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CONTRACTOR INFOR ON:
DIPERTONNO PE
BUILDING ADDRESS:
PERMIT NO.
19835 BAYWOOD DR
JDR CONSTRUCTION CO
02090001
196 STEVEN R AND CYNTHIA O
1801 TOPELA AVE
APPLICATION SUB DATE
09/03/2002
PHONE:
(408)295-9898
SANITARY NO. CONTROL NO.
ARCHITECffENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that l am licensed under provisions of Chapter 9(commencing
KITCHEN REMODEL
with Section 7000) a( Division 3 of the Busilsfpa and Profeuiom Code, uW my license
n full feree/rq ellen. Q ✓ '
uCllal�( /' Li,M Z
O L Caannss��f�mr _ 4---
ARCHITECPS publieA P
1 understand my plans shall be used a public records
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OZ
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Corm ctor s License law for the
following naso . (Section 7031 .5, Bitivionsind Professions Cade Any city in county
which requires a permit to construct. alter improve, demolish or repair any structure
$25000
r
.pnm to uuarwe. ale requires theapplicom forsuch permit 1. file. signed statement
- - - - -- --- - --- ---- -- - - -
thathsSlCbbkdpursp,Nt§11 mYisionso(theContractorsLicenseLaw(Chptr9
(c mm ncyyttgwuh Secgon.700Q)fDiv,non3o(the Bull nels and professions Code)
'1.qOf�5.f+}.�+C�p,ax I ppjj,,ryry++a a ^.
(_�S_?i°s �;3
Valuation
or that ye Al. rherefeam and the basis far the .Ilegdl.azempRon Any violation
.�D�:
i
-of Section 7031.5 byanyapplicant for( Permit subjects the applicant t a civil penalty
of at more than Five hundred dolLwx 5500),
AEN
101 i��PJA}FJAT I ON
+'n Occu ane e
--' Occupancy Type
❑1, as owner of the property, or my employee, with wages as their sole compensation,
102 - PIERS
-
103 UFER Required lnspectlonsi'; :
will dki wark:'andthe swcmre' is not intended or offered for sale(sa: 7044:
' Busiheki and Nbfenions Co de: The Contractor's License Law does not apply to an
owner of property Who builds or improves themon, and who does such work himself "
104 - REBAR
or through his own employees. provided Nat such. improvements are not intended t
._
ffvedion.the. If.- building improvement sold within one year of
,. ...
„__..... ..._.._ _-_,.
-BOLTS-_
I05 ANCHOR BOLTS
completion, the owner -Wilder will have the burden of proving that he did not build m
of proves
improve row paryose ar rale.)..
106 - SEWER & WATER
�x�ia���a�d�ewi�"nii«�r�ero�trxtet;to
,057:.—aw6e:'oimeyrop�ny,mi:elyeoh
--------202-`=-UNDERFLOOR"PLUMBING--',:-i:
co vinic, the project (Sat. 7044. Business, and Profession Cade:) The Cantiamtrs
2 03 - UNDERFLOOR MECHANI CALz'-F("' • - +' - =�'I
License law docs not apply to an owner of progeny who builds or improves thereon,
_.end-who.conuects for.auch projests.whb.a cumrecmr(s).liccnndi pu,emm.t.the
____.____2.04.__ -UNDERFLOOR—FRAME-------------
Nractre Licct Sa. ,, it.,•-
X11lamcacmprue" Sec !)` , 9 'PCforthiartasan
205 - UNDERFLOOR>�7INSUL''ATION
O
301 - ROUGH PLUMBING
RK R' pENoNdecG�;/rlop2
302 - TUB & OR SHOWER
I hereby affirm undegpenelty or perjuryone of ton following declarations:-
303 - ROUGH MECHANICAL
❑ 1 hove end' w111"maintain v Ccnificat of Canum'io self -insure for worker.
3 04 - ROUGH ELECTRICAL
Compensation. as -provided for by Section 3700 of the Labor Code, for she
`performanee'of
3 0 5 - FRAME
the work for which this permit is is ad v
❑ 1 h be add wil1'mid t In Wo kbr's Con ocastilo Insurance n required by Section
3 06 - HOLDOWNS
37011 of the LMWe Code for the Performance of the work for which this permit is
3 07 - INSULATION
,ilsned My Work e.0 rape tion I-Lira cart) e d P l cy umbc u.
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Eertier ^ a k zt'i t y 1 Pob Y No,+
. l c, if it
E13O9"tBXTEi�.TORlr,L3ATH°`I
FICATION' OF EXEMPTION FROM WORKERS
,., tz,tl' cern T
COMPENSATION INSURANCQ
1
t -
310,-. I-NTERIOR-"LATH
t'(Thrsaactionneed ani lecompleted Hilo, pe.it iafar one hundred aatiarsi
311'.,.r SCRATCH COAT
313•• ROOF.- NAIL•••
dkt*lyrmu„is e
flhaeh
si' t�
501 FINAL EL) CTRICAL ENERGY
y C Worker.
llrltcemeto nen iters a'roo eyh
rt
502.._ _ .FINAL...P.LUMB ING. ENERGY ..... _ ._ _.....
1'NOTICE SgkkP`PLC xe pion you oho id!
_
503 FINAL MECHANICAL `ENERGY
Int erre s 17 mann prat a the Lobar Code, you must
(he Workers
fonhbhti complyw;th such'pro,khms or this permit shell be deemed mmkul.
.504„ -,..,FINAL BUILDING ENERGY
•fir t +''” CONSTRUCnorvLErvowcAGENCY
505 - FINAL ELECTRICAL
iherttiy ufRnnd, dere is p cont clan lending bg nyfir the perfurmrme
'bich
506 - GAB TEST
or the work row this permit is issued (Seo 3097 civ C )-
IsadlName - ...
_ _ .-�._.. _ _.
507-'= FINAL"PLUMBING
Carucci Address
.
,
50 FINAL MECHANICAL`l�
c• I ion (y "'a" 1 ha a read this application and sine mat the above mf mut un s
5 9 - INAL GRADE
orrect 1 agree ro,complY w th all city and countyordinances and sum laws testing
po building wcr 'dhereby amhan pnmrrv- rd mryr _pnmrapon
5 0 - INAL NG
the elan mentioned property fun insfam". purposes..
f We) agree td sa a indemnify otM keep harmless th C'ty f Cupemno against
51 - INAL RKS 1
liabilities judgments. cash and expenses which may in any ay accme against std
Cry co uq come f the ram ngof thl it
/
OURCAMUI �'O$ Leo, WITH NPOI T "
I$suedby; Date
pow,,:,
-'
Re -roofs
ZARDOUS MA DISCLOSURE _-
.. Will the apphicart Lir future building acro pont suac lar handle haiardous nations'
.Type Of Roof.. -. ..� ... .. _. _ .... _ - __ ... ,:. - �" --+• -z .-_ .,.
. u de0nod byAhe Cupertino Municipal Cade Chapin 9 11 d the Health and Safety
,Code Section .I
, t' ' �' •, bT r s
t '{-j7+ . i''+1 t; 11.•R., 1,'I � ' ,
.3S533(a)77 v , 1.j 1 s
°Y "' .
j !%
-_ A1Lroofs shall be inspected.prior.to any.roo&ng material.bemg.installed._. -. _.
-
I'llyWll�heapplicant or future building pant use equipmentordevittawhich
'
If a roof is installed'wittiout first obtaining aWinspection'Iagree to remove
e r h a ao mr contaminants as defined by the Bay Am A' Quality Management,
Dant.all
new materials for inspection..Applicant understands and
comgly_with[I
Yes No
,will ,
all -non -point source regulations.;,
iais a under Chapin of the
rceA iSafety
iii
,
Cilde' Sectio
Colifomib Nwlth'& Safety Code. Sections 25505.3553) and 15534. Pundemmnd Ne['
505, 2 533 erst
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a of
g. I P
.if the bandit ages toe rtcnd navearonant dautism me anablt'"
,., _. _ _
_ ... .. ...
accts ora f the rc mer w wtimh must itis e. f it C orf f f
P ante roof,
be q
panty. .t
Signature of Applicant Date
t
All roof coverings to be Class B" or•better
.OFFICE-
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