02090169CITY OF CUPERTINO
MA"IUN•>`
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BUILDINGDIVISION PERMIT
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BUILDING ADDRESS:
PERMITNO.
10108 JUDY AVE.
CHUNG YIN WONG
02090169
OWNER'SAME:
RFiCHARD & INGRID LI
1049 SITKA
TERRACE
PERMIT ISSUE DATE
09/24/2002
SANITARY NO. CONTROL NO.
(408)985-9289
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm Mat 1 am licensed under previsions of Chapter 9 (commencing
lob Description
Job
wi th Seedon 70D0) of D Mslon 3.f the Brad. and Profsadcase Code. and my littme Is
in full forte sad effect
License Clara LAC. {
Dam Cumnarr
ARCHITECTSCon
DECLARATION
PATIO - -
1
I undenuad my plan 'hall he used u public numm a
.
Licensed Professional�---r'
OWNER -BUILDER DECLARATION
{
1 hereby Milan that l am exempt from the Contractor's License Law for the
I
following maron. (Section 703 1.5, Bushels and Professions Code: Any city or county..—
which requires a permit to eonsuuc4 her. Improv, demolish, or repair any alrmlure
prior to to Issuance, also requires the applicant for such Permit to file asigned statement
that he is licensed prsuanl mthc pmvisuns of the Contractor's Umnsc law(Chsplar9
Profession Cade)
Sq. FL Floor Area
Valuation
$1500
(commencing with Section 7000) of Division 7 of the Business and or
that he m exempt therefrom and the basis for the alleged taernpdco. My violalun of
�p�.I
Occupancy Type
Section 7031.5 by Ory applicant fm a permit subjects the applicant W s erwl Nearby of
net more Wan Rw hundred dollars (SM
3'T'� 11N���
00
0 1, u avner of the property, ormy cmploym with wages u dcbsom comp namt m,
waldodc"k.aMthes u umumtimmndedoraffendfmaW(Sm.7ou.Bmnom
101 —
Inspections
FOUNDftgLdMd p
and pa re does Cade: The Conmclues License law dans tut apply in an owner of
property who bulids or(mprows thenm,and whodmssmhwwkhimWforthmogh his
102 —
PIERS
own employees, provided that such improvement, am ret Intended morteaut forsale. IL
iawew6 the building or impermanent is sold within ON year of completion. the owner-
103 —
UFER
Wilder will haw also burden of paving that W did nor Wild or Improve fm purpose of
104 —
REBAR
ale.).
0 1, as Owner of the property, am excludniy cunuauing with licensed contractor, to
105 —
ANCHOR BOLTS
consumer IN project (Sec. 7D44. Business and Profession, Code:) The cantraemra w-
106 —
SEWER & WATER
sense Lew does not apply to a owner of property who Wilde or improws therean, and
who convects for such project, with aeontraCon(A) licensed Purse tM We Conualora
202 —
UNDERFLOOR PLUMBING
License uw.
❑lam camp under See ,B@PC (oe this nano
203 —
UNDERFLOOR MECHANICAL
Owner Dam
204 —
UNDERFLOOR FRAME
WORKERS COMPENSATIONDECLARATION
205 —
UNDERFLOOR INSULATION
I hereby afnmt under penalty of perjury ane of the following declarathne
301 —
ROUGH PLUMBING
thawendwlllnalmal&CertrOamofCunmn(W-If-inurefOtWOkesCompen-
maim
302 —
TUB & OR SHOWER
work for which this permit I1maxt oaf the labor Code, for We performance o(Wa
303 —
ROUGH MECHANICAL
❑ 1 ban and will maintain Worker's Compensation Insxamm, as required by Section
304 —
ROUGH ELECTRICAL
5700 of the Labor Cade. for the performance of the work for which MI, permit is mad.
305 —
FRAME
My Worker'' Compensation Inaraee canter and Policy number an:
Carden Policybht:
306 —
HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS
307 —
INSULATION
COMPENSATION INSURANCE
308 —
SHEETROCK
fmrtsseedm need not Wcmnptemu Rale pcmb Is foromhundnst mllara(5100)
orWx)
309 —
EXTERIOR LATH
I certify Wel in the performance of the weak for which this pamh is Issued. I shall not
310 —
INTERIOR LATH
Compeatiun
employ any person in my Warner se, as W berme subject to ler Wmkeri ns
311
SCRATCH COAT
Laws of California. Dau
—
313 —
ROOF NAIL
Applicant
NOTICE TO APPLICANT: If, after making this CenlOcate of Exemption, you should
became subject to the Wukefs CM11Nm hM provisions of the labor Cade. you must
501 —
FINAL ELECTRICAL ENERGY
' forthwith amply with seen provisions or this prmu sense Wdecmed mwkrA.
1
502 —
FINAL PLUMBING ENERGY
CONSTRUCTION LENDINOAOENCY
503 —
FINAL MECHANICAL ENERGY
that there ts rend (Sm. 0 lending agency for the performance of
1 herebywhich this
� We work for which this permit is iumd(See. 5077. Civ. C.)
504 —
FINAL BUILDING ENERGY
L<ndeM1Name
505 —
FINAL ELECTRICAL
LcndehAddress
506 —
GAS TEST -
I comfy that 1 haw rad this application and sum dot the abort information Is
corrta [.Sm as comply with all city ad county ordinaees and sum laws relating to
INAL PLUMBING
Wilding emsuuctiun. and hereby mabodee rtpreaautivra of this city m Cater upon thesenora-mentioned
fmInspection
FIN L MEC.' ICAL
property purples.
(Wo) agme to law, indemnify ad kap harmless the City of Cupertino againstF
%7—F
I
j Ilabitldcajudgmenu.easu ad"Nuea which may in my way secmO againstWd Cltyi
In consequence of the gratingof Thu permitNG APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
—
Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature m of AppllcRDam
HAZARDOUS MATERIALSnpant
moDISCLOSUREhorl
WIII the eDCreat or future building ocoupat atom or Inadlc haarmutSandal
a defined by IW Cupertino Municipal Code, Chapter 9.13, and IW Health add Safety
core, Sudna 35553(.)7
All roofs shall be inspected prior to any roofing material being installed.
Oyu [3 No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
a Iuvardaa air conuminanm u dented by the Bay Ana Air Quality Management
all new materials for inspection.
Du01c17
❑Yu ❑No
I haw mW the haudnusmatodW sequin ncntsunderchaplar6.95ortiuCalfor-
nlaHedW@$defy Codc,Swfiou25505,35555am135554.Inmm.WdthalirWe Wilding
does not currently hew a motor, that It it my uapnW hifily W rally the Occupaa Of the
regmnWunm which most W met Mar to Issuance ors Cenlncsu of Occupancy,
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or mhorized Agent Dam