02030050 (3) � 2O3o05 0
5 �/oz-
CITY OF CUPERTINO
BUILDING nn IbION PERIMIT comrRA&OR INFORMATION.
BL'1LL•i.`:l,ADDRESS PERh11"f NII
10235 S FOOTHILL BLVD 02030050
Oss'"ER'S N'A3'E APPLICATION SUB DATE
CHENG GARY F AND YAO HSIN-SH N 03/13/2002
PHONE. SANIIARY NO CONTROL NO
Z ARCHITECT/E':GINEER. BLTLDINGPERAITT INFO
—,F BLDG ELECT PLUSIB MCH
LICENSED CONTRACTOR'S DECLARATION Job Description
v,_ 1 hereby aff,m Nat 1 am lianutl utWn povisiuns or Ch.pm 9lcnmm,n-3
-�5 —h Smuan 70(T Drvision3of Ne Busirku aM Proreaiom Cnde.and my,license ADD 382 SQ.FT.
uin fall farce and effect.
o�u ttna aa•, Lk.e
i 3 Uwe G o ARCH s cDECLARATION
�N� I vi d mY Dlam shall used ubli[records
z<f
J 3 rti L OWNER BUILDER DECLA
I hereby aRrm that 1 am uemp,fmm dre nvu&CY
ense Law for the
F2� fallowing mason.is..—7W L5.Business and P-f Any dry or[ounry $45000
hich rcyuirt a permit,o con,wct,alter,improve itchpai Y wunurc
3 poor to aissuarca alsorcluina the esptscanl fa such Is—to fl e•.igrd aakrnnt
that be a Bttmed punuanam-,7D.
e pm• or Ne Canu'acmfs License I—(Ch.pn9 . vEt .3t- Valuation
(rommenc;y wiN SecHon700, Divaion3of the BWilrcsfaM Pro(wion%Cadei „'3 YL5�.4V/'L7 �lJ•. •_
or Net he is esemp therdmm grid the Wsi.for Ne alleged eaempiori.Any violation
of section 70315 by a„Y appli,ntV •pem,it auM1rnn Ibe appbcam to a rnil penalty J�taa p2tt��
of.w m..than fire nundrtd.11s.s Is500y 101 p'N�-FV CIIVDATI ON Occupancy Type
°I,a owner of dk Propeny,'+r my employee%"in wages u wit Bole essmpnsauon•
wdl do the wart.and the suuctuk is no,intended or offered for ale(sec,70u. PIERS
Business end Pmr—wins Code:The Conw[toi s License Law docs ria apply to an 103 - UFER Required Inspections '
ner of popsy Who hada,or impmv,a Merton,and who doe,scud,work himseB
tho.ggh his own empioyen.prn,1 ,nu,uch impmvemenit art nest inkeded 0, 104 - REBAR
offered nor wile.If,however•the building m innin, nt is.old wirhin one yaa of .
ompkmn.dk owner-Wdderwill have the When of proving that he did Trot Wilda 105 - ANCHOR BOLTS
imporeforpwpoaof.al..). 106 — SEWER & WATER
a L as ow k or d[p openr..m ea[I i.[Ir[on a ung wim littn%ea cont anon to 202 - UNDERFLOOR PLUMBING
Lknuc he pmjecl is..70u.Busmen sad Profession,Coda:)The Conuuror',
a-L-does not apply,n an avers,or limit" ho bodds a,impmves thinness, 203 - UNDERFLOOR MECHANICAL
andwW conouu such as Ion ch pojewith a ronu clerts)licensed le nuan w the 204 - UNDERFLOOR FRAME
Convut.e,License Law.
°I.m.sampl nodal sec. .B h PC fo,his mason 205 - UNDERFLOOR INSULATION
Dateopt` W'ORXER's COMPENSATION DECLARATION 3 01 ROUGH PLUMBING
-
302 - TUB & OR SHOWER
I henby.ffim,unae,pnahy of pe j,ry on,of the fouewing dealan6ons: 303 — ROUGH MECHANICAL
o� °1 lay.and will—innate a Cenifrnte of Consent m self-honal fm Witten'%
Comprnap
don,as wort
rill by station 370il f da,Labm Code,f«as 304 — ROUGH ELECTRICAL
pe f—o.of be wt rat which the.p.—i,I.i.mee. 305 — FRAME
01 n.re.ad esu mina n wmke,eampena.uo Inaunnu.a rtq.ircd by Seed- 306 — HOLDOWNS
3700 of tint Mbar code,rat Uk peAartrwse of dse work!ar which Nes pemdt fa
iaued.blyWonersComponeinel�sr.rcecarria,.ndMi[ynumber,re: 307 — INSULATION
Carrier. k PolkyNo.; 308, -;,SIJEETROCK
CERTIFICATION OF EXEMPTION FRQMWORKERs•- `309 - EXTERIOR LATH
COMPENSATION INSURANCE _
310 INTERIOR LATH
lslao)(Tits—on need ria be onmpined if the permu is Its one hursdred dollar 311 — SCRATCH COAT -
1 amfy he in the pedamanc,of the.onk fes,wh,,h this pemsit is mued.I 313 — ROOF NAIL
.hall not employ say a-la any^ ^n.r ro.%,°be[om, bj.,,o it.W°kns' 501 - FINAL ELECTRICAL ENERGY
Compcnsnian Law.of C.14—int.Date
Applicant 502 - FINAL PLUMBING ENERGY
NOTICE TO APPLICAM':If.me,oahtng Nis Ce,,frn.aI Exempion.yw dsoula 503 - FINAL MECHANICAL ENERGY
O p1,ai rc subject to the W oe e,s Comp—%inion pmvisiom of die Labs,Cade,you muse
fonh-h—ply card,...hpow—o,this pantoshall kdeemedeewked. 504 - FINAL BUILDING ENERGY
z.
E CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
C> I neleby affirm that Nen is a con—tion londin``ageory for the p,rfamrare,
ermi
of Ne work fm which this pt a issued(See.3097•Civ.C.) 506 - GAS TEST
Q Lend,,'.Name
�y LenaeaAderca 507 - FINAL PLUMBING
o c,nify he I have lead this appl-lino and.uta Nal it.A—infwmalian is 508 - FINAL MECHANICAL
i.gree ra comply w;h.n arty and cmtoty mainan[n and mm I.w,.lung 509 — FINAL GRADE
O(•,) roWlldmg comwnion.and birth,authortee repmsenta,im of Ni.city to entnupon
> mNeabo•e.me.ii—dpmpanyfonnspeel—pq—,.. 510 - FINAL PLANNING
t..•L IW',I agrte to save.indemnify and keep harmless the city of CupsNro againat
_v liabiliriea.j d.m ria.coon s d.spmu whi,h— in any way—spino aid 514 - F I NA P I C WORKS
.:1 Cu moa-:%ace d¢gnn al wspemnt, n--g
AF n AN7`.iA R R ANDS AND W"ILL C031PLY WITH ALL NON-POINT Issued by' �~ D.
—(�^d
gnats of App""a `o Nich,
Re-roofs
AZAIS DISCLOSLTE33asaupanl,tae« narardou,ounces 'Type of Roof
def sd byNCupenn 9.12.and dk Heald,and Sdelr
Code,seet,,253721st?
°1"°% �N° All roofs shall be inspected prior to any roofing material being installed.
Will Ne appl—aorfumm W,Idin svpan oqulpmernordevicn wNch If a roof is installed without first obtaining an inspection.I agree to remove
rtut haaa,dous ser a teninmisa defined byrhe Bay An.Ail Quality Management
all new materials for inspection. Applicant understands and will comply with
°Yei �N* all non point source regulations.
I ha•,nes&the ety 0..matmal,rtquirtmena undo Chapel 6.93 of 6.
California HeeIN h safety Code.sections 25503;13333 and 35334.1-demand the
if one W iId,,,dots not curmntly have•.....1.that it is my resp.—InMy to noefy N.
occupant of the rrvpit<menu which must be met prior m 1..—.of a Catlike,of
n`y Signature of Applicant Date
O n r a..aman,te ag n Dna All roof coverings to be Class'•B"or better
OFFICE