01060150 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
7895 BELKNAP DR SHOWCASE KITCHENS 01060150
OWNER'S NAME: APPLICATION SUB DATE
FORTUN JOHN R AND SYLVIA Q TRJ 12333 SARATOGA-SUNNYVALE RD06/26/2001
HONE: SANITARY NO. CONTROL NO.
// (408) 253-0412
O_O ARCHITEC iEHGINEER: BUILDING PERMIT INFO
u BLDG ELECT PLUMB MECH
�7i
z N i LICENSED CONTRACTOR'S DECLARATION Job Description
z_� 1 hereby affirm Ina 1 am licensed under previsions of Chap, 9(commencing p
F_r_w with Section T000)ufDivision 3ofthe Bosineasand Profci.SCWYd1myRcenu REMODEL&
is in�xs3 Linen
CafceandeBea' b BATHRM. REMODEL/ WINDOW REPLACEMENT &
z zy a License Claz Lic.a
wLLLL„ Date - SDECIta AHEAT/LI jfA1G, 'P)M & TILE FL.
1 understand my plan%hall Ebe used as public records
ai n I
HC e 1C Licensed Professional APR 2 5 2002
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am envord Inc.the Contractor's License Law for the
F' a following mown.(Section 7031.5.Business and Professions Code:Any city urcemmy
F 0 which requires o permit to cminert,alter,Impmse,demolish,or repair any strucmrc
ec
''i it, ',ala 4 tire 3pidliciontl m eatunit to file signed stalcincn Ri ..._-
that he is licrr. dpur.pursuant 16 the '.ia: fd Contractor.LceseL (Chapter9 S FI.FIoorArea.. . ; . $12241
I '. a ', : . 1uatlon
(corn " g to sect r te an f e v c f the Business d Prof tons codon �I' . r r
or that he is exempt mcrefrom and the bans for the nes alleged exemption.Any violation
.aur notSecmom thn 703 1 an inby hundred dollars 65 em,n sunir�ta me appr=anno a civil penury tk Occupancy Type
arnotmaremanEveWnareaaanarn(ssW). 362e���mU� 1:.` .. ..
01,as owner of the pmpcny,nr my employees with wages es their sole compn.vaion.
,It do the aurk,and he s,m,1 v not intended nr offered for sale(See TBLI'. -
Budineis and Professions Cade:The Contractor'%License Law does not apply to an 101 - FOUNDATI�Nuired Inspections
owner of property Who builds or improves dormant,and who d«s such work himself
or through his own employeesprovided that such improvements are not intended or 102 - PIERS
_
-ofeered for sale.If,Wunv8:the Wil,im - -- -
con kion,the owner g°7 improvement is sold-witniri one year of 10 3 - UFER
p Wilder rill have the Wrtlm or proving that M1e did not Wild or
improve for pupasearsale.). 104 - REBAR
- __ _
OLazawner ofinepropeny,vme me.dycomruc°ngwhnikemsede nan to -105 - ANCHOR BOLTS -"
onswm the Projen(Sec.70,44.Busiiines.and I'mfesanns Code:)The Convanar's
icon.eLawaaeanatupplrtaanawnerarrmpenywhnnwla�arimpmve.meream, 106 - SEWER & WATER
e n esuch : rte a contortions) ImenseA 2 03 - UNDERFLOOR'MECHANICAL
P 1 a .pursuant to the _
cot t . License La 202 UNDERFLOOR -PLUMBING-
0 ,
1 p, ndrrsc '' ' : .B&PC for his reason ICAL
owner Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
Ihereby,ffnounJrr1.-all,afp[rluryarmefurefollowing derbarionf: 205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
I have and wilf m 5aaln'e'Cr,ificaic of Comrnt so ujr-imm,for worker's 3 02 - TUB & 0R SHOWER
Compensation, as provided for by Section 37W of the L.tWr Cale, for the
pe,°rmana artne work rpt whim mise p rt i, n i.wee. 303 - ROUGH MECHANICAL
01 Iain and will nuintain Workers Co4npen4tion Insurance,as requirod by Section 3 04 - ROUGH ELECTRICAL
37W of the Labor Code,for the perfomunce of the work for which this Permit is
issued.My Workers ompermarla Ina•=•..carder and Policy number are: 305 - FRAME
s . . - - ; :._ . 306 -, .HOLDOWNS ---- - .
Carrier.' Policy No.:
" '1,'CE PI'AT NO EXEMPTION FROM WORKERS' - 3O'7 f=' INSULATION '
COMPENSATION INSURANCE " '
- --308-..._7SHEETROCK _.. _'- _..._
(Th.. t nn n 1 not be cnmple,J one pari t is N one hundred AMI us t
309 - EXTERIOR LATH `
I n ry mm t m petro one k r " n e ms a t .5ace.l 310 -- INTERIOR-LATH
•sen II net employ any serwo in any inane,in a1 m becooipublen to,the Workers 311 SCRATCH CDAT
Compensation fawv ol'Caliromii Dzte "'
-Applicant313 - ROOF NAIL
t
NOTICE TO APPLICANT If aft mak g rh. n C Bca¢ f E p,Dn.you should ,
W b, tt maw k c Rema Provisions bon LW code year mis, 501 - FINAL ELECTRICAL ENERGY
o forthwithr ply m np a n permit nu d Breva d
'� 502 -_ FINAL _PLUMBING ENERGY.- . .
CONSTRUCTIONLENDI NG AGENCY -'
In byafr m,m 5wr1 lending 503 - FINAL MECHANICAL ENERGY '
C4 > senry for Ina perrumtanire
W,. L, oer'sNamrwnanm pnn(inismealsea.31 zny.c.l 504 - FINAL BUILDING ENERGY
1 Q Ilnder's Name'"'•-'
p;z Under.AddR.. .. 505 - FINAL ELECTRICAL'
• i, I candy that 1 have tend this application and sure that the above inium lion is 506 - GAS TEST
�•- correct.I agree to comply with all city and county ordinances and state laws relating
V Wnd507 - FINAL PLUMBING
r m Wilding construction,and hereby torcW Ie repmsedae
nus at dry to enter upon
} W meave-meuredproPen,fimmnptttionP.,Iivcr. 508 - FINAL MECHANICAL
[.'Gr (WO agree u demdfy and keep hv 'I.ithcCty W C pninoaga nst
vl G r . judgments, t 1 penze Itch may t.any y gaunt 5a d 509 - FINAL GRADE
V-z coy y - -e of th g i nfIt pc t' ..
' PLICANT W ERSTAND A1)\ ILLCOMPLYWITHALI�NONPOINT' LO — A ING .-;:R-
) CE F L %TIO\S Issued ate
s but or p �ranOeanr dor - ll Dare Re-roofs
H OUS MATERIALS DISCLOSURE
Will the applicant or future Wilding aeeupant store or handle Incautious maarial Type of Roof
asdefined by the Cuyenino Municipal Cade.Chapter 9,12,and the Health and Safety - " `-- "" """" "'"
Cod Seci 255321+1 --
11 Yee, f
_-All roofs.shall.be inspected prior to any roofing material,being.installed
Will to .Pyheard f l� but"le" g« P , 1egn p , a icewhich, If a roof is installed"without first obtaining an inspection;''agree to remove
em t h " d s n t n h as darned b3 the Bay Area Air Qual ty Mamvg rent:
D1enci' �S.No all new materials for inspection. Applicant understands and will comply with
Orr,. - all nori-point source regulations:
I.
os
I h6.x rcad'the harardaus materials requimmenu under Chapter 6.95 of the
Cali(omis Health&Safety Code.Sections 25505,25533 and 25534.1 understand that
iftnebuildingdace. amemly have a term.that it is my responsibility mnotifY'the
; - ..... .
Cupar,°Erne«,juirernen vhic must be met prior to issuance of a Cendicam of
Occupancy
- -01 Signature of Applicant Date
_ .. . .
on °ndaea ag t Date All roof coverings to be Class "B"of better
�:.I - v OFFICE