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01030039 CITY OF CUPERTINO - ` BUILD INC,DIVISION PERMIT CONTRACTOR INF,ORNIATION:' BUILDINGADDRESS. ' " I '. PERMIT NO: 7427 BOLLINGER RD., ' ' r `/f� �! 0 0,1.030039 OWNER'S NAMH _ APPLICATION SUB DATE •' -HONG K,'AHhI .. s1? Z' L W 03/08/2001. �'PHONE: _ SANITARYNO.' _CONTROL NO. 2-Z ARCIIITIiC'HENGINIiIER:- BUILDING PERMIT INFO .W02 BLDG �ELECT'- PLUMB' MEGtI , ¢¢c m6 " 1. Eti _J CEASEDI a CONTRACTOR 5 DECLARATION - A z�y� � 'Jo •'scnption 2z— Ineren)arcro m"t 1" licensed underp rcn.tPrer9aomntl'i y , wilnf t 9WN :tn 3of lM1C Bu '" JP f.s .CJ nd i,Tecate ' �z�2 c�._run — "t IQ�f'J e" GRSI_I.NE �3wy D,I Contractor Is ARCHITECT S DECLARATION Id t y pl s shall be used p blc records g ))) % a OWNERBUILDER DECLARATION `-' Contractor's ul 1 h bfr ant 1.n y exempt f the C nt" I I 1" f IM1 F• y foil 6 (Section 7031.5,Businw,,aid P ! Cod,AY city or Inual, a F which"'urne,.pnait tociradmist, ❑dR,,inidnai pti y oirrource, prr t I " I. 9 'th ppl' tl I I II fl x d'tt nen - '• • - - c, 'hat he is licensed p ,to the n of the Contractor.License ro (chpler9 - - •(eontnene.nxwirnSu on7(NIB>nrDvi.,on3oftheBusiness and PrmcssersCode) Sq. Pt. Floor Area ' Valuation - nr(but h 'se pl the f in andth basis Be(It,allie...ir,dou.Any vwithon- • -� $� of Sed 70315 by Y PPI''" if 1 1.object,lhe aPpl"cnt to roil Peelty - of hot r.than rise hundred dt Ito s($500). .APN Number - Occupancy Type ' °1,a.......c,oftho Pro,at,or de"arployed,with -6," In I hatrn. 359236:19. 00 will the k d o thence ant o intended rce I does r tpem(se I 7o I B - - Required Inspections Business anC d Th is nt Ic. to - ' owner fP Perry Wl h Id' th J, I J h workl" If — ordr xhIn ply :.p ddmt - h" p idI' Indeler - ' 202 UNDERFLOOR PLUMBING- It sur sale If huwc.er.the building m provennt is sold within one you of - complf m III llnist,❑to nde fp xln.thedid not build or 301 — .'R000I•I PI_UMBTNG - .. . hu'voi for pp' II1 502 —' FINAL PLUMBING ENERGY' ❑1 sawnerormePrPnrtnexain9itiyeoman,xwlnreenralranrnemrato 507 FINAL_ PI_UMSJNG ' Lomwel the proJed(Sec 9044,Business and Post ..ions Code,t.'fhe Charncnor's ieeow Law dors nor apply u,an owner of pari who hunch or unpin...fifteen, end who...famous For such.,olper,with u ontracror(0 IicensW ,.,.ad,le the - Contractor'sLiccase Low.-. ' °l am ederi under Sec. ,B&PCfnflikodron h 0,no, Dam - - ' WORKIiR'S COMPENSATION DF.CLARA'I'ION I hereby affirm under peettlty ul perjury one ofthc following dcelamtion,, ❑ I'have and will maintain a Cathode,of Consent to self-insum for Worker's Compen.nuon,as provided for by SerOar 3900 of the Labor Cado, for the Performance of the work for which this punnil is issued. s711 nerve and will inairain Work Cat K:( I ne a 4uired by Section it - - „ 3700 of the Labor Code fid, dhe tw6untrace oft oak far which This pera't is x ' sued.My Workers Canknaamn Insurance carrierand Policy numM:r ore: , Carrier Policy No.; - CLRTIPICATIONOPEXEMPTIONFROMWORKERS , ' COMPENSATION INSURANCE - _ _ i (Phis section nein na he coniplemd trine permit is for one hundred dollars- ' �o 100)or less.) f I ccniry that a.the Penormmee of ae'work for which this permit is issued,I sh dl tot enploy y y t ha I h hI cl ds the l W kers' , Cop t IC ItuAI NOT ICr IO PLICANI�I df (IL egJ CFff "t fL Pi y 1' Id '• Z' hodure subjecttotheW k Ch Cd yu sr D.O fishavid, rattly won Iphoi,urn,ou this prect,shall be deead decked. " r%1 'CONS I RUC OON IENDINC AGENCY .a- • I I Intercity If t that t1 tt is acconi Inudingagiody forthe performance v � QLkfr h"hlh Pe oris xtizrl(S 1119],Ci¢C) 41 Lerou J N D z .Lender AJI t ; 20 • ' W correct.mRun l l havealt h II p(.li nand tt I_h"Ilh "y and cority undirancesIb c'stateIf fl - Oaws relating Ii.) Ian Ii g d i II by n p t tiex nnscnytoenter Pon 'MAR 8 01 - -r GS: the above.mentioned property forinspection purposes _ ^ r E„ pd (We)agree r Id Tyadd pl leeiCtY fCP i ""I VJ liabilities,jrd,arcrr, sI puuu hich nay in tiny way' rueagainst and - uU Z Cllr in or,,,teenrd ofine8saud,ofallepenhil. - /.m Q - SOURCE'TU DERST DS ANf)WILLC LY WITH ALL NON.POINT Issued by:,,�©� �TV ^•—"—/- ignarrreofn a h aafecmr .,Date Re-roofs . . . , HAZARDOUS MAT ERIALS DISCL SURE _ Will the applicant nr finale Buildingaeeulwnl store or hnnale nncrohnsmamrml Type of Roof:' -as droned by theCr,drno Municipal Cade Chapar9,12,mW the Health and Safety '+ _ Code,Section 25532(a)? ss - °V`" _' All,roofs shall be inspected prior to any roofing material being,installed. I W 11doh "pp,,a t r t n wing p" I : n p t I ,,uent. If a,`roof is installed.without first obtaining an inspection, I agree to remove c oil h" d ,,at t 'dlnuJbyN ByAeaA Quality,rwdvMmrxe err ,Dist'I - all new materials for inspection. Applicant understands and will,comply with °Yn all non-point source regulations. 1 have read the hamNans arterials redrdrenteas under Cnaptcr 0.95 of the - Calil'orniaHu�ith&SufcryC,d,.S,cllons25505,25.533and25534.1 undersand that • , if the building des ancurrently l itrood t Ih I'x my re"Pon.l Jlyl dry the P t ft 1. 'IF Its t. V�p rnelso m f Ceflcamof - m i Signature of Applicant Date oeeL a �" modu.daxem11 e Date • 'All roof coverings to be Class.,B" or better OFFICE ,