<s DATE A� q "1'lnG 1u TrlE Parr SIGNED (�nlouNo This set and F+pen kept on the job at all B MUST be aeuaroN to make any changes of af10 b i9 unlawful w+thout written of on am* �u fmm the Building Department, City 7rx; stamping of this plan and apecicatlons L N07 be held OMCE COPY permit or to be an g -Y Ord t�'Wfrjiation of any provisions of e+a :5 Ordinance or State Law. B' x 5° �1i wIND0.J Alosse.T �� x4� G?RAGE P947 'twlU4ttr courur P. .,354316q 7 3bAm 25552 *ITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM o � � �.6 Z � y APN # Date: 31 ( T ( 03 3 eljol%wY Building Address: Mailing Address (if different from building address): /9927 7wlwzcmr Counr Owner's Name: Phone#: CAl , Kv4g& &o"x0?-•/26� Contractor: License#: Caw 1NoumuEr yOZYBy Contact: Phone: Y2 *9z4, Cupertino Business License#: Rosixr HunoHy Fax:(doa)518-s501 .23525 Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Remo PmN& of exicnHy w1406wr Residential ❑ F1r4esr AND ?EMAMOV GLAs3 Ar AGQVI4eP Commercial ❑ Sq.Ft. Floor Are $/Sq.Ft.: Cost of Pr Iect: 6 Occupancy Group: i Type of ons n: Please check this b x if the project is a w�Noo,� uvGnkot second-story addition: ❑ Project Size: Standard 0 Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elee 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 2:6/6 L I of 73 7j'-- s 2 CITY OF CUPERTINO _:- _ - "`� pP�T `y°�"a�♦ y ''�'( ' - . . BUILDING DIVISION PERMIT sS"I C� CTQIht�Allli�/,LtYdtl. AA\a BUILDINGADDRESS: CRW INDUSTRIES PERMIT Ncb4060264 OWNER'S NAME: PERMIT ISSUE DAM KUANG LAI E: SANITARY NO. 9 CONTROL N0. (408) 378-2477 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BDG ELECT PLUMB MECH +�+op LICENSED CONTRACTOR'S DECLARATION ]Ob' Sccrl tl n I hereby affirm that I am licensed under provisions of Chapter 9(commencing y.P Q_9 _ with Seat!..7")of Division 3 of me Business endPtofeesions Cada,end my license is ss ^= infullf a dcfi t. 5 �/ fj stoy.l8�f WINDOW UPGRADE ;M_ Lk so a a LieN GLC 2004 �Fp De¢ ARCHITELTStDECr� 1 undersand my plain andl he used as imth w cards Des U6LH Ti 0 ; ,G Licenud Profesaftnal s' OWNER-BUILDER DECLARATION 1 hereby affirm that 1 1. exempt from Ne Canions Co Licenu Law far,me X 00 fallowing tomo..(Section 7(131.5,Business and Profdemoli Coda:Any city.,county K$ which requires a Pcrtnit ns construct.eller,written,Jcmnlish,or report any..renin prior In is issuance,also another she applicant for such parraft to Ne,signed statement ^^ thatW is licensed pursuant to she previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation zC� (commencing with Section 7000)of Division 3 of the Business and Promesinnr CnJe)or 3 that he Merchant exempt Merchoand the basis for Ne alleged exemption.Any=O of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 3 1NP3IlN ikletO 0 Occupancy Type not am Nan five hundred della.($500). ❑1,as owner of the prepany,or my employees with wages as their sole compensation, will do the wink,end the sructure is not intended or offered formic(Sec.7040.Business and Profession,Code:The Convector's Liceme Law docs not apply to an owner of Required Inspections property who builds or improves Merron,and who does such work himself or through his own employees.provided that man improvements arc not intanded or offered for sake.If. however me building or improvement is sold within ane year of mmpledo..the ow., ' builder will lave the burden of proving that he did not Wild or improve for purpose of sale.). 1,as Owner of Ne progeny,am exclusively connoting with licensed con racton In cousWn the project(See 704-4,Business and Professions Code:)The Canumnfs Li cense law does not apply to en owner of property who Wilds or improves themon,and who contracts for such pmjec%with a conuactor(s)licensed pursuant to the Convectors Licenu Law. ❑l am exempt under Sec. ,B&P C for this noon Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of Ne following declandom: have and will maintain a Cenificam ofConsem to self-insum for Workers Compere ion,se provided for by Section 37W of the labor Code.for Ne Performance of the work for which rets permit is issued. CO31 have and will maintain Worker's Compensation Insurance.ex required by Section 3700 of the labor Code for the performance of the work for which this North is issued. - My Warkels Compensation Im rnnm road.,and Polity number am: CaniSy S�� ll`tlJ Poligy Ng! /0L7�� C✓/� CERTIFICATE OF EXEMPrIONPIrOM WORKERS' COMPENSATION INSURANCE This auction need not W completed ifoa fermis is foroachundmd Mulan($10O or leu.) I certify that in the performance of the work for which this permit is iasocd,I shall net employ any person in any manner so m to become subject to the WorkesCompensation . Laws of California.Data Applicm, NOTICE TO APPLICANT.If.after making this Ganglionic of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must Oforawish comply wit such provisions or this permit shall W demand revnkcd. Z CONSTRUCTION LENDING AGENCY EI Wmby affirm Net there is a construction lending agency for Ne Performance of 7 the work for which this parent Is issued(SO:.3097.Civ.C.) WW Unders Name z Lender's Add. V I ccAfy that I ban read this application and sure that the above information is IL(~ comect.I agree to comply with all city and county ordinances and state laws relating to C) building construction,and heathy tathmism repreeenutivea of this city m enter upon me abon-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmlesa me City of Cupcnino against ti fA liabilities,judgments,costs and expenses which may in any way accrue against said City / V z in consequence of me listening of this permit. a..i APP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 50 ERE CATIONS. `-- OVA, Re-roofs Stgnewm fAppllcanUCunvacmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar future building Occupant Onto or handle hacaudi usmaterial as defined by me Cupertino Municipal Code,Chapter 9.11.and the Health and Safety coda.semen zss3z(a)? r-1 Yes &NU All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building accupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove I hazardous air commensals as dc0ncd by the Say Area Air Quality Managcmcnt all new materials for inspection. nester? ❑Yes (�NO I have mad me hanrdnmmau rialsmquimmena umfcr Chaps r6.95 of the Califor. nia Health&Safety COM,Sections 25505,25533 and 25534.l undersand mmifth,Wilding does not currently have a tman4 mat it is my responsibility n notify the necupent of the mqutmmmnts 'ch most W met prior n hausam of a C"O'can of occupancy. Signature Of Applicant Date I1r,/3D�2 All roof coverings to be Class "B"or better r or authorized agent Onto