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CIBUILDING
OF �tISSIIONNOPERMIT
CONTRACTOR INFORMATION:
DIIV
BUILDING ADDRESS:
PERMIT NO.
10211 COLBY AV
0205 73
OWNER'S NAME:
APPLICATION SUB DATE
'ELIX KWOK
05/28/2002
ONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L=
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license
PORCH
UPGRADE/PORTICO
is in full force and effect.
LicenRaaas uc.0
(NO STRUCTURE CHANGE)
Dam Convector
ARCHI'TECT'S DECLARATION
1 understand my plans shall be used E public TION
understand-�
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor'sLicense Law for the
7
following reason.(Section 7031.5. Biconessond Professions Cock: Any city or county'
which requites a permit to construct, alter, improve, demolish, or Rpair any swnuR
t s.
-prionoiu issuance, also Rqu'sees theaPPliwnt for atschpemunofileaaigned aummem.Tc�
'v
' - '-
that co i31ieehxd pursient to Tile provisions of Ne Contracm's License Law, (Chapter 9
(commencnig with Section.7000)of Division 3 of the BusinessaM ppssoofeniom C.
e.
r. •'9 -11- nT�r' aatlon
!J l tali
or that he is exempt tNerefrotsi and the basis for the alU,ge t oem}ulrb. Any violation
i1.rt
su
-of Section 70315 by any applicen for a permit subjects he applicant 1.. civil penalty
m e � '� Occupancy Type
dollars
,of not mum than live hundred doll
_
°I, as owner of the property. or my employees with wages E their sole compensation.
will do the work, and the structure isnot Intended or offered for In (Sec. 7044,
Business Cade: The Commcmr's License Law does
Required Inspections .t
9 ns p
and'Profession& not apply to an
102 —
PIERS
owner of property Who builds or improves thereon, and who does such work himself
through his employees, that improvements am mend d
—_,
UFER..
or own provided such not or
,offered for sthe If.w however; the Wilding -improvement ' s gold
not year or
..... -..10.3
ohe did
completion, the owner builder will have the burden of proving that he did not build or
104 -
REBAR
improve for purpose of sale.).
105_-
ANCHOR BOLTS__..---'-' ._..___.___
°1 E r-fTireproperlyamcactusvelycomrvctingwNlicensedcontramotam
106 -
_
SEWER & WATER
con muI the potpect (Sec 7t]M. Business and Professions Code) The Commcmr's
ucanse law does not apply to an owner of property who wilds or improver domain,
202 -
UNDERFLOOR PLUMBING
and.who.commem for.such.projecta with a contractor(s).licenexed pursuant to.the
rsLirew.
Conwemnsefa
203-=
UNDERFLOOR_:MECHANICAL__ -- — ----------- --
❑Iamexempt pEer cc "i "' B A P C fearthia REon
204 -
I
UNDERFLOOR �FRAM fi
/�/ /
ddU�.
erg- WORKER'S COM Ea SATION ECLA ATION
205 -
UNDERFLOOR INSULATION
U
301 —
ROUGH PLUMBING
I hereby ffirmunder penalty of perjury one of the. following declarations:
302 -
TUB & OR SHOWER
° 1 have and will 'mamta n e Ceinfieme of Consent to self -insure for Worker's
303 -
ROUGH MECHANICAL
Compensation, as provided for by Section 3700 of the labor Code, for the
peAomsance orthe work for which this permit is issued. „
304 -
ROUGH ELECTRICAL
❑ l have and will nommain Workers Compensation Insurance, as required by Section
305 -
FRAME -
3700 of the Labor Codes, for the perf ncri of the, work for which this permit is
seee: Mr worm, a comp ns don m.pn nee gamer a a Paley namb r a2:
306 -
HOLDOWNS
V
C' aaf.�. s - It•+f Policy No:
-
'
��4rAj `L'rSHEETROCR'
Vi. i.CERTIFICATIONOFEXEMPDONFROMWORKgRS'l
3OB
y -COMPENSATION INSURANCE',
3 0'5- =
.EXTERIOR LATH
section
(This section need not be completed if the perms is for one hundred dollen
(SIW)onea:.),
310.-
INTERIOR LATH •
„j Ic nfyNtin the pert miance nhc o'kf r'wh chN pe t'.'ia. aI
311--
"SCRATCH COAT
sh II t c pl y o pe I a r s b i t utew Ike
313
ROOF NAIL
co pe aaton/%off
Ap I tY >�OaNll - _.
501 -
L-;ENERGY_-
FINAL ELECTRICAL-:
NOE" OAPPLICANT If a[Rr mhkt gNi Cenilcme of Exemption, you should
become subjen io Ne Worker's Compemmmn of the laver Code, you must
502 -
FINAL PLUMBING ENERGY
Provisions
fonhw0h damply with adch provisions or rets permit thaltxdeemed Rvome.
. 503 -
FINAL -MECHANICAL- ENERGY,---_;_._,_
` 'r a '7 CONS MUCIONLENDING AGENCY '"
1 hereby ainim that there is a an nvection lending agency for the performerc<
SO4 —
FINAL BUILDING ENERGY.
orNework for which this pemhisiaauart(Scii. y.Civ.C.)
50.5._ -_
FINAL ELECTRICAL - --
Lender's Name= .-...,_ . .. _` .:•. ...
LendKsAddress ..
506 -
GAS TEST i".. •' .'i r`t lr -, 1
...
slttnify Natlhave read this application and smut thauhe above infomution is
507 -
FINAL PLUMBING
' 'corr'ect. 1 agree to comply with all city and county ordinances and state laws relating
508 -
FINAL MECHANICAL
,to building construction: and hereby authorize' mprescmztoes'of this city to enter upon
the above-mentioned, properly for inspection purposes.,
(We)'ugree io save: indemnify and keep harmless the City of Cupertino against
509 —
FINAL GRADE
liabilities, judgments. costs and expenses which may in any way accrue against said
City in consequence of the granting of this permit.
510 -
F I NAL NG
`iikP.PLIQANT UN ANpS,AN� \VILE COh1PLY wTTH ALL NON- ]I
%'„T�
? T
Issued%] -
F A WORKS Date
WURCERE'L Ns.(
`.'(-
✓Sigothem
Re -roofs '
of AppliepMCommmor --YYY. '. aje-,
MATERIALS
HAZARDOUS DISCLOSURE
will the applicant or formal building occupant store in handle hazardous material
Type of Roof
._.. .. _ _... .. ...-- _ .. .. __ _..
as d (tied by the Capectins, Municipal Cod Chapter 9.12. and the Health and Safety
Cbae Seas on Y5532(a)
', SOI j,"
,
i
t❑Ye No ?I sfr (t`'i
t s ,_n�
nstalled,_-
All roofs shall be.inspected,prior to any roofing material -being .installed._..
li
W ll the.epplicant or tutor building cupant use equipment or devices which
W
- If a roof is installed without first obtaining an inspection; •I': agree to remove
em t h d s'air rent min tx at refined by the Bay Are Air Quality Management
D t ct ,.,
all new materials for inspection, Applicant understands and will comply with___,
all non source
regulations._; t
1 have read the hazardous trwmrials requirements under Chapter 6.95 of the
California Health & Safety Cale, Sections 35505, 25533 and 15534. 1 understand that
ifihe building does not currently have a tenant, that it is my responsibility to really the
-
"
CCCapant of th[ R enf;Wlll[h mast bl.' not, poor m i"U.ee of f.• .I, ,C of
G""p°"` 6/X]//v"-(% . -Uy
V u Crp n�
Signature of Applicant
Dale
All roof coverings to be Class "B" of better
O'$~1110110o1idagemr,., „e.
- " ' OFFICE