03040053 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION .
BUILDING ADDRESS: PERMIT N0.
10630 CASTINE AV JEFF/MARY HULTQUIST 03040053
OWNER'S NAME: PERMIT ISSUE DATE
JEFF/MARY HULTQUIST 04/09/2003
E: SANITARY NO. CONTROL NO.
i
RCHITEC(ENGINEER: I BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
taro LICENSED CONTRACTOR'S
.^erde�n_a,❑[Cu�n{ f
CONTRS DECLARATION
Ihereby offmthat lamtedunder rbChapter
(commencing
I Job Description
wiNion70Mf Division 3oflhe Businrssand Prufeociam Cnde.andmy license is
llforcand
efloct 6i
in
class Lk./
Dem Conlraeor KITCHEN REMODEL/UPGRADE W-
eYLE®0
ARCHITECTS DECLARATION
1 understand my plans shall k used as public records
FEB 5 2004
s u.G Licerucd Professional
S OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Comment's License Law for the to r��ry.�
D o following reason.(Section 713 1.5,Business and Professions Code:Any city or county ediOBdY ,Yidtl
S$ff which requires a permit to consumer,aper,improve,demolish,or repair any sumeom
-2 L" prior m its issuance,she myvires the applicant for such Permit to fl usirmedsummem
< thotW is licensed pursuant to the pmviximu of the Contractors Liccnu Law(Chapter 9 Sq.Ft. Floor Area Valuation
Y�3 (commencing with Section 7W)of Division 3 of the Business and Professions Code)or $25000
.. Nat he is exempt therefrom and the buts for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of N he
nm matt men frac hundreddollars(s5oo). 3 N3��Kr. 0O Occupancy Type
❑I.a owner ofthe property,m my employees wish wages an theirsole compensation,
will do the work,and the structure Is not Intended mroffemd hassle(Sec.7044,Business
and Professions Code:The Contractors Liccnu Lew does not apply to an owner of 101 - FOUNDF$Fqblkii;d Inspections
properly who buildsof Improves meulmand who daessuch work himselfor brought his 102 - PIERS
own employee,provided thatsuch improvements arc not hounded oroli for We.If.
howeven the building or improvement is sold within one year ufcompletion,the owner- 103 - UFER .
builds will have hire burden of proving that W did not Wild or Improve for purpose of
al,.). 104 - REBAR
[1 1,as owner of the property,am exclusively convecting with licensed contractors to 105 - ANCHOR BOLTS
construct she project(See.7044,Business and Proctsiou Code:)The Commuctear'a U 1O6 - SEWER & WATER
cessos,Law dnot apply to an owner or property who Wros
Wilds or ImpveIverson,and,
who contracts for such projects with a contractor(s)licensed pursuant o the Conuacrors 202 - UNDERFLOOR PLUMBING
to.
lash eaemp under Sec. J ,B&PCfo nth rears 203 - UNDERFLOOR MECHANICAL
O ,AS/'� D.m dI o3 204 - UNDERFLOOR FRAME
i9t ORKE MPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
,�- Ihercby no
m underprnaftyofpduryomohthefollowingdeelmuions: 301 - - ROUGH PLUMBING
award will mrinmin a CeNOcamofCmuem Mocir-boure for Weaker'sC.Pen- 302 - TUB & OR SHOWER
.n,as provided for by Section 37M of the Isom Code,for she performance of me
work for which this permit is issued. 303 - ROUGH MECHANICAL
❑I have and will maintain Worker's Compensation insurance,an required by Section 304 - ROUGH ELECTRICAL
PW of the Labor Code.for tae performance of the work for which this permit is issued.
My Worker a Compensation Insurance carrier and Policy number art: 305 - FRAME
Cartier: Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS' 3O7 - INSULATION
COMPENSATION INSURANCE
(ITh sectionneed not Wcomplered lithe Permit is fmoac hundred dolhss(SIM) 308 - SHEETROCK
nrlesa.) 309 - EXTERIOR LATH
1 certify mar In c Perhnmance er the work for which this permit Is Issued,1 shell not 310 - INTERIOR LATH
employ an s in any courser arum Wrnm0 subject to the Workers Comperation
LawsorQlh t Int 311 - SCRATCH COAT
"ppl"a"' 313 - ROOF NAIL
NOTItBi CAM':If,aftp making this Ccnifcem of Ea pts n,you mou1J
licca u amt nc0wor4eh Compensation provisions arum Lahr Code.you must 501 - FINAL ELECTRICAL ENERGY
70
O, forth mcompywith such provisions or this permit shall Weeemed revokes. 502 - FINAL PLUMBING ENERGY
CONSInLUCnONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
1hcrchy ellirm mat them in.UC IONLENnlendingagency for the perfmrmantt of
>:7 thcWork for which this permitisissued(Sec.3097,Civ.C.) 504 - FINAL BUILDING ENERGY
D�q 1<naer'aName
I<ndeh Address 505 - FINAL ELECTRICAL
i z
;gyp 1ttNfythat I line mad this ty and counandsum tau the above information is 506 - GAS TEST
coerce.I agree to comply with all city and county nNinatta and sum laws reining to
e
hereby 7 - FINAL PLUMBING
shove-mentioned propcny far inspection purposes,
CL (We)agree te ave,indemnify and keep harmless she City of Cupertino against O - F I L MEC I CAL
r N liabilitlesjudgments,costs and expenses which may in any way accrue against said City 9 FI Z to conuqucove ofthe granting of this Poonah. 5 NG4Date /7/
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCERci4U TIONS _
y c3 Re-roofs
r (u icanUConuamor Dam
HAZARDOLt MATERIALS DISCLOSURE Type of Roof
Will the applieam tar future building occupant Imre or handle heardous material
as def nod by the Cupertino KN.
"pal Crede.Chapter 9.13,end tW Health and Safety
Code.Bathos 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yen /Will the applies rbuilding occupant tau cyuipmem or devices which If a roof is installed without fast obtaining an inspection,I agree to remove
1 "ardour air con ,u defined by the Bay Arca Air Quality Management all new materials for inspection.
.t7
❑Yen
Iheve mad tae hoc usmamrula requirements under Chapmr6.95ofineCarton,
nixHcolthl Safety Cole,Sccdou 25505,35533 and 25534.1 understood mmif de Wilding
does moo artentiy hast a lana that it h my responsibility w notify tae occupant of she
regmircmen , mmstWmmpdmrtmiamarcemr.cenifnmrr a cr. Signature of Applicant Date
y 3
Ow' All roof coverings to be Class "B"or better
isJ,gem to