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02100118 CITY OF CUPF,RTINO "- BUILDING DIVISION PERMIT C",eRACTO0WjNFORMATIONN 3r` tb Bu12Dk904RENFARTA BLANCA ST JDR CONSTRUCTION CO PERMITNG2100118 91TR&T LANCE AND MARY L 1801 TOPELA AVE APPLICATDO"I iW12002 ONE: 408) 295-9898 SANITARY NO. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATIONybD�� l>��® O O wor IMmbyaffirm Nallamlicensed under previsions ofChapter 9(commencing KITCHEN REMODEL n've'ltea �zu with Section 7hoo)of Division 3 of the Busine, d Professions Code,and my license is < in full intoe ffcct. Z 2��J mss : Date Gla �l.ic. JAN .1 5 my am-----�f'.—ZZ, cnnlra ter <F<—� DE ATION a 1 understand my plans shall M used as public records Q 13do u BUILDING tr Licensed Pmfcssianal (q=y1= j OWNER-BUILDER DECLARATION K a<S 1 hereby affirm that 1 am cumpl from the Conortior's License Law for the $40000 w—0O lidlawing ormum.(Section 8031.5.Business and Professions Code:Any city ser county $l which requires a permit to consumer,alter,improve,demolish,or repair any swcture FZ< prior to its issuance,also mquims the applicantfor such Permit to a signed statement �^�,� mm that he is licensed pursuanto the provisions of the Commitrh Licerre law(Chapter 9 3S46IIi310"A&O Valuation FO (commencing with Section 8101)of Division 3 of the Business and Professions Code)or y that he u m attempt therefroand the basis for the alleged eumption.Any violation of ec Stion 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of iOAPN NUN Occupancy T not mom than five hundred dollars(55th). 102 - PIERS p y yPe 1,u owner of the property,or my employers with wages as their sale compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Cmntracturs License law dots not apply to an owner of 104 - REBAR Required Inspections property who buildsor improves thereon,and who dasauch work himself or through his own employees,provided Nal such improwments are not intended methanol(mule.If, 105 — ANCHOR BOLTS however,to building or improvement is sold within one you of completion,Ne owner. Guilder will haus the burden of proving that he did not build or improve for purpose of 106 - SEWER & WATER sale) 202 - UNDERFLOOR PLUMBING ❑I,as owner of the property,am exclmively contorting with licensed contractors to 203 - UNDERFLOOR MECHANICAL construct the pmject(Sec.7(144,Business and Professions Coley The Corincem's Li- mine,Lawdas not apply to an owner of property who builds or improves thereon,and, 204 — UNDERFLOOR FRAME Ij Lho ttm=for such projects with a commtor(s)licensed pursuant to the Conoactors 205 - UNDERFLOOR INSULATION I am exempt under se _.B&PC for Oil on 301 - ROUGH PLUMBING Data 302 - TUB & OR SHOWER OR K OMPE! DE�LA[.p)ATION 303 - ROUGH MECHANICAL I banally affirm uMer penalty of perjury one ofty(following declarations: 304 — ROUGH ELECTRICAL .0 l have and will maintain a Certificate ofConunl to aclf-insure for Worker's Camper- mtion,as provided for by Section 3701 of the labor CMe,for the performance of the 3 05 - FRAME work for which this penitis issued' 306 - HOLDOWNS ❑ I have and will maintain Worker's Compensation Insurance.as acquired by Section 307 - INSULATION 3701 of the labor Chile.for the padomnre uof the work for which this permit is issued. My Worker's Compensation incomes canner and Policy number are: 308 — SHEETROCK Carrie= PolicyNo.: 309 - EXTERIOR LATH CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 310 - INTERIOR LATH (This union need not te completed!(the permit is furore hundroddollars($100) 311 - SCRATCH COAT ,it it..) 313 - ROOF NAIL 1 cenify that in the perfo once of the work for which this permit is issued,1 still not 501 — FINAL ELECTRICAL ENERGY employ'"' peaaon anner '2bjauothe Workers'Compensa'on Laws of C.Iifomia. I 502 - FINAL PLUMBING ENERGY Applicant NoT OAP ICANr:If,aBcrmakingthisCariftcatcofExemption.you nerd 503 - FINAL MECHANICAL ENERGY We. bjecttotheWorker'sCompensationprovisionsofthelaMsrCMe,yn 504 - FINAL BUILDING ENERGY 0 Z, forthwith comply with such provisions or this permit shall M deemed revoked. ZO CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL Fes. I hereby affirm Oat them is a comaniction lending agency lot the crformonce of 506 - GAS TEST 04 the Work(or Which this peamilisissued(See.3097,Ch,C.) Lender's Name 507 - FINAL PLUMBING f3) Q jz lender's Address 508 - FINAL MECHANICAL U O 1 certify Out 1 have read this application and state that the above information is 509 - FINAL GRADE (—' connect,I agree m ana comply wit all city and county ordins and sum laws rotating to building construction,and hereby authorm representatives of this city to enter upon the 5 FINAL PLANNING abovcmentinned property,for inspection purposes. uVi 5W - FIN IC W RKS (We)agree to cast,indemnify end kap harmless the Cissa of against against U fzajl in liabilities,consequence ofu,granting expenses ch,granting of thisPermit. may in any way acem against said City V tom+ APPL CANTeUN UNDERSTANDS AND WI PLY WITH ALL NON-POINT Issued by: Date 6 �� SOURCEREGU Re-roofs moo o pp cam/Co terDate HAZARDOUS MATE ALS DISCLOSURE Type of Roof Will the applicant or future building acupem amm ser handle hrrerdons material s defined by the Cupertino Municipal CMe.Chapter 9.12,and the Health and Safety de.Section 25532(4)'! All roofs shall be inspected prior to any roofing material being installed. 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 emit hic,arO s sit contaminants as defined by the Bey Area Ail Quality Management all new materials for inspection. District, / C]Yes mNu 1 have read 0,hmardous materials requirements under Chapter 6.95 of the Cabler- nio ItcalN&Safety CMe,Secui)u25N)5,25533 md25534.1 understand thmif the building does not currently hale a tenant.On it is my ns 'hil"In ufy IM cecupanl n(thc rcceirmontawhi bre mpoorI of.0 teof Occupancy. Signature of Applicant Date nen naa name agar Dae All roof coverings to be Class "B" or better