03050152 (3) CITY OF CUPERTINO `
BUILDING DIVISION PERMIT CONTRCTUR4INFQRMATION:�
BUILDING ADDRESS: WONG JOSEPHINE N AND HASTI v"§N°03050152
a'NER'S NAME: 1'BRFOT ISH&OATQ O/ZOO 3
NG JOSEPHIN
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: RUILDINO PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRACTORS DECLARATION Job Descri 1 hereby grim Net I am licensed under provisions of Chapter 9(commencing p
with Section 7000)of Division Sof the Business and Professions Code,and my license is
n�
infull(..andercn` ADD SHOWER/UPGRADE BATHRM, KITIIU `r—m®
j License Clans Lk.N
Z Dau: ContractorDECNOV2 02003 2003
ARCHITECT'S DECLARATION Y 4 C IIW']
SSSQ I undersunJ my p4na atoll be used as public reenNa
Licensed Professional R IN
Oat I am exempt
fr DECLARATION �I■�RYI
� 1 borehy.(fere that 11. uusin from tite ConcraeCo :A License Law for the
i o o fallowing reuoa(Section 711714,Business and Professions Code:Any omstcount
$ which requires;requires; m a permit cnnurb:L after.improvm repair
se,demolish. palr envctum
in
prior In its issuance,also requires the applicant for such permit 1.Ole a signed comment
g z�FA that he is licensed pursuant b m
the provisions of the Concor's License Law(Chapter 9 Sq. Ft. Floor Area $2 ON049tlon
3� (commencing with Section 7000)of Division]of the Business end Professions Code)or
3 that he 4 exempt Ncmfmm and Nu
e basis for the alleged emption.Any violadon of
Section 7031.5 by am'applicant for a permit subjects the applicant to a civil penalty of 3 4&Y> 41adt6el O O Occupancy Type
not more than fie hundred dollars(5300).
❑I,uawnss of the property many mmploym with wguulheb tole camRrmtion,
will do the wudc and the tenure 4 net intended oroffued foraa4(Sce.7044.Bualnru 102 — PIERS dInspections
and Prefecsbns Code:The Cornerstones License law docs trot appy b an owner of
property who builds or improves common,and whodrmsauch work hlmselfor through his
ownemployea,Provided met such improvements are not hmaxel or offered for sale.If, lO3 — UFER
hawevu.Ne building or improvement Is sold within one year of completion,the owner
builder will have the burden of proving that he did not Wild or Improve for purpose of 104 - REBAR
""')' 105 - ANCHOR BOLTS
❑I.as owner.(Ne property,am exclusively caressed.,with licensed centimeters he 1O6 — SEWER & WATER
construct the project(Sec. 044,Business and Professions Cale:)The Co misctNs Li
cense law does not pply •an owner of property who Wilda or lmprovea thereon,and, 202 — UNDERFLOOR PLUMBING
who contracts for such pro ei with a contractual licensed pursuant m the Conume es
c claw. ; 203 - UNDERFLOOR MECHANICAL
I am exempt under f PC ureas"" 204 - UNDERFLOOR FRAME
Ail wo R Co ATI oN 205 - UNDERFLOOR INSULATION
• Ihereby aflrea un rpenalty of rjmy rob Orthe DBowbgd IMUDs: 301 - ROUGH PLUMBING
❑I have and will mmetal aCeN Icahn C"nsenu"self-usef.r Wafte.Compen. 302
— TUB & OR SHOWER
aatlon.asprovided for by indent]700 of the Labor Code.for the p formance of the 303 - ROUGH MECHANICAL
work for which Of,Fermi la lasted. 304 ROUGH ELECTRICAL
❑1 have and will maintain Workmes Compeuado.Insurance,u required by Sued..
]700.f the Labor Code,for the performance of the work for which this permit is issued. 305 — FRAME
My Worker's Compensation lnsumue carder and Policy number an: 306 — HOLDOWNS
Carrier. policy No.: 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not hecw"plemd if the permit is forone hundred dollua(SIM) 309 - EXTERIOR LATH
or4ss) 310 - INTERIOR LATH
e certify Net in the inn y runner
dm work for which eltopermit rl issued,l alu0 raw 311 - SCRATCH COAT
employ any pmrsonin any manursoubbcmmc sobjecc co dm W.rkem'Campenution '
Laws of Cafnenji.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.It,after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject in the Woherb Compensation provisions of and Labor Code,you must
.JZ forthwith comply with such provisions orthis Permit shall Inc devoted mmkcd. 502 — FINAL PLUMBING ENERGY
z CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
F� Thereby affirm Wt Nem is a construction lending agency Tu the perrormamm of 504 - FINAL BUILDING ENERGY
CC>
hewk roawhimhth4permu4lasnd(se.]097.civ.ca
-meet-
505 - FINAL ELECTRICAL
W Q Name
�n°ef'Arrify 506 - GAS TEST
ILI ZO Ise"ce that Ihaw read this
ty and counandnateesu than sbowinformation4 507 - FINAL PLUMBING
ty F waren I agree m comply with all city and county.rdirttnceaand sum laws relating o
0U building construction,and hereby auth.drz rtpreunotiwaafthis city oenmrupon the FINAL MECHAN CAL
W ahovamenti.ned Property for inspection puriwaes O 9 F Ik.
G (We)agree to saw,indemnify and temp harmless the City of Cupertino Against
In Babllidell figments,costs and expenses which may to any way accrue against said Cit A NG
OF77 in conseq circ of the grentin of this Pmrmil.
APPLICA UND RST D WILL COMPLY WITH ALL ON-POINT Issued by:5 WORKS Date
SOURC N
i• �.
Re-roofs
esu " Appliean on m
OUS MA 4 ALS DISCLOSURE Type of Roof
Will the applicant r bre building cecupentuore orhandle hvudoumamrial
u dcOned bdy�the Cupenin unicipal Cade.Chapmr 9.12,and the Health and Safety
l25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Will
6tthe applicant or future building occupant use equipment or devices which A. If a roof is installed without first obtaining an inspection,I agree to remove
emit honchos air contaminants to di fncd by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Y., P \
Inn readdmhenrdmsmeerialsmquim=munder Chapmr6.95.fd¢Celifor.
n4H=IN@"afoy Code.Sw ns25305.25533and23534.1underpandthuirthe Wilding
dans not c c Iy \nal it 4 my responsiNlicy b notify the attupanc of the
mquiremc t r SI U. 1 b ts...face a roc ,limy. Signature of Applicant Date
near .t osiamd% lit o All roof coverings to be Class"B"or better
1