02020031 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
MICHAEL YINN TSENG PAO FEN 22368 SANTA PAULA AVE 02/07/2002
PHONE: SANITARY NO. CONTROL NO.
❑ O ARCHITECTMNGINEER: BUILDING PERMIT INFO
w - BLDG ELECT PLUMB MECH
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8 LICENSED CONTRACTOR'S DECLARATION
DZ_ 1 hereby aRrot that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section]000)of Division 3°fdm Husineu and Professions Code.and my license BLOCK CLUMN IN FRONT OF HOUSE.
<ie '°� is in full forceend'ifect.
iz w< Licenu Class Lit.M
a U. Date Contractor
gti.t; ARCHITECT'S DECLARATION
E }S 1 understand my plans shall be..it as public utnrds t
i p p
Licensed Profcssionnl -
,q� Oat I am aUILDER m the CoATION
I hereby.(Sect that 11. exempt from the manias o License law for the
C?< fallowing reason.(Section 703 1.5,Business and Professions Code:Any city or county j $1500
O which requires a permit re comwct.alma improve,demolish, fi repair any sanctum
�3a-v Prionous sensed a 0.resaw1.theres thevpplvo formula Coutreroduo Bleasigmd swemem - _ ation
that he is wit rSiatio to the pmDivisi of me Conannors Licenu law ons Car 9
(commencingthatbewith SectitfouniandMa viaionoofinelilmil viand Professions Code) i;'q;.N,�`h i;� SQ. Ft. Floor ..t,i it.p,, Valuation
or Natio is 31:5 b th yappli and Ne basis for the cts d.- exemption.Any violation 35`9 0 5 O`6 7 .'O`O''
-of Secnot mo a shim iv a undredi doll for a permit the applicvnrto v civil penalty
sof not more thon fibs hundred dollars(E500). APN Number ,•�a'.' .: Occupancy Type
01,as owner of the pmN"y.or my employees with wages as their sole compensation. 101 - FOUNDATION
'will do he work and N encu e s nointended'or offered far six(Sec]OM -_-- - - - -
•Bu mus and Frolics I n code The C ' e Law d of apply t Required Inspections.f. +
awns ofr poatywnowt s p - ere n n a ..,kbtmxeB 103 — UFER
or Hannah his own employee pr dad ars hip me dad _.__.._.--_104 - - 'REBAR
',off d for"ale ICb er,the budNn oveme t is d - noar
completion.thowner budder willhove of ins has id not it APJCI-IQR BOLTS '
improa for purpose o(ule) -
_ 1 WER. & WATER-____.
t ❑1 wneto(Nep pent am asci elYc oast Ice c to o •- j - -� - -
,; ro nstawdoeseaIS 71N4Bus ions, Co. DERFLOOR PLUMBING
r
License Law docs not t an caner f '
apply r p n b ptovesm DERFLOOR MECHANICAL
and ha rs LicensfL such pro3ttts with a contmcmr(s)b In pursuant- Ne _.. ... ___
C tmnor's License law. __ .r . _
I atn exempt under Sec:' - ,B,&PCfm Nis moron 2O — DERFLOOR, FRAME
DERFLOOR INSULATION
Owrrir� RKER'S 0 PENSATION DECLARATION 301 - ROUGH PLUMBING
Inemby.(in.unaerpe itYnr arary anp of following declarations: 302 — TUB & OR SHOWER
❑ I have and win'moinmin o Certificate of Consent to ael6i...re for worker's! 303 - ROUGH MECHANICAL
Compensation, ea pmvidcd for by-Scoom 37W of me Labor Cade,for they 304 - ROUGH ELECTRICAL
f - pedl'ormiirce of the work far
which thin permit is issued. 305 - FRAME
❑1 have and will maintain Worker:x Campensatidn Insurance,is required by Section 306 - HOEDOWNS
3700 of the labor Code,for the performance of the work for which this permh is
7. '] is'auedi My Worker's Compensation Insurance carrier and Policy number art:' " '
_. . 307.. . INSULATION..
' .
clamIFICATIONOFMEImPTIONFROMWORKERst }'� 9 308 f; �SHEETROCIC J..
CCIMPEN$ATION INSURANCE 3.09__ _EXTERIOR_LATH.__._._._
.<Thisettionneed not bdcompleied if the permit is for one hundred dollars 3101' _ 'INTERIOR LATH CUPI. i
5100)°.. 311 - SCRATCH COAT
shell not employ an ...
_ I temrl Nan i Ne peen omisce of me' otk b which this ct to - haea,I 313 — ROOF NAIL
p y y person m any manner so is to become subject to Ne Whalen' "
Compensation Lows o(Culdomia.Dem 501 - FINAL ELECTRICAL ENERGY
icants
NOTICETOAPPLICAW::lf,dB m -
maktg nirasionsofth Lather on, ,you mum 502' FINAL PLUMBING ENERGY '
z become subject me Wofkcr's Compensation provisions of the labor Code,you must
p � ronnwiN tothply wiin oath provitmnt or thin Tamnit ansa x seemed invoked.
503 - FINAL MECHANICAL ENERGY
tit" 1 h hr' R s CONSTRUCTION LENDING AGENCY
504' = ''FINAL BUILDING ENERGY.
vin that them is"'cnnswnion lending agency fr the performantt 505 - FINAL ELECTRICAL
' Len o k f r hub di pc t iutiW(See:3-097,Co'. )
G -Lepdct Norrar -. .... _ .Wu.,.�,., ---- - 506---- GAS- TEST --. . .-------
Lender's
EJB ndaI 507 - FINAL PLUMBING"tt''
1 certify Nm 1 have need this applicanon'erd state Net Ne above information is 508 - FINAL MECHANICAL
W_ coireci.I agree to comply with all city and county ordinances and state laws mlating
rto building constructim:arid hereby ionquirse nquiesentatives of this city to enter upon, 509 - FINAL GRADE
(y
the above-mentioned property for inspection purposes,
kyr fs; (We)igmi lit ac Indemnify and keep harmlesitheCityof&Nraoagainst 510 - FINAL PLANNING
F (A liabilities.judgments.cosi and expenses which may in any way avenue against vaid 514 — NA WORKS
U 4a City to icsequence of me graniing of Out Forma'
APPLCANTUNDER5fANDSAND WILL COMPLYWTTH+ALLNON-POINT
'' ISSUedb
-55r� CE EGULATIONS., y: D e
Ar..... np4'ahpw`t tmcmr •. „ _ ,..•,. . Date r Re-roofs
- ARDO MATERIALS DISCLOSURE 0''`I - " '
•^ W11 the applicant of future buiro
lding oupnt note or handle lv"dou'muaaial ``ype.of Roof _
as d fi ul by the Cupcmna Municipal Cod Chapter 9,12.end the Health and Safety -
Coda SettE)yea
n 25s532(rdl r No�, t _ (_1' + tl_ f�ll rOOf$ $hal r k� r Y i..r1 I 1
1 __ inspected poor to any roofing,material being-installed..
i� +Will the applicant or future building occupant uu cqupri mor devices which If a roof is itisialled'without first obtaining an inspection;I agree'to remove
em t h.oris air emiammmnts as defined by the Bay Area Air Quality Management
Dixmn7 all new materials for inspection. Applicant understands and will comply with
Elyas
,r) all non-point source regulations.
t' I have ,ad the hexa dons maieoils regdiremenm Oona Chapier 6.99 of the
);alifomu Health&Safety Cade,Salinas 25505,25533 end 25534.1 understand Nat
if thebuBding does not currently have a meant.that it is My responsibility to notify the'
occupant ofthe requirements which must be met poor to issuonix of a Certificate of
u
T y
Signature of Applicant Date
1.1out nnoted'.,art Dam. All roof coverings to be Class"B" or better
4r' �
.., .. - .. . OFFICE -