02120031 (2) CITY OF CUPERTINO a til' i;
14U1Ln, DIVISION PERMIT
�vCONTRACTORINFORMATION
Bmr150SA3I8n'sBUBB RD C K WONG CONSTRUCTION FERMI'IN02120031
owq-96ls 0NG CHIOU 28 1ST STREET, STE 520 ApP1.IcnTTnsIYl0757Y2002
ZONE: (408) 297-4069 SANITARY NO. CONTROL NO.
ARCHITECI'IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 area, o
LICENSED CONTRACTOR'S DECLARATION
ee w— 1 hereby afford'bar I am licensed under previsions of Chapter 9(commencingO e.
� G with Section 7a)O)OIDivfslnn3oftheBalmesssnJPmfeesion.fCode,andmylicense is REPLACE WINDOWT S ` ��Q LENT
s In full force and effect.
P' 2
oZ—r f2�: License Class Lic.N
O Datc Commit., FEB 0 6 2003
wj ARCHITECTS DECLARATION
a�04 j 1 understand my plans shall W used as public record,
060
3LLt,
Licensed Pnncoaxial BUILDING
� OWNER-RUILDIiR DECLARATION
ay 1 hereby affirm that I am exempt from the Contractors License Law for the $200
ar 00 following moon.(Schon 7031.5.Business and Professions Code:Any ciry or county
sae m�i which requires a permit )construct,alter,improve,demolish,or repair any structure
wu
�io prior o,its osmate,also requires lheapplicanl Imsucb Permit o file aligned statement
E2� that he is licensed pursuant o the previsions of due Conroi Liceme Use(Chapter 9 35rg21D2B(52A@0 Valuation
ee a' (commencing with Section701gq of Division 3 of the Business and Professions Code)of
i R 9 that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant w a civil penally ofPIAT N
not more than five hundred dollar.(scut). Occupancy Type
102 — PIERS
❑Lo owner ,the property, remyemntended with wages ualNew(Sec.compensation.
will do the work,and the structure is not intended or offered for sale(Sec.]f160,Business iO3 —
and Professions Code:The Contractor's License law does not apply to an owner of 104 — REBAR Required Inspections
property who builds or improves Jtercon,and who does such work himselfor,hrough his
Own employces,provided that such improvements am not intended or offered for rale.If, 105 — ANCHOR BOLTS
however.the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving wt M aid not Wild or improve for purpose of 106 — SEWER & WATER
202 — UNDERFLOOR PLUMBING
I.as owner of the property,am exclusively contracting with licensed contractors on Xo 203 — UNDERFLOOR MECHANICAL
struct the project(Sec.70,14,Business and Professions Code:)The Contractor's Li-
ensclawdoesnotapplywanuwnerof property who Wilds or improves thereon,end 204 — .UNDERFLOOR FRAME
who controlfor such pmjccer with a conractof(s)licensed pursuant to Ne Contractor's
Lieease Law. 205 — UNDERFLOOR INSULATION
>M�P;�dmS B&PCfonhisreazon 301 — ROUGH PLUMBING
wo302 — TUB & OR SHOWER
yaBi er penally of perjury one of the following declaralinnsr 303 — ROUGH MECHANICAL
O l have and will maintain a Certificate of Consent to Rif inure for Worker'sCompen- 304 — ROUGH ELECTRICAL
cation,az provided for by Section 3700 of the Labor Code,for the performance of the 3 05 — FRAME
work for which this permit is issued. 306 — HOLDOWNS
❑ 1 have and will maintain Worker's Compensation Insurance,az required by Section 3 0 7 — INSULATION
3710 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 308 — SHEETROCK
Carrier: Policy No.: 309 — EXTERIOR LATH
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 310 — INTERIOR LATH
lea.`) mit
(Thinwelion need nor rte completed if the peris!mane hundred ars(
d dollElad 311 — SCRATCH COAT
I 313 — ROOF NAIL
employ
that in the perk, cc nr the work for wman this permit is issued,1 anon not 501 — FINAL ELECTRICAL ENERGY
employany perwnia i n as nfrees bjca w the Workers Compensation
IawsnfcalHornia. — O 502 — FINAL PLUMBING ENERGY
App
(CANT:IL makin nil a'Ic '6xr' pnon.ynean„mtl 503 — FINAL MECHANICAL ENERGY
O zMcome anpjF to the work pcnmtion previsions of the Labor Code.you must 504 — FINAL BUILDING ENERGY
foMwilh comply wile sato inions o this perool mall M deemed revoked.
? CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
E-a Thereby affirm that there is aConstruction lending agency for the Performance of 506 — GAS TEST
C > Oneve kfar which this Permit isiorad(See 3097,Co,C.)
BJ Lenders Name 507 — FINAL PLUMBING
2.Z) Z <nJcrsAJJresa 508 — FINAL MECHANICAL
U O 1 cenify that 1 have read this application and same that the above information is 509 — FINAL GRADE
k. F comet.1 agree w comply with all city and county ordinances and.fame laws rclaing to
pU buJJingconstruction,and hereby iulhorixe representatives orthis city toenter upon the S5FINAL PLANNING
C W RKS
y (we)agree w.aave,indemnify and keep harmless the City of Cupertino against FINIiabililies,judgmena,costs and expenses which may in any way areme against said City
U Z in consequence Of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON OINT Issued byDate
SOU CE REGULAT Ns. \
' L' Re-roofs
aur Applies calor Dab
I RDOUSMATERIALSDISCLOSURE Type of Roof
Will the app( or future building occupant store of handle ha'rardous matinal
as defined by IM Cupertino Municipal Che.Chapter 9.12,and Jae Health and Safety
Code.Section 25332(x)'! aaX��a
0 o All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection, I agree to remove
Will the applicant or future building sacupam use equipment or Devices which g an p
emit torturers air cunmMnarm as defined by the Bay Area Air Quality Management all new materials for inspection.
Disuncf!
❑Yes �No
1 havemad Nehamrd,wsmewria,25533.d2554.1rde'p,ur6. t,fthe Califon
nix HathurSafely C,wlc.Stttinn.fnit It i,2myri and25537.1 he naurbd Naifthemt of ng
thws not currently have a¢rent.Na it is my respumibilily w nnu IM occupant of the
requi cols which Moen P;n roe ssu ce ora Cenificarce, upon
e G/ �U �a Signature of Applicant Date
ufi�
is 11,am nari d e I Date All roof coverings to be Class "B”or better