02070097t -
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CITYBUILDING
fC®�i' RACT®1[81CNFORMA ION:
DMSIONPERMIT
BUILDING ADDRESS:
PERMIT N
22575 ALCALDE RD
2070097
o'MMY & SHELLEY GUO
APPLICAT101�1 Tl Df72002
PHONE:
[
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
LL E_ __1 L _-7 L—)
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
11
REMODEL BATHRM�K-I=�' 2EROOF /WINDOW .
with Section 7000) of Division 3 of the Business and Professions Code. and my license
is in full force and effect.
License Class Lit. N
Date Contractor
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
$10000
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve. demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
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3 8(� 2F9.
�1> 'a � ', -
Valuation
that li 'R licensed our uant tq the prbvislons of the Contractor's License Law (Chapter 9
(commencing with Section 70W).of Division 3 of the Business and Professions Code)
•: •_ t ,
or that he is exempt theiefrbm and the basis for the alleged.esempubn. Any violation
-oPSection 703"1�'by anympplicam fora permit subjects the applicant'to a'civifpenalty
odfhotdnore ifihh fiVi hundred dollars ($500).
10 APRT J�FDATION
Occupancy Type
❑ 1, as owner of the property, or my employees with wages as [heir sale compensation,
102 -
PIERS
' win do the work. and the structure is not intended or offered for sale'(Sec:'7044,
Business and Professions Code: The Contractor's License Law does not apply to an
103 -
UFER Required Inspections'-
owner of property Who builds or improves [hereon, and who does such work himself
104 —
REBAR
or through his own employees, provided that such improvements are not intended or
6ffered for sale. If, however: the building or improvement is sold within one year of
1 O 5 -
ANCHOR BOLTS
completion, the owner -builder will have the burden of proving that he did not build or
10 6 —
SEWER & WATER
improve for purpose of sale.).
.o.n - ...
20.2. —
-UNDERFLOOR PLUMBING
❑ [„as owner o(the property, am exclusively contracting with licensed contractors tto o
construct the project (Sec. 7044, Business and Professions Code:) The Contractors
203 —
,. .
UNDERFLOOR MECHANICAL:: : -
License Law does not apply to an owner of property who builds or improves thereon,
and. who contracts. for. such projects with. a.contramr(s) licensed pursuant to the
- .. .. ... 2.0 4 .-
.UNDERFLOOR .FRAME. . _ .. .... _ ...
m
DECLARATION
302 —
TUB & OR SHOWER
JCvvU/
I hereby afrrm under penalty of Pedury one °frhe following declarations:
303 —
ROUGH ME CHAN I CAL
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers
304 —
ROUGH ELECTRICAL
Compensation; as provided for by Section 3700 of the Labor Code, for the
305 —
FRAME
performance of the work for which this permit is issued.
306 —
HOLDOWNS
❑ 1 have and will ratuntain,Worker.'s Compensation Insurance, as required by Section
3700 of -the Labor Code, for the performance of the work (or which this perinit is
307 —
INSULATION
issued: My Worlaiii'Compensai on'lnsurance earner and Policy number are:
..... .. * .. .....
. 308 —
SHEETROCK
carnet •. Po icy No.:
,
3Q,9 ' —'
`' EXTER I.OR LATH
CERTIE ATION OF EXEMPTION FROM WORKERS'
gWENSATIQN INSURANCE
31.0.._ .-...INTERIOR_
.LATH ... _ ...-........
' (This sec[iori need not be completed if the permit is for one hundred dollars
311 —
SCRATCH COAT - •' �''r
(S 100) or less.)
..:'.-:..
RQOF..NAZL... .. _......-.
1 certify, that in the rfo ,once of the work for which this ptmdi is issued, I
501 -
.............---._. ..._
F I NAL ELE CTR I CAL ' : ,ENERGY
shall not employ any person any manner so as o b come ubj ct [o the Workers'
Cbmpensaoon-Law if �. Date - •
502 —
F I NAL PLUMBING ENERGY
Applicant _
NOVC� T APPLI '1 after m-aking this Certificate of Exemption, you sn°inti
503 —
FINAL MECHANICAL ENERGY
be subject to the Worke s Compensation provisions of the Labor Code, you must
f_rteitth comply with such provisions or this permit shall be deemed revoked.
504 -
FINAL BUILDING ENERG ''.
CONSTRUCTION LENDING AGENCY
505 -
FINAL ELECTRICAL
1 hereby affirm thin there'is a construction lending agency (or. the perfortitance
506 —
GAS TEST
Of Un the work roe which tnis'pemrit is issued (see: 3097, civ. c.)
L'ender's Name hich is' rm , . . _ ., Ci ... .. ....: . .. i . -. _...
507 —
FINAL PLUMB I NG -
LeSaePs Address,
508 —
F I NAL ME CHAN I CAL
I certify that I have read this application and state that the above information is
509 —
FINAL GRADE
rec
correct. 1 agree to comply with qct, city and ordinance and state laws relating
i to building construction; and hereby authorize representatives
rerepprresentatives of this city to ewer upon
510 —
F I NAL PLANNING
the above-mentioned property for inspection purposes.
` (We) agree to save, o4ernnify'and keep hamdesi the City of Cupertino against
514 —
FINAL PUBLIC WORKS
I liabilities, judgments, costs and expenses which may in any way accrue against said
'
g of this rrniL
Cityy inconsequence dWR
APPLICANT ID COMPLY WITH ALL'N' N -PO 'T SWRCE
Issued by:
Date
St re' ” Date
Re -roofs
HAZA OUS MATERIAL$ DISCLOSURE'
' Will Qie applicant futuie building occupant store or. handle'hatardotu material
Type of Roof .
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as d(Sned by the Cupertino Municipal Code, Chapter,9.12, and the Health and Safety
'
Code: Srct m 25532(a)7.,.,
u Yes
All roofs shall be inspected prior to any. roofing material being installed....
Wo the applicant or future building occupant use equipment or devices which
hazardous defined by Bay
If a roof is installed without first obtaining an inspection, I agree "to'remove
emit air contaminants as the Area Air Quality Management
District? ' ' �(
°yC5
all new materials
for inspection.- Applicant understands and will. comply with
i"'°
all non -point source
egul tions.
I have lead 'the h2Zardous'materials requirements under Chapter 6.95 of the
California iiealth & Safety Code: Sections 25505, 25533 and 25534. 1 understand that
if.the �t 1lding dos not' trendy ve a tenant, that it is my responsibility to notify the
occupant of a Certificate of
Beep
4 DZ
i'
ature of Applicant
Date
�`
Al roof coverings to be Class "B" or better
autagent _ ; '
r horized Date