01100146 CITY UILDIING DIVISION � PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19847 BEEKMAN PL A PLUS BUILDERS 01100146
OWNER'S NAME: APPLICTIONS BDATE
MALIK MICHAEL ET AL 5602 CROYDON AVE 10,2972001
E PHONE: (408) 978-7500 SANITARY NO. CONTROL NO.
WO O O ARCHITF.CT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT LUMB MECH
u _
sZ LICENSED CONTRACTOR'S DECLARATION Job Description
Z-0 1 hereby effi 1 am licensed under provisions of Chapter 9(commencing
mtm wlmsectinn] Divia 3onneBasmessan aressmnscpecondmyhcma BATHRM REMODEL.
s ismronr and I.
0 6 O Lice lass Lie.X
Contractor
c F, S DBCLA 0
unsersmnd my plans shall rte used as public records (r�
�i
pO Licensed ProfessiormI
OWNER BUILDER DECLARATION
ono a' 1 hereby alfinn the I am exempt from Ile Contractor's License Law for the
t z following reason.(Section 70313.Business and Pmressmas Cade:Any city or many $7000
E o which recisions emotion,uita permit to emio,aleq improve,demolish,or repair any s ractum
0 .,inner 10 itsc also requires_tM1 applicant for such paint m file a signed statement-
that
tatement thou hen nadp ua iml6ep I ons sion the Ce Burin s mil Pr Law(ChapterCcr9 r d-'. a C .r Valuation
(commencing nh Sect ]BOB)of Division 3 of the Badness m Professions Cade? "�:a i3 1 ' S�'Cf 'l'l.( `. I ',:(�il 4 .
or S the a exempt Ihcrtfem and the bass for the alleged ideant t Any solation - - '
of Section 7031.5 by any applicant for a pcnnit subjects the applicam'Io o civilpenuhy"
of not more than five hundred dollars(s500). 3 0.54PN !E a Occupancy Type
011 as owner of the property;or my employees with wages as their sale compensation, 307 — INSULATION
'will'do the work,and the sncmrc is not intended or offered for ade'(Sec:71016,-
'Business ono Professions Code:The Contractor's Liccnu Law does not apply to an 6 0- - UQFfFtnspections'
owner ugh his ow em wads or improves at such dna who encs such wink himself
or 6 0---2—=�OOF'PL fW010D NAIL
or through his own howescces.provided thin such improvements are not intended or
'.offeredforsale If.howeverethe wadingarumarovemmtngsoldtha within one-year or - ,.:60--3-- ROOF—B-ATTENS -- - --- --'--- c : ... --- - -completion,the owner-builder will have the burden of proving That he did nn wild on
improve farpurposca'sale.). 6-e RpOF I=on—PRc^=GRESS'
O L as owner,pr the P(Secny am Businiss a d Profeisi wits licensedcontractorsConnors m - - - -- - -..
construct the pests(Sec. to a Business and Professions Code)The C uanor i '� t
License Law docs not apply man owner of property who solids se improves thereon,
contracts
and.whocontracts for such projec¢.with a<onncmgs)licensed pursuant Io the -
Contractor's License la.
❑lam exempt under Ss. ,B&P C for flus reason ,. ., i:,,
_
Osvni, Data ••
_ WORKER'S COMPENSATION DECLARATION �0r1a II AIS 11 �®
I hereby affirm under pmahy of to jury ane of the following declarations:--
IIII V�lI Is'asl f6e
❑ 1 have and will maintain a Certificate of Conan e"self insure for Worker's
Compensation, as provided for by section 37W or the Labor Code,-for the AUG 0 L 2�Os
pedormancc of the work nor which this panne,is issued.
❑1h Ifo ill mm densCompc tan Ys ice sreq red by Scctkaa
3]010 of th L;d furtive pert rm c f a work f which this permit BUILDING
ssb d M ersffi C 01 me J Poh y� be _
' CER FICATI EXEMPTION0. ard ' ;OOMWORe - k ?ricFRP.
COMPENSATION INSURANCE
•'' r'(TbisI
be coin d section
satis completed if the t - -----_
ISIW)or less.) P peRnil is for onehundad dollars "' _ - .• . '[Ilt]J� = "1C
I'ct"fy Ihat in the Iselficarrounce Of the work for which the penin is Issued,l
shall tat employ any person in any mann so'as to become subject to the Workers' t ���•"1. '
Compensation Laws ofCali f Date
Applicant -
'NOTICE TO APPLICANT:If,aper making his Cenificue ofExemption.ymishauld - - - -
Z became the Workers Compensation provisions of the Inbar Cmolic,you most • 3 '
Q 0 fonhwits comply with such provisions or thix permit shell be
deemed revokes.
I„i OS yf A 'CONSTRUCTION LENDING AGENCY
as 1 h by firm I I, s issued I d s agency fo Inc performance ,q
r LNit a work for which permit is IS .109],Civ.C.1
Leader's
.7 Lender's Name. . .. .I .-
Lenacilattnaf
U, •y have read this application and sinthat the above laws mins is '
+k+;[.. econtact.l agme tocomply with all,city'and county ordinances and sem laws elating
.�!V to building consw,blion,and hereby nnwiiamprescnmtivea ofthis city to enunupon
t' [ the ewe i neo so pcny f .pe do p rp
!�
tIn• (WHree gto sea foci and keep hama ithe C ry of enino againsth liabilities,ryas ms costs d expenses which may in n any way cescne against,said
V Z City nsq of the gmmng fthis pertni -
AP ANI' nD A $ANrfWI LCOMPLY\Vrm NONPOIN'f'-
SD. � . � _ PL /;�'� �0 Issued by: Date
igspare 1 nprrcarmContmcmr.' ,' a;:Vartaie,;:r Re-roofs
HAZARDOUS MAT RIALS DISCLOSURE
l.' 'w by c appfieart future wlan «c P ,done or handl banrdona mmaial .. .Type of Roof. ,
m def ed by N Cupertino Municipal C de chapter 9.13 d Ih Health d Safety - - - - - - -
CodeS❑ilim25532(.)^n aONo t w 1r' i' . ; E I,— a. 1, :_ t .It..s. t, —
yetci ', i � a _ L ,.
-, All roofs shall be Inspected pnor.to.any.roofing.material being.Installed.
zar the applicant r fumrebuilding he nt Boyuse equipment nt Mmur win<n If a roof is installed without first obtaining an ins eetiori;I'agree to'remove
emit M1 do nronta t azdefinedbyln BayAiwA Quality M agcmem g p
Disd;n - all new materials for inspection. Applicant understands and will comply with _
❑yon, ❑N l ,r ' ; all non-point source regulations._' PP I .
1 hh e d tha'h d s'materials q rem Is unde Chapter 695 of the - '
Califia Health&Safety Cad Sections 25505 25533 and 25530 1 understand that
if ilding docs not currently have a mean,Thal it is myrespomsibilirym mlifyrbe - -
u 'if,,th quirem / which mus,b met p"' m isame- "Ta C nificam of
Cyr Signature of Applicant Date
Owner or outhodzW a •
llem :' � ..Date. _ All roof coverings to be Class `B"or better '
;., . .• .'
11,v OFFICE