02070099 CITY OF CUPERTINO
BUILDING DIVISION PERMIT i,:CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N
10255 ANTHONY PL CUPERTINO KITCHEN DESIGNS 2070099
GW'ik�N)tkkN JOHN H AND HELEN S R10562 S DE ANZA BLV APPLICATIOM BfA7E/2002
HO1N�tE:: L U .
(408) 257-4900 SANITARY NO. CO TROL NO.
o c z ARCHITECnFNGINEER:
HC BUILDING PERMIT INFO
E BLDG ELECT PLUMB MECH
teen U C-1 1-
LICENSED
LICENSED CONTRACTOR'S DECLARATION
;Sv Ihereby affirm that lamlicensed under provisionsorCnip,er9lcommencing KITCHEN REMODE)Iob Description
wFc with Sasion7000)a(Divismn 3 ofthe Bvum)IeM Professions Code.and mylicense
m 3 is in full fo C d,ffca, �"
a.
te cent
t'
0 G 7 jJ RCHITEC('S DE RATI
I u deata d my plans shall be used as pu 's
0 Licensed Professional OCT1 0 2�o't
L
o 1C
OWNER-BUILDER DECLARATION II
s- p hereby afp.shat 1 nm exempt from the Convenor's License Law for the
u
a.
E-¢< nor i its issuance,P`(Section 7031.5.Business and Professions Cod=:Any city or county 1 ' /± $40000
Yin which routs a rmit to construct alter.improve.demolish.or repair my structure �1 'f�®Ipg/±
m (commencing
licensed nce,iso req thgPpl'antfor suchpermino file a signed statement. - -- BUILDING
tltlG
_ o , rt
3_ D rsua nt the p a sof the Contractor License Law(Chapter 9
tet ]0(10)dthebson]oRhc Businessxemp Profusvi Code) 1 },4.y St3�!�• 2�a�tA ip;L _' Ayv V310at100
or that ba is exempt therefrom and the basis for the alleged exempron.Any violation
-of Section]1131.5 by any appllcam for a permit subjrm she applicant to a civil penmry10 APN NVOWDAT ION ,
of tar more than five hundred dollars(S5Bm' . Occupancy Type
01,as owner of the property,or my employees with wages astheir sole compensation, 102 - PIERS
will do the vi orkfand the stricture is not intended or-offered for"sal,"(Sec:7644.-
'BusinBs'eM Pmressions Code:no Conunnor's License Law docs not apply to an - Required Inspections' - -
owner of property Who builds or improves thereon,and who docs such work himself 104 - REBAR
or through his own employees,provided that such improvements are not intended or
offtied for laic IL Im.-ever.the building or improvement is sold within one year of ..... ..... -'--10 5..._-- ANCHOR BOLTS -. _._ - -----
'colaleuon.the own=rbulde ill have tn=buN f
improve for puraseo ), pdvmngMathedidnotbutldor 106 - SEWER & WATER - -
reale.
— — -- - "--'202'----UNDERFLOOR-PLUMBING —
❑1:as a of the property.von exclusivelycontracting with licensed contractors m 1: � - --- -
r the project Peet ]oat Bua nese and Pr f e Code)The Cmi a ou's 203 - UNDERFLOOR MECHANICAL'-,-
License La does not apply to an owner of property who builds or improves th,rcan,
Law . .
. _. and whocontractsfacsuch projctor sidn a cmuncmrfs)Iicemand protonstothe. _._._._.. ..2.04..._..UNDERFLOOR—FRAME
Ciuntr
01runtoe License Secove. ... ,_.,,,,�, ,,, _.__..
❑lam exempt undcrSc 'B @PCfo this reason - UNDERFLOOR ;INSULATION
owns;' ' e 301 - ROUGH PLUMBING'
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby alarm under penwry e(f<rjJry vine er me muewing a«leaden:: -' 303 - ROUGH MECHANICAL
f a ❑ 1 have and will'moimain a Cemricaic'cf'&nu. m ro self-insure for worker's 3 04 - ROUGH ELECTRICAL .
zCompensation. as,provided for by Section 3700 of the Labor Code, for the 305 - FRAME
performance of Ne weak f h ch this perms ms ss ed
❑l base and wdlmvm .work " Com .sat 7 umck is 306 — HOEDOWNS
pe required by Section
370 of the Labor Cod for to performance of the rk for which this Permit is 307 - INSULATION
issued My Workoes Compensation husurance carrier and Policy'number 308,,, .SHEETROCK
. // � mm. _._ _.__.__. _ __ __._�. ..._._
policy No ��t�V �QZ .,! -
0 'L CERTIFICATION OF EXEMPT FRGM,WURIERS'i, �. 309;'?:i EXTERZOR:,_LATH,.
t; COMPENSATION INSURANCE 31.0---- _.INTtl� I OR"-LATH
_„` ffh s sseon need not be mmpinao if the permit is for one hundred dollars 311` — 'SCRATCH COAT p '' '` f?"C•:,> };,: �^ ��•
IS I W)or less)
certifymt in the Ptr(oo-en ?me workfor which thpermit
shall et employ two,d 1' 501 - FINAL ELECTRICAL+cENERGY ' -
P Y Y Person y' rte s ro ore s bJ t m % Workc -"--_- --
Compensation laws of California:Date _b! '” "
Appfitmn ' :'p- •� 502 - FINAL PLUMBING ENERGY
— - - _
NOTICE TO APPLICANTr a Commak gthsCnOene the
L ,pt on you should 503 - FINAL MECHANI CAL••ENERGY _ -
berm s comply
16 ythe Work s Compc t Per ns of the Effie Code you
'mus'
O 0 fonhwnhdomplywitns ehprovsuonsorthspermitshalibe I d nk d. _ _ _ 504 - FINAL BUILDING ENERGY
Fz„ 0 "'cONSTRuCnoNLENDING AGENCY 505 - FINAL' ELECTRICAL-' I -- --
I hereby afr,.th t the a construct o lending agency f the Pero ronin¢ 506 — GAS TE$T '-! T
WQ al the art fo hidfi th permh i sued(Sec 309] C C.) J
y. Lends Nm 507 - -"FINAL PLUMBINGI....._.. .
y1.�Z Levee 'Add ass ._..._
508 - FINAL MECHANICAL
•, ; IcmfyinceL plywiadthlsiVoldtonandordinance0edstatelawsoeonis 509 - FINAL GRADE
fay'Ea t obuild nagree to Ton,a whet all city and terry ordinances and state laws relating
OU tab-bcwigcommanion/pertyfrinspNonieitposes. ,civ<iofthiicity mnarupon 510 - FINAL PLANNING
;,,,,fel the abovem=m tined property(o inspection p liposes .
say fit' (W,)agmerosavt noadexpa, Itpnuml YtheCityofCperimoagainst 514 - FINAL PUBLIC WORKS
lin' liabilities.judgments,mese and expo us.wh ch y n ray w y ttm gains said
U Z. City in censcqucnr of d grant ftpis permd
APPLICAN ND W ILL COMPLY,P'1TH ALL hON PO ,T'
R —. "' Issued by: Date
na o ApplicamJc-d atmr.,7:,• >+a•..y;r _.-.. Da "' • /
pp g DISCLOSURE° '"''r ''
Re-roofs ,
"HAURDOUS MATERIALS . .0
I'Will dte hent ea Porte lase Idm arse sore or handl baeardms m motel Type of Roof .
as defined by the Cupertino Mu pal Cod Claps 9 11 d th Health end Safety -
Code,Settled 25532(x) r fun t I•I s It -. s. l . .. . ..
: . ❑Ya �T ❑No 1, -., •,I
.�•- m+ _ All.roofsshall be mspected.prior.to any,roofing.ma[enal being installed...._
wBm applicant rota buildingOccupant use equipment ee Managech
ment If a roof is installed without first obtainin an-inspection, I,agi'ee'.toiremove
�m h seders ci mm t az d ed by tM1 y se e Am Quality Mm s,mem g
yt, is all new materials for.inspection. Applicant understands and will comply with
allnon point source regulations _ ....
"'-
'� 1 h e reed m8nwdous mmenIs ce remtnu under Chaple'6.95 of the
Cel(Orta Hcihh'&Safety Cotle,Section 5:25533 and 25534.1 understand that
if the ildidg dons nm iv eptly ha- - am 'has it is my responsibility to notify,the-
occbpi t of N slb!met'no,m issuance of a Cniflcate t
Oa
,Signature of Applicant. Date _
_ . _
""° '" to age , —" e, � All roof coverings to be Class,"B"or better
` t r:` t . . , ms..._�- " - 'OFFICE