01110078CITY OF CUPERTINO
BUILDING DIVISION PERMIT
•CONTRACTORINFORMATION:
x
BUILDING ADDRESS:
PERMIT NO.
881 COTTONWOOD DR
CHI -YUAN TZOU
01110078
OWNER'S NAME:
APPLICATION SUB DATE
CHI -YUAN TZOU
11/16/2001
HONE:
SANITARY NO. CONTROL NO.
00
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ay
ya
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of mmencing
P
t°u
an3oftheBusinessandProfessionsCode.andmyliccnse
nsChapter Code9 and
withfallforcean
WINDOW REPLACEMENT.
Lein fall force and effen.
effect.
d•a
ap yU
eClasn
Date cuarimcm[
FINALE
ARCHITECT'S DECLARATION
I and ernlead my plans shall be used as public records
.2
DEC 7 1 20 01
Licensed Professional
cela.
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt room the Conuunor's License Low for the
?<
following reason. (Section 70315, Business and Professions Code: Any city or county
which a m construct, alter, improve, demolish,
$ 6 0 0 0
$6000
En
�-prior
requires perms or repair any stmcture
t' Is requires theapplicant for such perms to file a signed statement
BUILniNG .. __....... ... ..__ _ _
[ pp A yx
,t;+lij`j5,j,(OAI e'}6!pJ�t.l `'
Valuation
—
(Hath slaE;edp udn the 1 sa3 fine oil LicenseLaw(Chapt 9
(acts fw SwthSt ]11f10)fD 'si 3fm Bsness hnJ Profew ons Cad)
or that he is exempt therefrom and the basis for me alhged ezempunn Any v olat on
of Section 7031:5 byon,applicant for a permit subjects the applicant (o a civil penalty
afnottrumdonfivehundreddollars(s5o0).
10 jPN_N>rtl�lr�DATION
'"'0' •' Occupancy Type
owner
°1, as rofine property, or my employees with wages as theirsolc compensation,
will
ww'Jo me stracode: The not Contractor's
offered Law does
sine apply to an
Professions License
Brxi�esss he Professions Code:The Contintens License Law does not apply t0 .
10 3 - UFER Required Inspections:' .r
owner mf,t Who b Id mp es thereon, and who due, such work himself
or through his own employees. provided that such improvements am notintended or
104 — REBAR
offeredT--f'If-h a the b"Id -
g ar mprovemem (s IJ 'tfi rte year of
'complton,ihe mamr-lulderwill have the thrdenofprov ngthathed'd ambuildor
_ _ _
... ___...- _-___.. ..... ._. . _.. __ ........
105 -' ANCHOR BOLTS '-'
improve N"mrTseafsme).
as herofinep(Sec.7 mBusinssof t 'tCadensT
106 - SEWER & WATER _
-
:
onstruct the project (Sec, Busies and i eContrt° t
cProCade:) The Contractor s
202 - UNDERFLOOR^PLUMBING I"'"i
License Law rices not apply m eny %hon,
to a owner of pmpemy who halide sex
improves thereon,
2 0 3 - UNDERFLOOR MECHANICAL' ' '' "'
s
.and veho ctors Licens for such projects. with a con[mna(s) licensed pursuant. m.me
of
Contractors LBW.
..........____... 2 04 = UNDERFLOOR
_
-
pt under
❑ 1 m exempt under S " ; B & P C for his rtason
Ownei of 16'7",'' •'
.,FRAME,—-�
205 — UNDERFLOOR'INSULATION
Date //��VV))
WORiPENSATIONDECLARATION�
301 - ROUGH PLUMBING
302 — TUB & OR SHOWER
-' Ihereby,flim,naaerperallyofperjury one ofinefollowing declararans:
303 - ROUGH MECHANICAL
I haveandveal mamtnm itr by togas Consent [ouL-bor for workers
Compensation, providrwhic by Section 3700 of the Labor Code, for the
V
3 04 - ROUGH ELECTRICAL
he
performance of the work for which this permit is issued,.
305 — FRAME
❑Ihave had will maintain Warker Cmaressafiris Insurance, as ox;oirsid by Section
-work
306 - HOLDOWNS
3700 of-lin Labor Code, for the puff.surnare. of he for which his permit is
issued My W k "s Compensm n in' ane d Porcy'mumber ore,, ,,
307 — INSULATION
c.� tr r) f'. ! ,r 'Ca
Policy No
a 308's SHEETROCK:,,.
°'30'9(
CERTIFICATION OF EXEMPTION F ROM WORXERs
""' ==('EXTERIOR"gL'""ATH
COMPENSATION INSURANCE'
s stet on need not be completed ((rhe permit is for one hundred dollars
- '�NTERSOR-liATH ;,, —. _...-_...__.
3101,', t,r'r
i'
(gl War
oB)anea..,�, -
311 '- SCRATCH COAT'
-'-. .
i.. 1 certify (y m i'in lin pert rmance -f'b' w rk f -hien this P< t nsued"1
_.. .. .._...... ..,,. .. �, , ..Its,
3'1..3': `NAIL"` -
etabee
shall templyanyLaws ,personmanymann s befame ub3ecnotheWorken'
Comps aeon
501 - FINAL ELECTRICAL ENERGY
Pp .. - '..-.:. ..
NOTICE[ TO APPLICANT If afi., mtaking his Certificate -
reamoeLaboromyooshould
_. _. ..._.-'502.------ FINAL '-PLUMBING--ENERGY._.. _. _ .,....._.._... --._.
the Lobar Craft, ba must
becuitim
the Worker's Compensation permits
"plywirn
503 - FINAL MECHANICAL ENERGY'
0
fonwmc suchp iiansorm'sp h an bed«mmrtraked.
comply sloal
_504-----.FINAL-BUILDING-.ENERGY----
,�
CONSTRUCTION LENDING m
1 h mby affirm that there is a construction lending agency for the p rfoim
505 - FINAL ELECTRICAL ,, 1i
,I
a
i, ,
arm rkfor which m x r 'suea(sc 719c.c.1 ""
:. '....
506 TEST_
.Q
Leader', Nam _. .�-:., i_.:, ..:,
---.GAS ..
Z
ser Address - ,
507 - FINAL PLUMBING,
,�.. , 1 venify but 1 hart read th s application and shoe that the above informhtlon is
,I,
508 FINAL MECHANICAL
9F,
corrects agree to comply,with all city and county ordinances and state laws relating
mbuilaing cons traction. and hereby authbiiae representatives of this city m enter upon
509 - FINAL GRADE
W,
0.
meabore-menrichedproperty for inspection purposes. ,,
(We) eg 'to see nde rrify and keep la Ices the "city of C p ii no against
510 - FINAL PLANNING
.IiC
liabilities. judgment,. emoust oil expenus which any in any why issurium against said
' '"
514 - F I NA P I C WORKS
ZCity
n consequence of thegranting of this permn
APPLICANT UNDERSTANDS AND WILL COM PLYWITHALLNON-POINT"'"
,
-
500RCERFGULATIONS '' t,
ISSDed by: Dale
SignatureDate
Re -roofs
AZARMOUSMATERIALS DISLB
Wnm pp cmr ngoc.rhandle hazaN mho"T`ype
def bythe Code. Chapter 9.12.
- of Roof ,.
2p
ad Heahh d
CdeS t c
55321x1
Ys .
All roofs shall.be inspected prior, to any roofing, material. being Installed
W ll m applicant o future building ccupa , use opt p t de a wn n
hada d by
_
If a roof is installed without first obtaining an'inspectho 't'I agree:to'remove
emit ayAreA.. Quality age
Disr ( - contaminants xee
El °N
ll new materials for inspection. Applicant understands n`d co.nt. 1 with
°t
Inregre
.a. `a.w...ill _
alnon-point source regulations ..,:. "
nu'ndrChapter95bf
C[if m.Halth &SafetyCode Sections 25533 and 1 understand the
afetz
(fheb Idmgdaem ahanusmy,.e,i tomcatand
oceup t fme requirements Whichmail of anet poorto issuance'of. Certificate of
�'•' "' "' y "'' `
_Signature of Applicant , Date
All roof coverings to be Class B or better
owner l. married.ge t Qa[e;, t