02110081 [,n1jDjS2&6RI44T
ITY OF CUPERTINO « *. ", , , :)
BUILDING DIVISION PERMIT CONTRACTOR�;INFORMATION.
CREST DR CHAM KIT M AND NG SAU L PERMfrrI0.2110081
aHAWEKIT M AND NG SAU L APPLICAl10111-JJILRT/2002
NONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
Cee, O D O D
CENSED CONTRACTOR'S DECLARATION Job Description
�-u LIm ..w
1 hereby affirm at 1 am ficed under provisionsPifir chapter v(commencing
with Section 70IDECKgq of Division J o(the Isusincrs and Pndessinns code.aha my lianw is
t+,ato
' infmllinceand effect. ORIG PERMIT 99080181 EXPIRED 11/13/02 .
ioq= uceawcmaa uc." NEW PERMIT ISSUED 1/2 ORIG FEES CHARGED.
OZ' Dam Cnnvactor
F H H w ARCHITECTS DECLARAYION
1k:M I understand my plans shall be wood us PUMm recomc �y p �.+
now FINALED
w 3 w I LiccnxJ professional fig OWNER r BUILDER DECLARATION
� �y 1 hereby urrrm that 1 am cxcmpl from the Comncror's License Law for IM1c
w 0O following reason.se,don 7831.5.Businesx and Pn+fexsions Code:Any city in county 0 2003
e w a which requires a Permit lu cnnarum,altar,improve,dcmolisR or cpwr any structureMAY
prior,,its issuance,also requires the applicant lir such permit a+file a signed statement
mathcisrecncedp.rs.antrothe provisions cut the Contractor's License Law(Chapmr9 Sq. Ft. Floor Area $20MIOalion
FFG (commencing wind Scninn7lXX))of Divisinnlof the❑mincss and lknfcaionxcndgon
y Nat M is exempt therefrom and the basis for the alleged exemption.Any violation of RHILDING
Section 7831.5 by any applicant for a permit subjects the applicant to a civil Penalty of b WP14 Wi[imbey U Occupancy Type
not more than Eve hundred dollars($501).
1.mownerofthepmpnymmyemploymswiNwagamt irsolecompenenion,
will dome work,and the structure is not Intended orofrertd percale(Sec.7041.Business
and Professions Cade:The Commetor's License law does not apply to an owner of 102 — P I ERS equlred Inspections
property who builds or improves thereon,and who does such work himself orthrough his
own employees.provided that such improvements arc not included or offeree for aale.If. 103 — UFER
Low e Wilding or impmvemenlis(colwithin one year of completion,me owner- 104 — REBAR
builder will hors tburden o
he bdf proving mahe t did not Wild or improve for purpose of
atle.h 105 — ANCHOR BOLTS
0 1,as owner of the property am exclusively contracting with licensed contractors In 106 — SEWER & WATER
construct the project(Sec.7114,Business and Professions Code:)no Contractor'a Li-
cenwLaw does not appy le an owner of property who Wilds orunionists mcreon.and. 202 — UNDERFLOOR PLUMBING
who centimes for such projects with a conrwri )licensed pursvaauo the ColuVanur'a 203 — UNDERFLOOR MECHANICAL
License law.
❑ I am cxcmpl un/dJer,Sec. .B&PC f 'she no 204 — UNDERFLOOR FRAME
•n i)("��x./ i Dam OL 205 — UNDERFLOOR INSULATION
T54ORKE COMPENSATIONDECLARA �� 301 — ROUGH PLUMBING
I hereby alum+ander penally or Pe do,ma,of lM1c fallowing Oscillations 302 — TUB & OR SHOWER
I have and will maintain aCenifefc orCo.scmc.wlrinsum for Worker's Compere 303 — ROUGH MECHANICAL
satin.,as provided fon by Section 371X1 of the labor Code,for the performance of the
work for which this Permit is issued. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Workcr's Compensation Insurance,as required by Section 3 05 — FRAME
3700 of the labor Codc,for the Performance of the work for which this Permit financed.
My Worker's Compensation Insurance carrier and Polity number art: 306 — HOLDOWNS
Carrier: Policy No.: 307 — INSULATION
CERTIFICATE OFEXEMPIION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(This,wcuumweednol becomplemd;rthe rermilisforonchundred dollars(f100) 309 — EXTERIOR LATH
odes') 310 — INTERIOR LATH
I ccnify a in the dna of the wort I r Is.h cis permit is tan ed,I shun not 311 — SCRATCH COAT
employ any Peron O.'manncrmatoffe wunjc ll,ur 0¢workcrs'CamPelussdon 313 — ROOF NAIL
laws of Califo Da //OV
Applicata Howe 501 — FINAL ELECTRICAL ENERGY
yOTIF sTO APPLICANT:r tar making Itis wisio cent or C Labor
Code.you x
.��la(p/, scomplo the Wnrh mCompensation Pnwisinnx fir the Cobertardyou must 502 — FINAL PLUMBING ENERGY
ZD mwimeamplywanCONSTRUCTIONLENm+it shut[GAGE deemed warded. 503 — FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
[-. •N+ Ihereby affirm that Ncrcisaaonswaionlending agency lot the perfom+anaof 504 — FINAL BUILDING ENERGY
C> the work for which his permilisissued(See3097,Cis.C.) 505 — FINAL ELECTRICAL
II] 0 Lcndcr's Name,
CL., Unit,sAddmss 506 — GAS TEST
U O 1 awdiry that 1 have read this application and stare that the above information is 507 — FINAL PLUMBING
correct.I agree to comply with all city and count ordinances and sum laws rclatin m
QUbuilding construction,and hereby auNorimrepresentativesofIts ciylocnmrupoonm 5 — FINAL MECHANICAL
above mentioned pmPcny for inspcninn PUTnscs. 5 9 — FIN GRADE
(We,)agree to save,;ndcmmfy and keep harmless the City of eupedl.o against
f' In Liabilities.judgments.costs and expenses which may in any way accrue against said City 5 N G
U Z in consequence of the granting of this permit. I tj•,/Y/
... APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bp51 WORKS Date
SOURCii REG Atl NS. /4/ 2,/0-L
� L D
Re-roofs
Ignamrc Appl al A'!.n of DOUS MATERIALS DISCLOSURE am Type,of Roof
Will the applicant or future building mcupanl.store or handle M1avawous material
ea dermal by the Cupertino Municipal Code.Chapter 9.12,and the Ilealth and Safety
nic.Scetion 25532(a1'' All roofs shall be inspected prior to an roofing material bei. Installed.
❑a �+ P P Y g g
Will me applicant or future nnamm occupant use mem m devices woken If a roof is installed without first obtaining an inspection, I agree to remove
pp g I pan quip
emit haeavinus air contaminants as defined by the Bay Arca Air Quality Management all new materials for Inspection.
DisvicR /
❑Yes pNo
1 have read the hasallous materials requirements under Chapmrb.95orthe Calton-
me licad&SafctyCndc.Secunm 255115,25533 and25534,I undcisund of if Be,Milling
Jlws nrn<u tly hove a tenant mal it ix my rcsrymsinillly to nntily Ih tcc pant ul the
equ;rc tsw c palbemelpdormkssuanaoraccmficamo(Occup a. Signature of Applicant Date
tpgn�i nam ��� �y/0 All roof coverings to be Class"B" or better
Ownerroramhoruc gent Dame