01020046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
auuLONG ADDRESS:
9145 TILSON AVE NANCY CHAO PER"nT"°.
1 0102004E
OWNER'S NAME:NANCY CHAO APPLICATION"iM9/2001
PHONE: SANITARY NO CONTROL NO.
O AltClll'I'l1(II IIINGINIilili: " /
BUILDING PERMIT INFO
m 6L 1!1.1!CI' PLUMB MliCll
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8 ' LICENSED CONTHnCIOH'5 DIiCLAR111I N Job Description
L_ 1 hereby%filo"thin 1 it,licensed under pmvi%ion%nI Chapter 9(commencing
�. wimSection mannfni,i e.3oftneltaamessart]Professi n,Coda,ndmyBcense SHED
xY= is in sen fume and effect.
0 n cense Clash Lic.9
3 Dare Contractor
L
< ARCHITECT'S DECLARAI'[ON
=vo J 1 undevelnd any Plana%hall 0.used-p.hire tec nil,
m a S Licensed Prof v%ional
�6p0
Gat I a.BUILDER DE he ColuI'IGN
,31u, 1 heathy.sect that 1 um eampt an he Colnrucws's hianse law for the
!"Z kchwhnwinguresa unnel ll 9onL5. t.alter,
Pc.dir idose,or Any city orcounty
which I '� Ik n out a �1t I 1 r,h r any structure,
le a pr', t t I' Ili SPI' t u fl .y d.t t seem
a. Ih:tl II I d p tC le Law tClarlccv Sq. Ft. Floor Area Valua{�q�t,00
rant a any'I'llu
Saan 9100)or D'v%i t a 3tl heRe%nae., .IProfus nne Code) w
or Ihw Le is exurapt rocrchoun and the haav lot roc anew]exemption.Any violation
or SWlion 9031 S by any applicant for a pernauanjttt,me applicant ,,o civil penalty
of serf Ia.re roan fine hundred dahnrs(s500). A FN Number Occupancy Type
01,a%owner of[tic posPeny,or my employees with wages as their sole compcnmtion.
will do the work,and the swnum is not intended or offered for sale(Sec.71PT
Business and Profs ons Cade:The Contranm's Licenw law Joe%not apply to an Required Inspections
r of prnpeny Who builds or impawes theme.,and sdo does.such walk himself
or thomeh his own anployees.provided that such improvements are nm intended we
offered Iia sale.If.N carob,the building in,improvement is sold within one year of
completion,the nwnerbuilder will have the burden of proving that he did not build or
rap pa"'e 1 1 1
Gk, 0th Pvrtexclusively t t y tel lcontractors. �/
ry I d 1 (Sc,.7(94 B 11 1': '( I ) Ili C t atnr'v
Lu I , nch I1p 1 ty 'I h II P . testa
W . r.. uvryopvta w lh, a nu'a rte) l I p I.live
C� t 1'u mL:
❑I nn+r�e'.�cnmt unJer sec ,11$1'h for h's rcapm ✓/
OwInA ,>,.� e
/' WOR EH'S COMPI!NSA'fl(1N UI!ChARA DON
• 1 hereby affirm under anally of perjury nne of the following declarations:
❑ 1 have and will maintain a Cmificatc of Coram to cl-insum for Worker's
Coopeneatinn, as provided for by Section 370N0 of by LaMn Cade, for the
perfsmnance of the work for which this permit is issued.
01 have and will maitnain Worker'.%Compensation Insurance,as rcyuimd by Saetion
3700 our the Ladin Code,I the performance of the work four which this permit is
and.My Worker's Compensation Lnsnnmce currier and Policy number Ire:
Currier: Pullcy No,:
CliRe FICATION 017 E%11M 111 ION FROM WORKERS'
COMPENSATION INSIIRANCH
1'I'h Is woimt aced not be aund,161.1 the*'mut Is for not hundred doll..
ISI all our less.) %
1 comfy that in the performance of the work for which thi%pennit is issued,1
%hall not englny any person in any manner so as to Mone subject to the Workers
Compensation Irws of Califumia.Date
A,,Ilc,utt
NOT ICE TO APPLICANT.If.alter making this Certificate of ExemPfion.you should
Z become whjcct m the Workers Compeosatiou Pro vi,ioroof the LaMn Case.you el
O forthwith comply with such pow Won or pemait shill be declared rooked.
FVi CONSTRUCTION I.I;N DING AGENCY
a ' I batch,affirm thin them I,a cunewnino lending agency for the performance
of the work far which this pernut is isSmd(Sec.3097.Co.CJ
Q Lendcs's Nana
5 Z Lender's Address
U O I col lly that I have read this application Iu d Imre text the thus,nor.nation i%
❑+ c next.I agree.cou..ly with all city and county ordinunees trod mala laws relining
O U muildindm
g .vactlorou
I,and larch,aami. apsanunivcs of'his dry,,ry ,tour truant
p
:u
bhe abmommtdm,ed properly far ro'c'io I Pumnas
[}a 6
(We)agree to Save indemnify and keep hnfmlcss the City In CuPenine against
fA habiliaics,judpn¢ms.cogs and expenses which may in any way acerae against said
City in conscbaerwaol a he grraingofthis permil.
SOPPLICANT URCE EGULAT��IOyyN��SISAND w_ILLCOMPLY WITH ALLNON-POIM' Issued by: nate
—gav n— manv(.�ntmnm Dae Re-roofs
HALARIX)U$M1tATEH1AIS ISISCLOSUHF.
Will the applicant or future!wilding evapant.store or andle h:vvNoun oamrial Type of Roof
as defined by the Cupedin t Municipal Code.Chalaa 9.12,and the Health and Salary
Cn le.Section 25532WC
ED Ne, 0 N All roofs shall be inspected prior to any rooting material being installed.
w'11l the apputant or ware hal III nengwnl use eq....dcm our devises whleh If a roof is installed without first obtaining an inspection, I agree to remove
ouit InIali ous u l cmua Imams as demmd by Iha Bay Area Air orality Mmuagemaet
. Dilubt.? all new materials for inspection. Applicant understands and will comply with
IDYc' 0 N all non-point source regulations.
I have read the ItumMous m thanals rest irmnans under Chapter 6.95 of the
California Health A Safety Coale.Sections,5585,25533 and 25534.1 understand that
if the huildie,does an,ar en0y have a¢nam.Inat it is my rnpmsib lay et notify the
reupam of the requirements which Inst be tract prior to issuance of a Cenifcme of
Ov'n'ney' Signature of Applicant Date
Twa�rmamm�riaed reg t Date All roof coverings to be Class "B"or better
OFFICE