02020019 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10541 JOHNSON AVE . H & H CO 02020019
TMVAfWONG 725 PIERCY RD AQFI.ICp(�6/lis 2
(408) 224-7777
PHONE: SAUNIITAARYNO. CONTROL NO.
O
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
a S H i LICENSED CONTRACTOR'S DECLARATION �W}{z Description
m_ l hereby arrant that 1 am licensed under provisions of Chapter 9(commencing REPAIR SEWER LI1VG.
Fr_n Cud withSmion 7810) fDivisionJof the eusincss nd Professions Cale,and my license
Ex f•s is In full fOrf/en 1C yl u` y,s'-�.7�
o q U L'rtnu�l (9i 1`Lic.
X LL KKo altcomm r
VI ARCHITECT'S DEC ATION
-on
1 undersmad my plans shall be used as publis
ic record,
O O Licensed Professional
m 1 hereby Rirm that I am exempt from the Contract"
- Co License Law o coolie
E Z C Which fol
lowing R C' q ( p C°de:Any city or counry, 2 00
Which re a non.(Seniors 7n11.3.Business and Professions h,or repair any,wcwm l
a permit mwn °Iter,improve,demotes
�$ priormil Issuance. ) rectums tthe provisions o for such Contractor s Licenfile ase
ned aw(Cha mem .. .".
thatnn 'elicensed urs 11 Bobshk provisions of lM1e Consmclors Lmcnu lave(Chapter _ :,I,3-)932Tde �[.A�a., ,T r,r:I y Val
nation
( Ing with S Ion 7WD1 of Divisors 3 of the Business oad Prof5ss ons Coder d': Z Y.`d •.F_ P I 1 S'j ,
or that he Is exams therefrom and she basis for the all 'rd ejleni ser A -y""s. -f' A'� L' "•' t
P LS P to ny violation
-of Section 70315 by enyvpplirnm for a permit sobjess she upplicum to o civil penally
of not more Than rine hundred dollars($5011). 10 6APN 15WftR & WATER l f:<'.;: .n Occupancy Type
nLa,ownerollbe property or my employee,with wages as the sole compensation, 202 UNDERFLOOR PLUMBING
will do the'work;and the structure rs no,Intended or offered for safe(Sec.70x4;' - - - 2nn��(a'''�� - '- ---------
'Business
---- - -
'B' es and Professons Cade.The Contractor.License Law does not apply to an ...3.0 1. _- .ROUGH....P r1bT Qs ections t
o ner of property Who Wilds or Improves thereon,and who does such work himself 507 - FINAL PLUMBING P
or through his own employees provided!that such int rovemenu arc not intended or
officialr,sthe owr.hohmidethell hav ter urden of pro ngthat he
oneyear ofcompletion,purowner-builder will have the burden of proving thus he did not build or
improve for pulpase crania.).
❑Iowner of the propi am exduvvely commcnng wnh I censed convacl°rs to �� � '�' ""'"__-' -' "' -_ : .__. .� ,..� ,-n -_._-.-
onswes the project(Sec 7041,Business and Professions Code)The Conuacmr s
License Law does not apply to an owner of property who builds or improve thereon.
' ".and who.commets.for.such.projes,with a.conlmctoof licensed pursuanl.so the
Cnmmcmrs 1.cense Le
O l umesemm undrSe B&PCm,this reu°n
b ner
WORKER'S COMPENSATION DECLARATION
I hereby af(nn under permhy of perjaryonepf the following decimations:
0 1 have and will'maimein"u Ceni026b,of Consent Ir',e1&insule for Worker's
Compensation;ns,provided for by Section 3700 of�the Labor Code, for the
'performance of the work for which this permit is issued..,
❑1 haJc'and will'rwiniain Worker's Compcnsaiion Insurance,as rcqu'ved by S<6sisn
__ _ J700 of the Lahr Code,for th6 performaru'e of the work(or'whicb this pnmli is
s some nl and Polley numbe -re
llS'I o �c t n In
' COMPENSATION INSURANCE^' _ _
:•;:.V" :'..:.. I,.I .. -p pcnnis izfnr onchundrcd dollars •'�l(:'tL'::C:f � ifti 4'I '. i4_s:•.'qi7.' -...)I'_ -_
(This sceiian need not tie coat lard if the
(Elot)or les.) ...ry.s .. .
r I en fy that in the Perf rmance f the k'f rwh li Ili s perm 1 Is J 1
shall not employ any person In any'manner,o a.to become subject m the Workers'
mpe -
Conmtion taws of California.Dale)
-APplicxnf.' '
NOTICE emoc'uj APPLICANT:IL ager making this Certificate of Esemption:you should
M1ecome'subjen m the Workers Compensation provisions of the Labor Code,you most
00 f nh Ili mply With such Provisions or this perm n shall bedeemed revoked
217 .. . .... -
F7 CONSTRUCTION I.ENpING AGENCY
far ffm that the a r. -o d sc n lend 6 ag y for the perform nee i I _
of the work for whsh thrc perm,rs Issued(Sec 1097,Civ.CI o
y I1, Lsndcr's Name._ ._.:...:..:.. ._., ._. t-_
O.Z Lc J' AJdrcu'.. r 11 1
V e� I c ufy than I h e read this application and slate that the Outs. of°ratlon is
�:[o corrccs:I agree to cotrPly,wah all ci(y and county,ordinances and state laws relating
U 1.Wildir,emebacoon:md hereby ambociin repfesenmlives ofthis city memer upon
W she !W e u t nod pri far inspection p rpo s.;_
0. (W 1 agree is u Indemnify and keep huNen the 6,b(C pcilux gatnst
++i��. V1' I.b has Iudgrrppenls costed as rrm z h ch Toy in any x y cense against said
C,5 Z
City d e Ence fthe givntng of ppemlu r O�
"" gPPLICAN7 NDBRSTAN°S'AN ILLCONPLY ALLNON'POINT" Issued by: ! Date
gr IRLF' N t;ATR)
gnat, I'APPIIc COmmaBr l.,.r .' am
I r ° ry Re-roofs
A9ARDOU3 MATERIALS DISCLOSURC s
,def Y l Gpcm f VncbbpaId oapters. arte wtanvryof Roof- -------
Code,'
__
Cod -
,,•-.,.: -`• -.'
pcY n {SJ2(aj t . I •' n j h n :n
, i { I ,� ."�t.f({ a. V 1: 44 , �, t
r" All roofs shall be inspected poor to.any roofing,material being Installed
• ^'_ W II Iheappl nt r,fumrebuild ng oc p m useeq p e n de �e te ch If a roof Is instilled without first obtainingan inspection,>I a ree td remove -
e t h No s a r c t vents a Defined by she Bay Aua A Q aluy Manag m of
g
all new materials for inspection Applicant understands and will comply.with
non- oint sonrce re. ulahons .
P $
.. i h rve rentlthe hu Nousunate ak rcyu cements, oder Chopttr 6.93 aLihetime '
ti l foram HeahH&S fny CnJe,Sections 25505:25533 and 255Ja.,Lunderstand that
. Y aleaam that 4sm tymnmsfy the' _.. .. ... .. ____ _ _
oce I Yf 1 qtr t h¢h mu Abe cret poor m t en a Cenifca¢of
nnnnJOea gent - " ' ' e _ SignatureofApplicant Date
_ _ to
In not curt m a y pont b 1
Oce P of
Date All roof coverings to be Class B or`beitter
. 4
s.'_,. �.:. . _ . . -OFFICE ... .. . . ... . .. . . . ... ... ._..- ._ _... ._ .