01010041 ._CITY-OF CUPERTINO - ' - c ''BUILDING DIVISION, PERMIT CONTRACTOR INFORMATION:, ., " a, s�
BUILDING
NFORMATIONv '
BUILDING ADDRESS: - PERMIT NO.
18455 CHELLMSFORD DR . BUDGET 11 PLUMBING 01010041
OWNER'S NAM&. ' - • • - f APPI dcAI ION If SUDATE ,
PHONG LEE. 28f�95 RORNf]I:E ST I '' 01/09L,U00i.. A• ;
:PHONE: - - SANI'I'ARYNO." CONTROLNO.
(51'0)303-7847., .
OO ARCHITECI'IENGINBER _ t BUILDING PERMIT INFO .
z 'BLDG ELECTPLUMB ' MECH
de tb e, LICENSED CONTRACTORS DECLARATION'
I hereby t'1 licenseddF of Chapter �t JOb DeSCQ hOn
Oz�pwthS 1 90001 fD3 fthe Bn IP Code admyl ' ♦ '
oa ccn fall
License Class Jeffect. « REPALCED WATER;, HEA'
wp
'3mm Dat Contractor
t -
J ARCHITECTS DECLARATION
I ta accurst 1 arypl shall be :ed as public records
Licensed Pf.: nal 1- ••'
-
OWNERBUILDERDECLARATION
w 2, I hereby affirm thin l am exempt from the Contractor's License Law for We r `
zz C
b9apttl e , -t II p any cf II 6 (S c 7031.5.B I I C I A y virtually
t
prx t pp ,Paa not
that her, id6ritedrarrulact the......onI
(be C tr cl f n L (Chapter 9, Sq. Ft..FIOOr Area.-. Valuation
6o nest tbwth Section 9000)of Division3 or the Bovines, dProfessions eo
dm - h
n that he i exempt therefrom and the basisI' theII bell a apu Any violation $332
ofSta Station by.IS YaYmfor ap t bimu the applicant PnY`�'Pe
civil penalty N
m not sere than rte hundred dollar,dollar,r85(rc0. ._'. t • '"� , -APN Number �.. Occupancy '
. . CI - flnP prlr y ply 'h ab: Ih I peal 7 � .
. =
will J 1 k d thet 1 h intended c H J 1 :' (S ]044 -
45- 06
business J Pmfd,vms,Car,'TI Contractor's L' Law does not apply h an s. Required Inspections
,howner I property Who ba ld r' such
ppr P at u n and 1 tend Ir :502 — FINAL PLUMBING ENERGY
oaththrough h, mvereth building
Oat. h P n l t intended "
oopAftrsaeuvVwhri[,ihel have
'mpr< e powar,aid within(me year of '
provef,n.meow„efsale.ef wm'have me nnrtmn rar terracing lm,l he ala sat soda or 506 GAS 'TEST - ,p
improve fur paryrate of sale.) '
507 FINAL' PLUMBING
e I as.,net r the property, exclusively nl y"tI I 1 1' Ir to
rad...c,the tented(Sec 9044 o ince I P,E whola Codor The improve,
the mdt • '
= and %l Law tract mi apply t an owner of properly uho hulld ed pur c,c nto tare • '
and who mLreac for h projects with v crannacmr(x) licensed p ,vin to the t • d
El I a
Connector',Licence Law: i
❑lam exempt under Sem ,H&YCfor this reason Lw '
WORKER'S COMPENSATION DECLARATION ' a
I hemby,affloon notharpenalty f r
Y P 1 ry �of f II gdNl t a
• Compensation, .. n. r
CIh I will I nCn'fcn fC : , t ll'mu frW ke :
Camp sni en as ptovJed for by Sc t t 3900 f the 1 nrr Code, for the -
petfonnanee of the work for which this Fenn t is issued
Cl have ]still armut.i.W k ,C .
P t 1 q Ib)S t
3sa,of the In CnJ f th p fIh khIh p 1
anJ. Worker •. - i- - - r ,
My WnrkersC p ul cotlnstmnw waicrmd Policy numbvarc • - e
Cagier: Policy No,: �••
CERTI FICA[[ON OF EXEMPTION FROM WORKERSnI 1'
r COMPENSATION INSURANCE
-
Ohn"4otion intestinal be cn Hs'lod f l he knom,is for raf nJ'ed dollars
(5100) I 1m
I certify chit'm the p fact ' fth work to, a' hths dfit issued, - ^,
shall 1 ply y p , nn
any 't h come width to the Work -r , - '
Cramp frac Lows of Cnl(omla IA Te . - -
Applicant
t a.
NOTICE TO APPLICANT:IL.after makingflux Certificate of Exemption, ounhould= -
P Y ,
O Qhionmenflucalt the Workers Compeamrimaplookinimul the L.nor Crthr you mutt °c `
'. forthwith comply wimsuch teposters or this Fcnmt shall be dot sed mvnked -
rr - ..
V1 CONSTRUCTION LEN DING AGENCY
4”
t
n
� ,.1 horcM1�nl�nnt vt / -
y L h there is csued(So,, lending agency Ina the purfnnnan<e
Leads work for Marti this R v tx Issued(sec 3097,civ C,)
Q Lender',Name - . . • t.
Lender's Address _ .. . t .. i\
v O a.
• II aR certify man na I all.city
an r y rdeances h f ,Halloo it
LTi f~'S correct.1 agree to comply d hereby l
icy and county representative,
and ma lav c relining
O C..1 tlihabma-contamtiogandy for im counn,unposenwlives of thlx oily master"Pon
r� the xbm r).g cm publicity for incper keep
p harmlc.
Fy Q,t (W 1 b t .a end pa dk ph II CIY monme t, aguml - '.
Fr Vi Cn'yi ) Jg of t:' J p 1' 1 yin unY 'Y'une ubu not cud _
U AIPPLICANT UNDERSTANDS amal—l'the AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. _Issued by: Date, -
'Signature of Applicant/Contractor - Dnte Re-roofs
HAZARDOUS MATERIALS DISCLOSURE -'
Wi1I the appram or future banding neenpam m shiorhandle baaa,ves material' 'Type of Roof
at defined by the Caperton Maine cal Code,Chapter 9.12,and the Health and Safety ,
Code,Section 25532O
❑Y �: oN - ' ;tell roofs shall beinspected'prior to any roofing material being installed. '
Will the Piplibranm
1 t n l T g orb1' if use cgmp t m dioice,which if-a roof is installed without first obtaining an'inspeciion, I agree to remove
smith dont air com name as defined by the Bay Amin Air Qtallty Management
District'
ist tals for inspection. Applicant understands and will"comply with
Cl yes c El No all new materi
all non-point source regulations'.
I have read1he Isi 1 u 't 'al erm....ein,under Chapter`695 if theCalifornia Heaps&Safel Code,Seetionc 5505 25533 atd25534 I understand that ..
'ff,hadd' gl t nmoonfl,throo.lenardiffialiti yrep hltyt ffy the'
wer,nan of the qt i r t. which must be met prior m issuance of a Ccri 1 cam of
Ochi p cy. _ _
Signature of Applicant : - Date
'owngr or amthndmd agent - -,Date 'All.roof coverings to be Class "B'• or better .
OFFICE
- u