03070032 (2) CITY OF CUPERTINO a rn h
BUILDING DIVISION PERMIT • F'iCONTRMTOR I� ® MATIC�
BUILDING ADDRESS: THANH HA CONSTRUCTION PERMITNO03070032
OWNER'S NAME: 1236 CULPEPPER DR. PERMIT ISSUE DATE
PHONE: (408) 293-7888 SANITARY NO. 2 CONTROL—NO.
C HITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� 0
+00 LICENSED CONTRACTOR'SDECLARATION lob Description
i� 1 hereby. !but 1 am licensed under provisions of Chapter 9(commencing
wish Section]IXkl)1 OiAAOE1IF'TE1`CTS
1Dusimamd Pm@asinna Code,and my license is
in full Mgr f .{►F�{{�j. .I}����
Lmensecl xa
L. Gin SIGN--EXPERIENC }
a h,p Date _ Cummctor
ee 700 DECLARATION Q
emu IundernanJmyplonsahsllheuudaspublicromds DEC U 82003
5� Licensed PnJessional
OWNER-BUILDER DECLARATION BUILDING
00 1 naso affirm Dal 11. exempt from 09 Profession
nab License Lew for she
C w fallowing mama.(Sadao lonsu Business and Fe.dem na Codc:Any tiny or roomy
5 B which mquirw a pcnnit rat cnnurvcL olmc improve,Jcmnlish,nr repair any nrvcmac
-a> prions its issuance.also requires the applicant for such permit to rile a signed statement
££ < that he is lice nod pursuant in the Provisions or the CommnorsLicense law(Chapter 9 Sq. Ft. Floor Area Valuation
e�S (commencing with Section 7")of Division 3 of the Business and Professions Code)or
.. that be Is ammpt Ren from and the basis for Ne alleged exemption.Any violation of 31621029 . 00
S,<dan 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number - Occupancy Type
not more Nen rive hundred dollars($500).
❑1,Ou owner of Ne property,or my employees with wages as their sole compensation,
will do We woh,and Ne structure is not intended or afford for cele(See.7041,Business 101 - FOUND
and Professions Code:The Convector's License Lew does not apply to an owner of Md Inspections
drop_rty who builds orimprows demon,and who does such work himselfor through his 103 - UFER
own employees,provided that such improvements are not intended ararfemd forssle.IL 104 - REBAR
however,the building or improvement is cold within one y:u of completion.Ne Owner.
builder will have the burden of proving that W did not Wild or improve for purpose of 105 - ANCHOR BOLTS
sale')' 304 - ROUGH ELECTRICAL
Q1.as Owner of the property,am exclusively eontraning with licensed contractors to 505 - FINAL ELECTRICAL
conswn the project(Sea044
7 ,Business and Professions Code:)The COObmmng Li.
cave law does not apply to an owner of property who Wilda or Improves themao,and, 514 - FINAL PUBLIC WORKS
who contracts for such projects with o contractor(s)licensed pursuant to the Contractor's
License Law.
❑ I on
exem/qptt under Sea B k P C for Nb reason
Owner 2z03 I,..-
�— WOP�RKER'S COMPENSATION DECLARATION
1 hereby aRom under penalty of petjury oro or the following declarations:
I have and will maintain.Cur iroste of Consent no self-insure for Worker's Carrico.
on,as provided for by Section 3700 of the labor Code,for the performance of the -
rk for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3]00 ofth Labor Code,for the performance ornhe workin
whichthiapermitiaiaued.
My Work_ ,d0__ sai nlnsq dPollcy n rrwZrare:
rro7V •C1Policy Na:
CERTIFICATE OF E% MPTION FROM W OFKEKS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is Rod.hundred dollars(SIM)
m lea.)
I certify Not In the performance of the work for which Nis permit is issued.I shall not
a iploy any person in any manner an as to become subject o the Work_r{Compemadon
Laws of California.Dem
Applicam
NOTICE TO APPLICANT:If,after making this Ccnifcalc of Exemption,you should
become subject to the Worker's Cam pcnaation previsions of the labor Code,you mut
..Jz fpMwi th comply with such prevision or Nis permit sill be deemed revoked. '
z_t O CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that Ne re is a construction lending agency for the permrmance of
Q'.> Ne work for which this permit Is issued(Sec.3097,Civ.CA
�W Q Lcnd_/s Nam.
ng
zrcss
buildiAdd
U Q 1 certify that 1 have read this application and aau the,the above Information is
Is, (r-' correct.1 agree to comply with all city and Countyondinances and sure laws relating la
Q U building construction,and hereby eutharirz rtprexnuuwa of Nis city to enter upon 0te
W above-mentioned property for inspection purposes.
'(We)agree m save,indemnify and keep harmless the City of Cupenino against
,0 liabilities,judgments.costs and expenses which may In any way accroc against City
UZ inconsequcnccofthcgmningofthisNmin.
APPLICANT UUNNADEERSSTA\N/DSS�)AFjN/y[q�,WILL COMPLY WITH ALL NON-POINT Issued by: Date 3• 3
SOURC `/ .`til--L 1 �7 ��/
Signaturcof ApplicamoLontractor SCJ 6/ Damy Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hanerdous materiel
as dcRncd by the Cupertino Municipal,Code.Chapter 9.12.and the Health and Safety
Code.Bunion 25532(a)] �/ All roofs shall be inspected prior to an roofing material being installed.
El Y. I]lNa P P Y g g
Will the applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
until harmdous air connmimnu dcfincd by the Bay Am.Air Quality Management all new materials for inspection.
iurict?
❑Yes Nu
1 have read the hanrdnus materials requirements under Chapter 6.95 of the Califon.
meBeat"Safety Cade,Sections 25505.25533 and 25534.1 understand and ifthe Wilding
Jots not cuncndy hese a tenam,that it is my responsibility m or tW roc putt of th
requo-emcnts whit muxtWmet pdnnn iss ca qra Cumfle.uof Oeeup dy. ignature of Applicant Date
wattor a.Lh.n cde trot Data All roof coverings to be Class 'B"or better
HAIR &
NAIL
I �'
8
�v ACCDRDA.NCE W1TN THS
oPVRTINo CUDfS AND
-� 7 - I RECEIVED
-'e ucation9 nod",
Th st set o "o� a times and it 1a un JUL 0 $ 003
pe kevt °n Use Bill change''' or altefa Uotr,
lawful to mak_ y. itten petmi9s{on �!'-
withaut onrtino•
=j
on same C'fii of ®�
uildtng Dei" "nand s0ecilicationa`
the b m iag of tti s a" , os U
The s% NDT tsa moldµ �omanY Dtovision`
�>� U t'.. /�SyL ate Law.
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NORTH ELEVATION OF OFFICE BUILDING
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�ITY {
0�F-CI7PERTINOj 3
CUPEkTINO PERMIT APPLICATION FQkM; ; _ =I {
35
4aw
i r
APN#
fft ` Dae p7
BuildingEName: Ph '0
ess: "!
�Otq c9cf` �7 eU�.v�S X22 � � U GL r0 • ' '` l ! i'
Owner's '#
Contractor:
itk CMf_��j[�II'/^T f 6U1 License#:
1 '-^-" `
Contact: Ptione;#
Applicant/Contractor:
Building Permit Info:
BldgElect ;. Plumb Mech is
Job Description: {�!;
Residential: Commercial:
Sq.Ft. Floor Area: 70
0
-
Y. ` 1 •1 1
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Architect/Engineer: Valuation:
Type of Construction:Auk S IG� ,. {,; ;. Occanc Group-
up
Y
Qty. if !
Applicable Fee ID Fee Description Fee Giou 77,
! ;
BENERGY Ener r'" BUIIIDNG,
I BPERMFEE BldgPermit Fees BUILIDNG• •: ' ;:.` :•-
BPLANCHK • Plan'Check Fee BUILIDNG
BSEISMICOM Seismic Commercial' BUILIDNG
EPERMITFEE Elect Permit Issuance ELECTRICAL' 'r.-
BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL; i
BREMSIGNS Rhidl Signs,Marquee '. ELECTRICAL i'!
1,
BUSLIC Business License BUILIDNG.
CI TY.OF CUPERTINO k'�•`^"^—ei �" ' '
BUILDING DIVISION PERMIT (CONTRAC !VV'ORMATION
rA . .ask' .,h
BuaDING ADDRESS: THANH HA CONSTRUCTION PERMITNo03070032
969 STEVENS GREEK BLVD
ER'S NAME: 1236 CULPEPPER DR. PERMRLSSUEDATE
It SANITARY N0. CONTROL N0.
(408) 293-7888
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION
fi 1 hereby from met lam Ilecnaad ower provisions of chapter 9 0mmmerte ng Job Description
with Section 70th))of Division 3 f me Business and Pmfessums Code,and my license is
in full forecen r I CI r4 SIGN--EXPERIENCES HAIR & NAILS
34- License"Wer Lic.g
Data Contrac�� �I�A`,EO
A CHITECrS DECLARATION
I understand my plans shall M used as public records
10u.t; Licensed Professional DEC 0. 9 2003
5 OWNER-BUILDER DECLARATION
A x I hereby affirm Nal I am exempt from Jut Contractors License Law for the
00 following mason.(Section 1131.5.Business and Pmroccons Code:Any city or county
5$ which requires a Permit to construct,alter,improve,demolish,or repair any structure
prior to its iswance,aIs.requlms the applicant far such permit to file asigard statement
< that he is licenuJ pursuant o the pmoielons of the Comment's License Law(Chapter 9 Sq,Ft. Floor Area aluation
e€� (commencing with Section 70M)of Division 3 me Buaiacn and Profession:CnJc)ur
that he is exempt therefrom and the basis for the alleged...minion.Any violation of 31621029 , 00
Section 7031.5 by any applicant fare permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mart than five hundred dollars(5500).
❑1,as owner or the property,or my employees with wages as their sole compensation,
will do the work,and the station,is not intended or offered for sale(Sec.7044,Business - FOUNOAgMd Inspections
and Professions Code:The Contracrers License law does not apply to an owner of 10 3 - UFER P
progeny who builds or improves thereon,and who does such work himself or through his
ownemployees,provided that such improvements are not intended or offered for sale.If. 104 - REBAR
however,the building or improvement Is sold within ane year of completion,the ovencr.
builder will have the burden of proving that he did not Wild or improve for purpose of 105 - ANCHOR BOLTS -
aala.).
(-)I,as owner of the property,am exclusively contracting with licensed contractors to 304 - ROUGH ELECTRICAL
construct the pmjcn(Sec.7o44,Business and Professions Code:)no Contractors Li. 505 — FINAL ELECTRICAL
cense taw does not apply to an owner of property who Wilds or improve,(lemon,and. S14 — FINAL PUBLIC WORKS
who contracts for such projects with a contractors)licensed pursuant the Contractor,
License taw.
I am exempt under Sec..3 B$P C for tab mason
uRoKER'S COMPENSATION
ie
I hereby,Roe under penalty of perjury one of th.(allowing declarations:
it,
ave and will nomman a Cenificam of Consent to.1N.t.um for Worker's Compen.
.re provided for by Section 37W of me labor Code,(m the performance of the
for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as required by Section
of Labor Cod,,for the performance of the work for which this permit is issued.
orks Com s i rales '.rand Policy nnk,ima:I Policy No.:
CERTIFICATE OF EK MPION FROM WORKERS'
COMPENSATION INSURANCE
(TMs section need not becompleted if the Permit Is for one hundred dollars($10()
or ess.)
1 unify that in the performance of the work for which this Permit is issued,1 shall not
employ any Person in any mmner so as to became subject to the Worked Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:IL alter making this Ceniacem of Exemption,you should
become subject to the Worker's Compensation Previsions or the tabor Code.ynu man -
.J z foMwith Comply with...a provision,or this permit shall W deemed scouted.
zO CONSTRUCTION LENDING AGENCY
(~ I hereby moan that there is a Construction lewi ng agency for the Performance of
!Yi the work far which this permit Is issued(See 3097,Civ.C.)
1 Q Lender's Name
5 z builderg Address
U 0 1 cenily that 1 have read this application and state that the above information is
{f. F correct 1 agree m comply with all city and county ordinances and state laws misting to
�U abovengconstruction.inuteand herfor by mracdonp rposeumariru of Nis city reenter upon the
Qk above-mentioned propene for inspection krlmus. A4�
V) (s.j.agree to save,voluntarytafrm and hick hay I. a the city of Cupertino against
V) inconsequ consequence
Of the granting
expanses which may in any way¢cmc against said City
(„),'� in consequcncc of the granting of this permit. //)
^ APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by:940�j Date / 3- /
SOURCE E- AI �]
signaarebrnpph.wcon, 7a; 6 0 ,3 Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Omupant nam or handle haudous material
u defined by the Cupenimo Municipal Code.Chapter 9.13,and the HcaWt and Safety
..Section 35532(.)? All roofs shall be inspected prior to any roofing material being installed.CYeNa
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havardnm air canuminanu defined by the Bay Area Air Quality Management all new materials for inspection.
inter.
❑Yc.
I have mad the aanardouemeterlals requirements under .Chem er6.95 of the Cxlifor.
ilia HealthA SafetyCask,Sections 255(15.35533 and 35534.1 understand thmif Ne Wilding
dors not carnally have a ICnaaL that It is my responsibility to nod(y the rte Pant of N
mquimmen,whit must be tan pnonnl a raccmficate rCZ ignature of Applicant Date
wncr ser authonncJ agent All roof coverings to be Class "B" or better