02010114 CIBUOF
G DIVISION
ONNO
t PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10963 N WOLFE RD ARKIUS, INC 02010114
OW ER'S NAVE APPLICATION 5 B DATE
L -SH N-YEN (Q CUP) 20547 E WALNUT DR 01/ 28/ 2002
PHONE: (909) 861-4501 SANITARY NO. CONTROL NO.
o-Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
u�
a i I__1 L7
LICENSED CONTRACTOR'S DECLARATION
0 z y I hereby affirm that I am licensed under provisions of Chapter 9(mmmencing Job Description
Mv_:I_m with Section 7000)of Division 3 of Ne Business and Prom,sw Cod, a my license REPLACE COUNTER & INSTALL SOFFIT
Y E J i full f0�_L[ ( ��
re0 w U Liccnse Cls Li.N !kl
Dat Contract
3 c rn RCHITECT'S D RATION
I understand my plats shall be used as public records
ori
WoO Lcensed Pmfoasiol
OWNER-BUILDER DECLARATION
1 hereby aRrm that 1 am exempt from the Contractor's License law for the J
h Z< following teamn.(Section 7031.5,Business and Profesdon.s Cade:Any city or count' $10000
f x o which requires a pemtit to constmn,alter,improve,demolish,or repair any saumurc
deal 63$ pn tans ss td Pon. rtqu res preNu , fi s chmrce,License
ic 'am,PCh
(eoodmkring puh iam,7.into ppprgjlo fine nrvctm Lad seta mms Cock) valuation
(< enc gW th Sct 7000 fDiv. Jo'In ne mdi fes inns Cock) j^Q -'31 10�1O�9rOC�.¢a u`pp11 `` t
or that he is ormt torefrlomondtne basis for the.11 t m' 9_I ' J.xv..a A tl fY�. f.: If��:"3.
P !thy eke npt(op Any violation
-of not Section iv any u dreddontforapermit subject the applicmnoaeivilpenahy
- 1
ornotmtrr<thanrvenanarmdtruan(ssBol. 101A�NPIl7�fDATION P•,H:� it Occupancy Type
°1,awwner of the proper.or my employees with wages as their sole compensation. 102 PIERS i
'-will do thew rk..0 the structure'is-not intended o,offered for sale(Sce.7tYxs, ----------- - -- -- - -- -
-Business and Pmfess,ons Code:no Contractors License Law does not apply to an 103 - UFER Required Inspections °k_i:'"1,
owner of proper Who builds or improves thereon,and who dues such work himself 104 - REBAR
orr through his own employers.Provides that such improvements an,not intended ymir of __ _ __ _
-foRcicd(d Bale:If;howe-ver:ttic building or ii'nPmvemeni is sold within one Ydi oY ----------- - ' -'---`------' '---------.._..(,_.. _ _...._._..._
completion,the owner-Wilder will have the burden of 105 AN BOLTS n. .,
p for s fsale.). proving 106 - SEWER & WATER
improve puryo.eo
❑7:a n«arfrie �— —`y--- 's with- — --- --202...__--UNDERFLOOR--PLUMBING---'- : -" - ---
property.am exclusive) contractin licensed contractors to Yt I"
onstruct the project(See 71N .Business and Professions Cei The Commcmrs 2 03 - UNDERFLOOR MECHANICAL'-
r -
License Law does not apply to an owner of propenY who builds or improves thereon.
_ane who contraca.for such.Projects wid,a contracmrtsj licensed par mans io.the. __...__..__..-2.04- - -UNDERF-LOOK--FRAME---
- Contm License Law.,
a ❑Iamex cxcmptundcrScc'. I"s ;B& PC f."hi, 205 - UNDERFLOOR'' INSUTsATION
'- pwnr' '''' One 301 - ROUGH PLUMBING
- "'WORKER'S COMPENSATION DECLARATION
-__ 3O2 - TUB & OR SHOWER
lhet<bY—afemtunaerppt.hy1 . yone
ofperjuierth following declaratlone:'- 303 ROUGH MECHANICAL
° I heve' n t win mamam.&rrifichte of Consent to ren-insane for worker: -
3 04 ROUGH ELECTRICAL
Compensation: .,,ravided far by-Section-3700 of the Labor Coderfur the
performance'of tfie work rnr wmgn tats permit is issued., 3 05 - FRAME
❑I nave and well rw tom worker's Co pc spi I �urpnc< as required by Seeman 306 - HOEDOWNS
3700 of the Labor CWC f th ,perform of th work f cton ish ch this A 3 0 7 - INSULATION
Is ed My W okeri Co p< ton Insurancena Policy be "-
\
� RTTI�IPICA o EXEMPolicPTION PRUM1I�W�ORKER �Z d� ,iZ ? 3O,>t. )iEXTB1�I0I2.tlliA'.I'H^%
..., .COMPENSATION INSURANCE ) sf`M I -...-------310-',,--INTERIOR'—LATH - _
_ -_ .___.__.._..,__,,,_
LThis section-need not he completed f the permit is for one hundred dollars 311 ' SCRATCH COAT
3=13 ="- .•ROOF=-NAIL••
v I c mfy Nat m the perform f the oA,fo h ch dall pe t o issued lI .1 -
hall not employ any permn an any ttu ncr w ai.m become mbJea to the Work,., 501 - FINAL ELECTRI CAli" ENERGY
Applicant Callforn in Date .
cmmicard, ,n Law,of 1. : , , ,-, __ .,-_,-- _.502-_-.__FINAL _.PLUMBING. .ENERGY._.
NOTICE TO APPLICANT:IC after making this Cwhieme of Exemption;you should 503 - FINAL MECHANICAL "ENERGY
z become: h)a mile Wo ke C omen atp .ions of the Labor Cole,You must
p fnnn the tPlywon such pro,man, his tehallbedeemed c,nkvd. 504 - FINAL _BUILDING ENERGY
z 2 -.- ---:-_. _ - __... ..-
-'CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL _
'I weak""d hi,b that t is consd(See097.leading agency for the performance 506 - GAS TEST
of In k! Kch his pe u':issu d(S .1097 Cie C,)
-507 .. .. FINAL.. PLUMBING. ...... . .. _ .. . ._ . -_.. _ . . ._ .. ._.
Lder agr
UC ( rty�nailn < edm. ppl t Jsitmtm b ' r r' 508 - FINAL MECHANICAL'
E. co t I g e t comply,with all city andeo ry cWina!ma, ad statele s nebuir, 509 - FINAL GRADE
toWlding conatucton.and b<rcby rad :e reprtiotnat s bring city to arm,upon 510 - FINAL PLANNING
th above-mentioned ned p p ny lot inspection parposov
F_.IL, lW j'peems a wemnifyindkeep hvmleisth tl rC p nttioagainst 514 - FINAL PUB C WORKS
Cs; list I Rte. ludgmems c t t and expertsea which may in any Y aecme'airs,sod it
U:Z Cty co n gcove of the grantingmf th pc n (f
.. XPYLICANT UNDERS rANDS AND WILL C)bI PLY wirH ALL NON.POINT I
stiukce RE .AnoN..,r ,i h.-'• r Issued by: r D to
ig"gm of Appticanu:.n,.t;-,';. ..:..!• .77,v.e . Re-roofs /
' -F.HA ARDOUSMATt RIM.SDISCLOSURE
11 the ap,li,bimo panic'Wgdigoccupant suren handle b'"nosmamml _..Type.of.Roof :" ..__....._._
as def ed by,the Cupertino Municipal Code.Chapter 9 12,mod the Health and Safety f A "C i 1.
Ctv3< O li n 2553;111 I r d N '. )r� °, :3'ti R i't .1 '. . . °.'.
�. i + x _All roofs shall be inspected pnorto,any roofing,material being.installed.
Will the applicanto future Wilding occpat use equipment or devices 'h n If a roof is installed without first obtaining an mspectlori,Fagree to remove
emit h e tlou.air contain t.a tv,deJ f by the Bay Aies Air Qu Imh1y nag t
D t t all new materials for inspection Applicant understands and will comply with
L. °Y ..,j.- "all non point source regulanons `;,1, ,
'1 have read she'haibrdnuv materials requirements under Chapter,695 of the
Califomia Health&Safes CWe,Scnions25505;25533 and 2.534.1 aYd<man Ythot _ _ _,..
m s
it thebmldngdocs notcumently have a tenant.that it my responsibilitmnntif the "" "' -
'ddupant of the requirements which,must be,met prior to issuance ora Cmifeato of
Occup.ne..� - - "
Signature of Applicant Dale
owncrnrammo ma s Date All roof coverings to be Class"B"or better
.. .. ...
'.. .. -OFFICE.. __ . .. .. ...