02060039 (4) .,CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CONTRACTOR INFORMATION:
BUILDING ADDRESS:;, _ PERMIT NO.
.:21261' GARDENA DR TRUNG VAN NGUYEN "' 02060039
OWNER'S NAME:' - APPLICATION SUB DATE
TRUNG 'VAN NGUYEN 06/06/2002
SANITARY NO, CONTROL NO.
Lu O O ARCHITEC(ENGINEER; -
BUILDING PERMIT INFO
.m'F BLDG ELECT PLUMB MECH
<�z - -LICENSED CONTRACTOR'S DECLARATION
ZO G ,, 1 hereby affirm diI 1 licensed under provisions of Chapter 9 unmmenang Job Description
P {_ iinfnin]000)ofDv o 3o(theBuvnessadProfessonsCodeanemyr BATHROOM REMODEL/REPLACE SINK," -
Ls ofllf resodO'ttl a
uppeen eras a r ADD JACUZZI , '
V pipry +'f r V N CHffEpl'SDECLARAjiON .. .; - ( r ]J.r - '
5 s�IWnd'Vf'rCM_in�Platu shall be"used mpublic Acords- _ s;r- - f ."'` r'
C �T
iii?p
Licensed Profesxiowl -
:S OWNER-BUILDER DECLARATION �I
t"1r ,m 1 hereby affirms that 1 am1. exempt from the Contractor's License Law for the p�
tZQ
which
nquires a(Sectionmito cont. t.alte,imponess and Professions Code:Any city or county' Y�
v wh h ts permit re cores[he anti.Improve demolish.o Ps my structure _
pdnnniuu ance.airostto the provisions
rovision of fortho Cohpermu fl aw(Chtpterc) -
--- -
drattiefshmesedpuicibmtomepfDivisiorNe,hcBusiness
ustor License Lawresc 9 S FP Roor.Area SS S Virluation
:(es mmencing lyih Section 7000)o(Dvson3of rhes Bush ss and profeuiesnsCWe) f�(,i',' I xAlt G9 A .JF.. 7'.46 '1 JrL 1,:•i :0. 90
octh f he A exerrjpt ihercfrom'and the basis for the alleged exeinpdon.Any violation
C
-:of Stttion 7011.5 by any uppliconl for o permit subjects the appli..t too civil penalty
mfaut more than rive hundred dollars($500). Tit a a'Wll• J Occupancy Type
❑l as ow rofthp perry y employees with wages as their sale compensation,' DIAfn
011 do the workand the trunure is not intenaed-or'offered for sale(Sec: Re - .� - "'- - _"-"- -- -'-----
rBis n s f rd P ,al sir Cade The Contractor's License Law does not apply t 102 - PIERS-
I ERS quired Inspections I'•
owner of property Wh builds p n thermos, ad who does such work himself
or through his own employees.provided that such improvements arc not intended or _ 10 3-_---UFER...
,gff,W for sale If,however,the building improvement is sold within one year n( " — - ---'
'comply 0 n;the 16,oa- uildcr will have the burden of pressing that he did not build or 104 - REBAR ' ` - �-
improvemrpnryosenrsale.).-• 105 - ANCHOR BOLTS ... .• . .. .
(•illm n fjecppyam" cls ly tr tog uhlbens 1 tmtorsm 106 SEWER & WATER
eons tali Project Tap ]WS B dPtywhon case)m c tmeinrs 202 - UNDERFLOOR PLUMBING b ,"
License Law toed not apply man owner th property who Wilds or improve Ncreon. ``
bid: and'syho c"ntrvcU.fnr-such prolttu.wnh.e cgmmcmr(sl GcenuJ.Punuant to.the. -•_.-__�- _..___.-.-_._-.._-_____.
C nimetoraLrentt nw., 2'03 UNDERFLOOR—MECHANICAL
1 mexmpt onil S -�1 r B&PCT 9hsversa"
?q
D� CZ/'oil/ Q2� 204 UNDERFLOOR FRAME
It
{ ` r WORKERS OMPCNSATION DECLARATION'
205 - UNDERFLOOR INSULATION
x v'll yarebyafffrm nd,K1 . by. pe0ury oheof Nef ll ng declamdimic 301 - ROUGH:,PLUMBING :nwwA t _ .•
� gXar wr p^ 302 - TUB & •,OR' .SHOWERi.r Yt r:,
'❑d haJ and well:ma mein C mfeule of C .ent'm"selfmsure for Worker's -Compensation, as.povded for bySecton 37W of the Labor Code: for the 303 ROUGH MECHANICAL
pertesrmadee or the work for which this petmi,,ia.iaaaed,,I, .' 304 - ROUGH ELECTRICAL
01 have d ill'mewe n Workc Co pensxuon 1 iurance a rryu red by Section 3 05 - FRAME
1700 of the Labor Code.for the performance of N 'work for which the permit is
ion
'floimpen aai
T' •I}
s ce com�e.r�and
Policy number
,are„_'� ,•..i _.„�..330067HINOLDOWNS
Picy ' 1SULATI
ON_N•.`1S�t .CERTIFIQATION is EXEMPTION FROM WORKERS308, -1HEEtfbK'
1. s . • ` COMPENSATIINSURANCE
t _ `Mh.d•5'{'
w....„..•._.,•..-•,_.-._._-.•._..
..,
•.
30'9; EXTERIOR LATH :,: -
'�: + hundred dollars
WIOOI I ') p °`°°, 310 - INTERIOR LATH '
(Thi sect n d t Ise m IeteJ f the i Is f one hundrc
„ ( p i.
tory-fliaf" N! , f rmani'e the work I r whi h this perm i ti is a,i " '` `''31`T"="SCRATCH ''(COAT '-
Tsh ll nm emPl y'anY Perron nanY no n so m become au�e ito h,v� 313 - ROOF NAIL'I � tttl.nlhrS*' - '!•l
t Compeneu
ufC if a.0
503-- "F-INAL " ELECTRICAL"'ENERGY-
�N TO PPLICAKn If otter k- safe t of Lx rap ion y u lin Id '0
. C
Z her n, "it w kercomps t Pr^ anon Lb Coo youm t 502 z FINAL PLUMBING ,ENERGY
G p forthwith clyoh _clip o .....pcmi t hall bed d revoked
z -- - —• -- 503 -- -FINAL. MECHANICAL.-ENERGY-.----
F„ u�'I �' e ' 1'•CONRUCfIONIENDINGAOENCY r''
ST -I "" 504 - FINAL BUILDING ENERGY,
I h by Rini ih i ST aces t i Ind g age ry f th-herr c •._',
WW.E'� brmeaar bicnN,p�taa, arse3o97ciw,c3._.d - .. ...__5.0.5.......-...,FINAL.--ELECTRICAL ._, . - _ .. . _._. ,...
Le . Add es 506 - GAS TEST p
z a
teensy that 1 hsve mid ihsppl¢at y ordinances
Neabove inawsre is 507 - FINAL PLUMBING _
W,[.. -1bmccal ocismaomply Noby'itonnd aunty aminessand attela relating 508 - FINAL MECHANICAL
V rowlding co.t tin antlh reby authona p <nutive of th crymenter upon
(� the a1 a errneap pony res sped sip pas. . . 5.09 - FINAL;'GRADE s lv'FI
yF:,i ll l�yg9 agreet'l yeidem'fy;un lkeph relay in lan Cny aCp tno'agaid f illi,
N .IGab hna5 ludgme is costs andapcngCs menmy any say acerae agoinatsa'd 510 - FINAL' L ING 'i •'' 6
V Z 'City n)o6domuenoe fthegrntng ohh perma
APPricxTr WDERSTpN05 AND WILL FOSIPLY NRH ALT'Nb9:pO1NT`" 4 �� C WORKS
s k_EREGGLAnpns• �6 0� o Issued: Date
i
Yn t r'p, ApplicanUC ma ., "'. -i Date Re-roofs
i 'HAZARDOUS'MATERIALS OISCLbSURE
'•` Will Nepplicant be furan Wilding occupost store or hardbc'luz�ardyu,onsiteral ,..,Type Of Roof
as d f cd by she C penin Alm p l Cede Chapter 9 12, d the H IN d Saf ty P I -�- - �-•.m•n. "v -��'�
Cada OV n25531d -J' No
3, a a It tT• s> lT.y >. f Pf
t P 1` All roofs shall be inspected rior.to any-roofing„material being installed. _.•-• •__„
iW II the pplc t s t It fi g « p i seitequipment devices moan If a roof is ins[alled'without first obtainingan inspection';:I'a ree'tofreldove
ran h raN a ra t t as defined oc u Bay se Are. Quality ev nag mem g
4 t tY qn -
0 ,. _ all new materials_for inspection _Applicant understands and will comply with
N it r all non-point source regulations' .
, .1.,;
- 'Ii -
1 ha tl'Ne'halt ardoux hal, y ms under Chapter 695 of he
Calif mm Htorb Safety bide Seckmv25505 25533"nd25534 Iunderitiodihat
if thepF l yin dues si t ally h room,,e,t o is m of fy the
is B YY Po still mnfrom of
7 p e 9 P
ix t of me re n q' t hi,h must be m( nor t' uanc of cdniD` Signature of Applicant - Date -
Y
__ _._.... .-.. . ._ -..- _ ..
wncru anthmixedag st , „ Date,' All roof coverings to be Class "B” or better
"'. .... .. OFFICE