01110012 (2) i 1
cITY,OF;CUPERTINo PERMIT'
9WLDtNG DlvtstoN .: CONTRACTOR-INFORMATION.
- -- --- . _..--- - -
- BUILDING ADDRESS: . - .., a :. , ,, 1,, PERMR NO. 1
20163;''�SOMERSET .DR j' BATH ROOM INC, THE 01110012
_. _ _ _
... _. .. - .,r.. APPLICi T10N SpB DATE __ _.__ - _.
oCA> VEN CHEUNG 1910 W EL CAMINO REAL •11/02/2001
Alm
PHONE: (415) 968-7666 SANITARY NO. CONTROL NO.
v ARCHITECTIENGINEER: BUILDING PERMIT INFO
0 C BLDG ELECT PLUMB MECH
<> u o u u
LICENSED CONTRACTOR'S DECLARATION
S I hereby ffirm that I am licensed under f Chapter 9(commencing Job Descrip t�ion
_
Ya provisions p g
=tom wimScction]"IofDivision3oftheBusinessandProfessionsCode, dmylicenx REPLACE SHOWER WALLS VALVE.
is in full force and effect. q, O
w U Liccnx CI s/ Lic.p '
a. Uam Contractor
I u.0 G ARCHITECT'S UECLARA ION p
i •a 1 understand mY plans shall be used as Public rccoida FINALE® i
Y
i i p O Limned Professional - - -
LL Oat I out BUILDERan the RATION �t •r _
'_�-' 1 hereby affirm that 1.m exempt tram the Cmntmnor's License law for the ,NO.0 1 ZOO 1
r i a following rtasoa lsauon 7031.5,Business and Professions Code:Any city memory t $1500 -
Y F G which rcgpims a permit to constmet,olar.improve,demolish,or repair any smar um
i3m port tst .atwrcq the ,p,pimam lir such permit tofllasgited smenar - - - - - -- -- --- - ----
trethc Icg With Sectiot Ih ,mull ns Itne Cot noraLnd ulawmus C 9 �,... R� Valuation
{ tt99'' VV -_- .
Icommcncmg With Sectio ]OGO) fDivisio J fth B sinew ardPpfmaionz Cod) C•. .res�t r.•�.?Y,„y ,.t � i:a
or tum he in exempt therefrom and the basis for the illegal eilmptioa.Any viola im, ac - -' - - - - --
of
Saturn 9031.3 by any applicant fora permit subjects the applicant m a civil rally
rnot than five nes aaa BnaRsm) Occupanc-
y Type
of thpampany.or r employees is ith wagesastheir sale compersatmn, .._.__ _ ...102--=-...P.IERS _.-.,._.-. .-... -.-_., .__,----- —
wit do the k i the dud 'C not Contractor intended offered,Law doe sale(Sm-T3aa ;103�- UFER
rBunt' and Pn fes.,ns Wilds
The Conti a C e Law docs not.,ply m an Required Inspections '
s
owner of pmpmr Wmm i,aes mr improves t att such improvements aw wm d«.wen work himsor 10 4 - REBAR
or through his own however,
oemployees,ver,therovided that sacrovememare not intended yetis or.._. __ _ __ -
' orc�rcd T shit H no �e m w Ia s m p t' Ia 'm -yio<or - __-__3:05 ..._°..- - —" - -' ---'-- --- --
complevon,them ne=Wmer will have the burden or proving that head not Wild or - - - - ANCHOR $OATS ,n
' improve for purpose ofale.h 106 - SEWER & WATER
- - -- UNDERFLOOR- PLUMBING - - - -. - -
nd 0I..aeowner anhepropertyamexclusivelycontracting with 0«rsedcontactorstoe 202 - ".. .. t
e construct the protest(Sm.roma.business and Professions code:)The Contractor a 2 03 - UNDERFLOOR MECHANICAL' "
License Law does not apply to an owner of property who Wilds or impowas lMome.
and who,connoti a.for.such project,-with.a cma., (,)Rcemod.,wsaim,to the.. ..._ ...... ..204- UNDERFLOOR-FRAME
_
. T Contractor's License law. --._.._............... ... . ...__.. _..
- ❑1amexemptunde,5ce. ' .B&PC,formisrc.... 205 - UNDERFLOOR'' I'NSUL'ATION
Ow net
' Dxic " ' 301 - ROUGH PLUMBING _
WORKER'S COMPENSATION DECLARATION 302 - TUB (iso OR SHOWER
I hereby orfrm under,penalty or perjury ane mnhermnrvmg declarations: - 303 - ROUGH MECHANICAL
J
❑ 1 hdvc and will maintain a Certificate of CIonum to self-ineare for worker's 3 04 -- ROUGH ELECTRICAL' -•Compensation, as provided for-by Section 3700 of the Labor Code, for the -
FRAME
J_ perfounce of the work far which this permit is issued. 3performance
01h d -ill maintain w'k Compensation Insurance uregwicd by Senior 306 - HOLDOWNS
3]00 r theLiam Odle for the"perroima c of me work for' hien this permit is 307 - INSULATION '
stcJ M W kc sCo COMPENSATION INSURANCE v
f�9� p308 SHEETROCK
G Hit •AnoNOFl.xeMm NMOMwpRKEItSJ �' {3 � f +3019-�'t� EXTER'•IOR'kLATH - - -
- 310 INTERIOR—LATH -
insnoi raid nobe wmpetcddmepar is forms, Jolles' 311' \ SCRATCH'-'COAT' ! . ,.
313-----.ROOK-'NAIL"=
-. 1' mfy th t in Ne pctf int-c f th k f h ch th K t soda -
shall ot,erphyany pe nnany mabne so u:tobecome ' bj t} the,wmkea 5O1 - FINAL ELECTRICAL^'ENERGY
Compensation awes of e;frdmia.Date Alldiatim 502_-.- FINAL. PLUMBING ..ENERGY _
NOTICE TO APPLICANT.If,after making this Cenificam of Exemption,you should 503 - FINAL MECHANICAL''ENERGY
become subject t the W k r C ,sonar Provisions or the LWr Code,you must
0 p Forthwith r,ly'itha nn provisions 't a hall be deemedrcvoked. 504 ,-_FINAL .BUILDING ENERGY
: '1 hereby a'-I that - _. . - .._ .. ...
� i ' " ' ' ICONSTRUCnONLEhDINGAGEIJCY ' - SOS - FINAL ELECTRICAL
mnsuuci Icndiii agency far m performance r
� > arm krm mehm p min . aadeerse3W] c se.tY ° 506 - GAS .TEST
507 FINAPLUMBING - --" -
U,O <me Address
L 508 - FINAL MECHANICAL -
IunifymtlheereadthsapPl' •, ilii vat. W f ion is
m p. tiolaot 1 Poem tempi,with e all, nil many ordinances offthistated hung 509 -- _FINAL--GRADE—
O a; t bolding msion and hhins m on representatives s roe city to a upon 510 - FINAL PLANNING
} 0._ tM alto a mem ed sprowriny f inspection purposes. t
Ey G (We)dual i e oder 'fy pans which
anyCity
way fGuineas i grana - 514 - -.FINAL' PUB IC WORKS
'h 1'ab' dgme ts,cow itl xpem wh h nay m any ay c m against said
U•Z ty ,cons quence of thin ranpng D atapalmi,. '
z APPL'1 iUN&i S Dw1EL MPLY'WITIy/,r Con
Q�' 791-S
�
S R GO l sl -- i/v/ Issued by: Date:
O Re-roofs -
IAM
s MATERIALS DISCLOS RE
wntheapplrc In Wilding t p t orlr dlmhaard s material Type of Roof
as defud by the Cupertino Milarc pal Code Chapter 9,12.and the Holm and Safety r+ ,
CodeSn .1, :f
ovs:hall be.t ins-pe.c' t;e,id,nor-ior :a-ny.ro,o-f.ing--m.atenal.being inst.a
lled..__- ro _
Will the applca to future Fuldmg me lis eegaip t device with If a roof is installed'without first obtaining an inspection;I agree'to remove
mit haxvd s nr ismma a as dein th Bey Arca Air Quality Milaga t
Dlxt n - - -w. • . _-_al ew ma rials for inspection.,-Applicant-understands and will-comply.with--
°Y 4 1non--poi so a regn
'.I'Waw'rcad Nil hareanims'Inemrials,requinernam under Chapter695 or the
Califon avert allCod`Sectors 2550525533 and 2553x1 understand mat
Roc i2 g d x t a len th t t s int respom b 1'tY to notifY.ihe -
62c i rine rc e 'whin a iii n n I Can cede of
oe p r aa / _ Signature of Ap anY Date
' aAll roof coverings to be Class "B" or better
,3 a,,on t mired.,art' t: . Dara
+.:•'- t. . '. .. . ! ...... - OFFICE