04080065 CI•rY OF CUPEIMNO .
BUILDING DIVISION PERMIT CONTRAC,TOR,FINFORMATION `,•
i ,ai,.•,-u T E-, .«'dew„w- �a;.ss .�>;....,,, �f
BUILDINGADDRFSS: CRAFTSMENS GUILD INC PERMITNOb4OHOOES
OWNER'S NAME: PERMIT ISSUE DATE
L:
SANITARY O. NTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
+�+Oo LICENSED CONTRACTOR'S DECLARATION lob Description
y C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
<iw with Section 7IX)0)of Division 3 of NC Business shot Peaboamm Code.and my license is
m full m Fnd ✓ S O'?/S 2 BATHROOMS REMODEL
5 q? L;cep tic.a �p� q
�F•of Da¢ Gantra CUIr RA”'r t l�
ITECrS D mbloo O ^'^r t Nag s• •-
,i e a 1 undersia�my plans sM1all W used u public rc th 6u t(./
JyU l_
3 N Licensed Professional
'• g OWNER-BUILDER DECLARATION
f 1 hereby after that I am exempt from Ne CmulmoroYs License Law for the
p o following mason.(Section 703 1.5,Business and Professions Code:Any city or county
k m� which myuima a permit reconstruct.alter,improv,dcmolish,or repair any strucwm
w poor to its issuance.also requres the applicant for such Permit o file a signed abdomens
=E< that he is licensedParstran(totheprovisionsoftheConuacwr'sLiccnsaLaw(Chapnr9 Sq. Ft. Floor Area Valuation
M (commencing with Semon'")at Division 3 of the Business and Potassium Cade)of
Nal he is exempt therefrom and an basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to Advil penalty of 3 2V443'' o*dzro 0 Occupancy Type
not mare Nan five hundred dollars(6900). - r
❑ 1.An owner of the propcny,or my employees with wages As their sale compensation.
will do the work and the euudwe is oat intended or offered Tarsale(Sae.7041,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of n Required Inspections
own enywyOb.praorimpmvesthimprovndwho detonation work himueedNmughhis @ {rp I� �® -
crtywhom.providednim roveshat tr ,m r,and who
nds an not on work or himselfodfor ale.lL 6p �Vn(I�y��Oip9u
however.the building or improvement is sold within one year of completion,the owma,
builder will have on human of proving that he did not build Or improve far purpose of
Cale.). FEB ��rr
❑ I.as owner of the property,So.704,.H exclusively contracting with licensed mnlnemss U. 1005
come La the project(Sec.o an Business and Professions Code)The Cantonment's V.
msec Law docs not apply to an owner of property who Wilds or improve Nertan,
License race for pmjc<u wiNaconvacmr(s)licensed pursuant to Ne Conuac 11 �I�t) ®� as .�
who co Law. II\II JIT 11''L� �ss\\\vIfII
❑ I am aempt under Sec. .B&P C for Nis rt
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby An.under penalty of perjury ane of the following dmlafniam:
have and will mainuin a Cenificam of Canons to self-insure far Workeel Compan-
ion.as provided for by Section 3700 of the Labor Code,for be perfomana of be
work far which Nis permit is issued.
❑I Move and will mainuin Worker's Compensation Insurance,as required by&Non
3700 of on labor Code,for the performance of the work for which this permit is issued. -
MyWorkeriCompenationlnsurancecapier Ad Policy number aa: p
oladeflN., -20
FICATE )F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ttusccdion need not W completed if the permit is for one hundred dollars(Slip)
or less.)
1 terrify Nut in the performance of the work for which this permit is issued,1 shall nut
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Esemption,you should
become subject to the Worker's Compensation provisions of the Labor Credo,you must
.J z forthwith comply worn such pmvisinm or this permit shall tr demand revotrd. .
zCONSTRUCTION LENDING AGENCY
(~`N" I hobby aRren that thea is a construction lending agcmry for Jm performance of
C4 the work fur which Of.permit is issued(See 3097,Civ.C.)
W p sander's Name
G Unf's Addreas -
ZPz
C) 1 airily Nat 1 have read this application and from don she above information is
come,.l agree to comply with all city and county ordinances and sun laws rtlating to
C building construction.and hereby authmtae represenutia of this city to cnur upon Ne
r ahove-mcndancd properly for inspection purposes
w save,save,G (We)agree , ordcmaify and trap harmless the City of Cupenino against
liabilities,judgments,casts and expenses which may in any way accrue against said City
Q z in consequence of the granting of this permit.
^• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL PON-POINT Issued by: Dat
SOURCEw '6vyG oilly
Re-roofs
oApio au5um
g� HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will be applicant Or future building occupant store or handle ha amaus manual
as dcfired by the Cupertino Municipal Code.Chapter 9.12,and she Health and Safety
Cale.Section 25532bd' All roofs shall be inspected prior to any roofing material being installed.
C]Y.
Will Nc applicant of future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haramaus onbmina^nts As/de/fied by the Bay Arca Air Quality Managcmer, all new materials fodruipection.
Irict1
I have read me ocamous materials requirements under Chapter 6.95 of the Caliar
ma Heald k Safcry Code.Sadom 255(15.25533 and 25534.1 understand thmif Nc Wilding
Joos not cuacndy h a imam,that it ism reponsihility w nad ly do omupant car Ne
to Olmme prior ha!5 aafaCudOmnoIOccupancy. Ignature of Applicant Dale
All roof coverings to be Class"B" or better
�. •rue ser authoo' agent Dau