04120148 CITY OF CUPERTINO p -?T- - -- r'"""- ''a•> t'�aa dr -
BUILDING DIVISION PERMIT CONTRACTOR�INFQRMATION -
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BUILDING'ADDRESS: _ PURMIT NO0 4 12 0 14 8 ..
1117 KENTWOOD AV
OWNER'S NAME: PERMIT ISSUE DATE
MARK ZHANG 12/21/2004
HE - SANITARY NO. CONTROL NO.
ARCHITEC VENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0, LICENSED CONTRACTOR'S DECLARATION - -Job DESCrIpI100 '
C I hereby effvm Net 1 am licensed under provisions of Chapter 9(commencing -
b wish Seetwo 7")of Division Sof the Business arM professions Code.sod my license is
In mu forte andCnacL INSTALL Cl0
j b_ Lice.Chia Lic.• _
F Dau Core.,
ARCHITECrS DECLARATION
I undersand my plans shell W used as public records
OyU
;off Licensed Profcssinnal !!//
3 OWNER-BUILDER DECLARATION
in
I Wrcvy anion that I em exempt(rum TW Contractors License Law for she
c o fallowing season.(Section 93 1.5,Business and Professions Code:Any city m county
K m which requires a permit To construct.am
lar,improve.dcolieh,or repair any structure $600
construct.
vim'^ prior to its issuance,else requi,s The applicant for such permit u rile a signed statement
that he is licensed pursuant to The provisions of the Commcmr's License Law(Chapter 9 Sq. Ft. Floor Area "' ., Valuation
FFG (commencing with Section 7")of Division 3 of she Business and Professions Coda)or
y $ Net he is exempt the,from and the basis for out alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit wbjccu the applicant to a civil penalty of 3e _ Occupancy Type
not more Nan five hundred dollen(5500).
❑I.ssownm of Ne propmy,mmy employes with wegesalheh ulc mmpenuuon,
will do the work,and thesT,mu,is not intended orofferad forsak(Sec.7064,Business Required Inspections
and Professions Code: Licensee Connector's License Law dors not apply to an owner of q p
property who Wildsor improves Thcuon,and who doessuch work himself or through his
own employers,provided thmsuch improvements ace not intended oroRered foraale.If.
however,thc building or improvement is sold within ane year of completion.In,owner-
builder will have the burden of proving that W did not Wild or improve for purpose of -
sak.).
1,as owner of thc propcny,am uclusivdy contractin6 with lianud convectors u _. -__ -
\ co swa thc pmjecT( 704.Business and Professions Code:)The Conerecur's Li-
ceve taw des no, pply m an owner of property who Wilds or improves thc,o and, _.
who coolness for such pmlecut with a smossicur(s)licensed pursuant o th Convactor's
License Law. ..
❑lam eaemps on ,See .B&PC for is -
O n Dees .. .. __
ARK 'CNSATION DEC ATION� -
I hereby anion under porosity of perjury one of One fallawag de\Llannions:
I him and will mainuin a Cmtifcate of Caveat to self-moon,for Worla r'sCompen-
salmon,u provided for by Section 3700 of thc Labor Code.for the perfmmana of thc
work for which this pmmin is issued.
I have and will maintain Worker's Compensation Insurance,as requited by Section - - - - - - --
3700 of thc Labor Code for the performance of she work Tor which this permit is issued. -
My Worker's Compensation Insurance carrier and Policy number arc:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hccompleted if tW permit Is for one hundred dollars(SIM)
or less.)
I unify Nm in the performance of one work for which this Permit is issued,l shall not
employ any person in any c a tuaran as To become subject,thc Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CcoiOcau of Exemption,you shmiM
Wcome subject To the Worker's Compensation provisions of the Labor Code,you must
C z fuMwi,h comply with such provisions or this permit shall he damcd,voked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a consvuctinn lending agency for the perfurmana of _
Cd 7 thc work for which this permit is issued(Sec.3097,Civ.C.)
W 0 Lenders Namc
0. Lendeis Add,as
V C I certify that 1 have mad this application and suite thu thc above information is
U. F-' CO=L 1 agree To comply with all city and county ordinances and sure laws relating To
C C.J building construction.and hereby amhodxe Mirrsenutiws of this city to enter Orion the
}W .1xim n entloned property far inspersion purposes.
,r C
WC)agree to save,indemnify and keep harmless the City of Capetian against
r/] liabilities,judgments,costs and expenses which may in any way starve against said City
t.)z in conuqucnec of The graming of This permit / /v
.. APPLICANT NDE TAN S AND WILL COMPLY WITH ALL NON.eO4Yf Issued by:9 Date
SOURQE LA O
2 / Re-roofs
n o Appli V RDO ere
AZARDOUAT
S E SCLOSURE Type of Roof
Will the applicant Or future building Occupant store or handle hanincous material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
o&.Section 155310)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will dre applicant or form,Wilding..Pa.,esu cquipmcnt or&vices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air conaminaneias defined by the Bay Area Air Quality Management all new materials for inspection.
Disviai
❑Yes No
I have read the haxid usmatenalsrequiremcnu undr Chapurb.95 of the Califon
raiz HcalN&Sichly Co&,Satiov 25505,75533 and 15534.1 understand!theacifthe Wilding
dna not cunmrTly have is tenant d4T it is my responsibility in notify the occupant of the
mw�'���enaw m T cT toissundccOfa c tea,,JRr, a a Signature of Applicant Date
r� BT� �-- I All roof coverings to be Class "B"or better
Owner or authorircd agent Dau
i
- Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS: rNa PERMIT # / /�laD�
� i KtVFW60-b Il�,� D `{tel
OWNER'S NAME: HONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• 1 � �o
er/Con actor, e Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE 0 Z°
CUPEkTINO PERMIT APPLICATION. FORM
APN # 3� 3/ ()D Date:
Building Address:
0o E
Owner's Name:MARK �� A/V/ Ph na#: 366 _ �r r
_ Contractor: _ Phone: License #:
Contact: l Phone: Cupertino Business License#:
Building Permit Info:
-
-Bldg Elect Plumb
Job Descriptioj^ /
;
Residential ❑ Co ercial ❑
Cost of Project:
Qt 'fes
A li aFee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture - - PLUMBING
BPWS VCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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