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03080016OF CUPERTINO •: rl � � fl 5 � 4� x,'��BUILDING DIVISION PERMIT r CONTRACTOR INFORMA INDG ADDRESS: GEORGE TU PERMIT Noo3080016 iITY EWS NAME: PERMIT ISSUE DATE =VX SANITARY N0. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO ' /✓��. BGDS ELECT PLUOMB MEOCH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that ma licensed under pmvisims of Chip,., 9 (commencing Job Description p with Section LAA)) of Division ] of the Business and Professions Code, and my license is ase a to mu One and erre`'` BATHROOM REMODEL/ADD INTER. WALL License Llc. p Dam Contractor ARCHITECTS DECLARATION C INALp� 1 understand my plansshell W used as publicTIOrecords r ■ D DEC 15 2003 Licensed Pmfcssional Oat I am eUILDER mDECLARATION I hereby .(fere thin 1 am escmpessan the Contractor'sCoLicense Law for the following mason. (Section 711] 1.5. Business and Rvfessinn Cwk: Any city .,county which requires a Permit to construct, alter, improve, demolish, or repir'any stricture 2 O O 0 Prior to ill issuance, also requires the applicant for such permit to rile a signed statement Carolina's he is licensed pursuant (a lbe provision of the Comcmr's License Law (Chapter 9 Sq. FL Floor Area Valuation (commencing with Section 7000)of Division] of the Business and Professions Coda)ser 35708004.00 Nat M is exempt therefrom and the basis for the alleged exemption. Any violaion of Section 7031.5 by any applicant for a permitaubjecu the applicant to a civil penalty of APN Number Occu ane T e - P Y YP of more was five hundred deltan($50)): 1, as owner of the property, or my employees with wages u their sale compensation, I U I — I. d Inspections wr oNe work and On nemrt is not monded or offered fonale(See ,7 d .Business arid Professions Code: The Contractors License Law Boas apply to an not owner of 102 - PIERS property who builds or improves thereon, and who does such work himwtror through his own employees, provided that uch Improvements are not intended oroffend for of.. if, 103 — UFER however, Ne building or improvement is sold within one year of completion. On owner builder will have the burden of proving Nat he did not Wild or improve for purpose of 104 - REBAR Ik 105 - ANCHOR BOLTS 'a'owner of the property, am exclusively contracting with licensed convectors to 106 - SEWER & WATER co un the project (Sec. 7044, Business and Professions Cade:) The Convaetori Li. Genu wdoes not apply toanowner ofpropenywho Wilds orbarrows Ncuon,and 202 - UNDERFLOOR PLUMBING who contracts ronuch projects with ecanmaar(q licensed pursuant to the comrectoh' License Law, 203 — UNDERFLOOR MECHANICAL ❑ I am esmpf under Sec. .B& P C for this reason 204 - UNDERFLOOR FRAME "" r DECLARATION 301 — ROUGH PLUMBING I hereby artists under Penalty of perjury ane of the following declarations: Ihave and will maintain Cenifate of Consent to sel6inaure for worker's Compcn, 302 — TUB & OR SHOWER cation, as provided for by Section 37W of the labor Code, for dm performance of dee 3 03 - ROUGH MECHANICAL w "A for which this permit is issued. 3 04 - ROUGH ELECTRICAL ❑ I have and will maintain Worker's Compensation Insurance, n required by Section 305 Plp of the labor Code. far the peRormarce of the work for which this permit is issued. — FRAME My Worker's Compensation lnunnce carrier and Policy number art: 306 — HOLDOWNS Carrier: Policy 307 - INSULATION CERTIFICATE OF EKEMFmONFROOM WORKERS' _ COMPENSATION INSURANCE 308 - SHEETROCK (TMa suction need nm W completed if the permit is far one hundred dollars (SIa) 309 - EXTERIOR LATH iirenify 310 - INTERIOR LATH e certify Not in the performance of the work for which this Permit is issued, I shall not employ any person in any manner urasln Wcome xubjecOo the Wolters'Compemation 311 — SCRATCH COAT Law, ofLaws Of Californle. Dam Applicant 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: IL after making this CeniOcake of Exemption, you should WCOme Subject to the Worker's Compensation provisions of the Labor Crede, you must fonhwith comply with such provisions or this Permit hat) be deemed invoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm Nat them is a construction kndingagency for me pcffurmarnc of 504 - FINAL BUILDING ENERGY On work for which rola permit is issued (see. I, civ. C.) r'k O nName 505 506 — FINAL ELECTRICAL - GAS TEST Leml iAddm.. a I certify Nat I have some and stain dust the above information totalling is inf Nisty 507 - FINAL PLUMBING torten. I gree comply with all city and county d es and sate with and county relating to building construction. and hereby amhoriu roprwnmives of this city to cmcr upon the FINA MECHAN CAL abovcmcntiuneJ Property for inspection purposes. (We) agree to save, indemnify and keep carriers the City of Cupcnino against O 9 FIN liabilities,judgments, costs and expenses which may in any way accup against aid City in consequence of the granting of this permit. 5 A NG 03 APPLICANT UNDERSTANDS AND WILL LY WITH ALL NON-POINT Issued by:5 Date SOURCE REGULATIONS. Re-roofs Type of Roof ^Dam Slgnnum of ApplicanUCCyy acre IHCLARDO(J f TERIALS DISCLOSURE Will the applicant Or tutu a building Occupant store or handle hanNuus material as defined by the Cupaninn Municipal Code. Chapter 9.13, and the Health and Safety We. Section 35513(a)7./ ❑Yes KN. 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 dcvicu which Is havardous air eomaminum, as defined by the Be, Area Air Quality Management all new materials for inspection. ❑ Yes 1 have rtaJ the hasaNrws materials myviremcnu underCWPmr695of the Califor- niaHcalO&Safety Code,Sccdon25N15.25533andn5].lundersmndOmiftW Wilding dose not currently have a SO.M. t is y reasoner In I ty m n my the acuPal of the requiremenB ;gZ � O iZw t— LQ J )qU N 0 :ora �ino u—y L. 02 C z� �V W� UC wF U�2 r CITY OF CUPERTINO C�R�,GT+C12 �1`d�'bI�MATa BUILDING DIVISION PERMIT BUILDING ADDRESS: 1040C 2C_T,!NTC GEORGE TU PERMIT NO03080130 3080130 OWNER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG E ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION - 9 ' Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter (commencing With Section 7000) of Division 3 of the Business and Professions Code, and my license is License Class d effect. Lic a REVISION --IN-HOUSE USE. ONLY Date Contactor NO NEW PERMIT/ ORIG. #03080130 ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair'any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation $ 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or , that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 �'�T$�glppl ;rQ Q Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who docs such work himself or through his 101 — FOUNDATION own employees, provided that such improvements are not intended or offered for sale. If, 102 — PIERS however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of 103 — UFER sale.). 104 — REBAR ❑ I, as owner of the property, am exclusively contacting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- _ 105 — ANCHOR BOLTS. cense Law docs not apply to an owner of property who builds or improves thereon, and , 106 — SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 202 — UNDERFLOOR PLUMBING j)� 1 am exempt under Sec. , B & P C for this reason °wn 203 — UNDERFLOOR MECHANICAL ' r`y f COMPENSATIONDEC ,0 204 — UNDERFLOOR FRAME I her under penalty of perjury one of the following declarations: 205 — UNDERFLOOR INSULATION ❑ Ihave and will maintain aCcrtificatcofConscnitoself-insure for Worker'sCompen- 301 — ROUGH PLUMBING sation, as provided for by Section 3700 of the Labor Code, for the performance of the 302 — TUB t$c OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL ❑ I have and will maintain Workers Compensation Insurance, as required by Section 3700of the Labor Code, for the performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL My Worker's Compensation Insurance carrier and Policy number are: 305 — FRAME Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 — INSULATION ' (This section need not be completed ifthc permit is for one hundred dollars (SI00) 308 — SHEETROCK or less.) 309 — ' EXTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation 310 — INTERIOR LATH Laws o(Cali(ornia. Dale 311 = 313 — SCRATCH COAT ROOF NAIL Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. i 5 O Z — F I NAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 — F I NAL PLUMBING ENERGY I hereby affirm that there is a construction lending agency for the performance of 5 0 3 — FINAL MECHANICAL ENERGY ' the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Na � mc 504 — F I NAL BUILDING ENERGY Lender's Address 505 — FINAL ELECTRICAL ' j 1 certify that I have read this application and state that the above information is 506 — GAS TEST ' correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorim representatives of this city to enter upon theFIN PLUMB G above-mentioned property for inspection purposes. (we) rag to cast, indemnity and kith harmless the ay of Cupertino against 08 FI L j liabilities, judgments, costs and expenses which may in any wayy accrue against said City ' 5 in consequence of the granting of this permit. APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON -POINT Issued by:5 ING Date SOURCE REGUL NS _ 514 NAL PUBLIC WORKS Re -roofs Type Of Roof , 5 Ic AZARDOUS MATERIALS DISCLO3 Will a applicant or future building occupant stoic or andle hararduus material as defined by the Cupertino Municipal, Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑YesAllu 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 hazardous air contaminants as_dcfincd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑ Yes lb veread the harar ouemaurialsrequirementsunderChapter6.95oftheCalifor- nia Health & Safety Code, Sections 25505, 25533 and 25534,1 understand that if the building docs not currently ave a ten t that it is my respoosibility to nodl'y the occupant of the requirements ch mus tri r to issuance of a Certificate of OC c . " 0 Signature of Applicant Date All roof coverings to be Class "B" or better • r a on'. 9ent Date CITY OF CUPERTINO BUILDING DIVISION PERMIT' BUILDING ADDRESS: GEORGE TU PERMIT NOO 3 0 9 0 0 0 7 OWNER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 ' LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions n! Chapter 9 (commencing P with Section 70(10) of Division 3 o! the Business and Professions Code, and my license isin . fullforce Class d effect. License # REVISION/BATHROOM - Lic. Date Contractor ` ORI G PERMIT #03080016 ARCHITECT'S DECLARATION I understand my plans shall he used as public records IN HOUSE ONLY—NO NEW PERMIT Licensed Professional OWNER -BUILDER DECLARATION , I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, imprnve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 0 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)- - - - ❑ 1, as owner of the property, or my employees with wages as their sole compensation, - - 35708 004.00 - Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, 101 — FOUNDATION however, the building or improvement is sold within one year of completion. the owncr- builder will have the burden of proving that he did not build or improve for purpose of 102 — PIERS sale.). 103 — UFER [:]I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- 104 — RF -BAR cense Law does not apply to an owner of property who builds or improves thereon, and , 10 5 — ANCHOR BOLTS who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 106 — SEWER & WATER I exempt under Sec. , B & P C for this reason 9%��.//�_�-' —�._U 202 — UNDERFLOOR PLUMBING mer to U� COMPENSATION DECL ATION • 203 — UNDERFLOOR MECHANICAL 1 hereby affirm under penalty of perjury one of the !allowing declarations: 204 — UNDERFLOOR FRAME ❑ I have and will maintain a Certificate of Consent to self -insure for Worker'sCompen- 205 — UNDERFLOOR INSULATION sation, as provided for by Section 3700 of the Labor Code, for the performance of the 301 — ROUGH PLUMBING - work for which this permit is issued. 302 — TUB & OR SHOWER ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 303 — ROUGH ME CHAN I CAL My Workers Compensation Insurance carrier and Policy number are: 304 — ROUGH ELECTRICAL Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 305 — FRAME COMPENSATION INSURANCE 306 — HOLDOWNS C17his section need nothecompletcd ifthe permit is forone hundred dollars ($100) 307 — INSULATION or less.) 30& S HEETROCK I certify that in the performance or the work for which this permit is issued, I shall net - employ any person in any manner so as to become subject to the Workers' Compensation ' 309 — EXTERIOR LATH Laws ofCalifornia. Date Applicant 310 — 311 — INTERIOR LATH SCRATCH COAT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you muss forthwith comply with such provisions or this permit shall be deemed revoked. 313 — ROOF NAIL CONSTRUCTION LENDING AGENCY 501 — FINAL ELECTRICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of 502 — F I NAL PLUMBING ENERGY the work for which this permit is issued (See. 3097, Civ. C.) Lenders Name 503 — F I NAL MECHANICAL ENERGY Lender'sAddress 504 — FINAL BUILDING ENERGY I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to 505 — r, FINAL ELECTRICAL building construction, and hereby authorise representatives of this city to enter upon the t GAS E S T about -mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 0 7 F IN l liabilities, judgments, costs and expenses which may in any way accrue against said City 5 4 A I CAL in consequence of the granting of this permit. NT APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON -POINT Issued bY: S _ Date _ �/ 510 NAL PLANNING ' Re -roofs 5], 4 — Type of RoOI INAL PUBLIC WORKS ' nature MATERIALS DISCLOSURE Will Ih applicant or future building occupant store nr handle hazardous material az defined by the Cupertino Mu. icipaLCodc, Chapter 9.12, and the Health and Safely Code, Section 25532(a)9 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant o future •building occupant use equipment or devices which emit har-ardous air contaminants as defined by the Bay Area Air Quality Management -all new materials for inspection. District? ' ❑Yes u I have read the haiarit us materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirementsi - ow met 'o to issuance ofaCcrifo a Leofoeeupancy. Signature of Applicant Date "� All 'roof coverings to be Class "B" or better " o m mtbu „ed nt Date v /-