S 4541 CITY OF CUPERTINOe.,• -ta_
nuu.ofNc DIVISIONPERMIT CONTRACTOR INFORMATION:
RUILDINGA .3 CEDAR .TREE CT - MAY CONST. &.'CUSTOMIYI�y'I�G 4541
f
OWNER'S NnWO RE THOMAS A AND THELMO 210 SAN JOSE AVE APPLICATION SUB DA ,
HONE _ f s` SANITARY NO. 0` f, L
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ARCHITECT/ENGINEER: (408>294.-6763 BLDG ELECT' PLUMB MF.CH ,
pp BUILDING PERMIT INFO
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LICENSED CONTRACI OR S DECIIARAIION
0 5�c In.. pgJob Description
F=C� is in
n full have
efDivisionJof the Rosiness soil Professions Cnde.and mylianse
x�� is in^ull force and effec�y S ( 5 S� 4T _
m 6
License Class IF Lic.p i
%M O u
Date Contractor
ARCHITECT'S DECLARATION
�yOg pl hll bem I us public !
o o L, . n t :,'oral KITCHEN REMODEL ss"a"'�
c�n OWNCR BUILDPR DECLARATION
ARATION -
I h by Rrm th t 1 rapt f th C tract License Law(Lir the
t z< follmv g n (Sect 7031.5.Business and Pndevsiom Code Any city or .holy
F O which requires o permit to cnnslm n,alter,improve,demolish,Lir repair any structure o- -
�3m ,no, its issuance,ulsorequire.sd,applicant locsuch permiunlileaxigneJ stxtemem ;
mat he is l arc ed pimment wile,Ina,,smnsofo,e Conuacto/s Liars,Law(Chopmr 9 S Ft. Floor Area
mommencingwith Swdor7000)ofDivision 3onbtBusiness and Professions Code)
9• Valuation
(commencing
or that be is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subject the applicant to a civil penalty
or not more than fisc Hundred sonars(s500). AP. IGlug b0e'1 3. 00 Occupancy Type
❑I,as owner it the property,or my employees with wagesas their sale compensation,
will do leu work,and the saonure is not owndal Lir offered in sale(Sec.70,44, - -
Rosiness and Professions Codc:.The Ciatmelm's License Law Line,not apply It,an
owneRequired Inspections
r,f property Who builds Lir improves therein,and who does such work himself - -
or through his own employees.provided that such improvements rhe not intended or
offered for sale.If,however,the building or improvement is sold within one year of
completion,the owner-builder will have the burden of proving that he did not build or FOUNDATION'
improve for purpose of sale.). 1.01 —
❑I,as owaa Alec properly,ata mm
exclusively cocting with licensed'contractors to 1.02 — PIERS
construct the proea lS
jcc.•7(1 ,Business and Professions Coded The Contractor's
License Law all said apply man awave of proti who build,or improves ,nomm 103 — UFE R
and who commit for such projms with a prominent)licensed pursuant to the
Communist',License Law.. 104 —: REHAR
❑I ad,exempt under see ,R&PC mrmis ,a,aa ,. 1.05 — ANCHOR BOLTS
owner Dam . 1.06 SEWER & WATER
WORKER'S COMPENSATION DECLARATION
I heron fnm,under Penalty of perjury 202 UNDERFLOOR PLUMBING
ya yoaeofthef�llowingdedarwions:
Cl I have:and will maintain a C=rm<atc of Consent 200 —
self-insure for Worker's UNDERFLOOR MECHANICAL
W
Capolamodon, ors ....WI by Section 3700 or me Labor code far the . 204 UNDERFLOOR FRAME
peHarmnmreoftneworkrarwm<nlnixpermitisis.a=d'
❑I have and will maintain worker's Compensation Insurance.as required by Section 205 — UNDERFLOOR INSULATION
37W of the Iwwr Code fir the performance Lir the work(or which his pe.i,is 301 — ROUGH PLUMBING
issued.My W'orker's C rpcnsadion Insumnce carrier and Policy number are: _
Carrier: Policy No.; / 1911711 V_ 302 — TUB ' & OR SHOWER
CER PIFICAI']ON OF FXEMPI ION IROM WORIORs' -
COMPENSATION INSURANCE303 — ROUGH' MECHANICAL
' 304 —
(This section reed not Wcompletedifthelen�,nisforonehundred dollars ROUGH ELECTRICAL
($19(horless.) _ _ 305 — FRAME
I nmify had in he performance or he work(Lir which this permit is issued,1 306 — HOLDOWNS
shill not employ any person in any manner, I ale subjeul In the Workers'
p '.In `°ri7-f 307 — INSULATION
AppliCompensator latlar Luv�yecar i:a.Unto
NOTICE s<VF(L� 5HEETROCK
NOTICE'IV nrLir a Alsruk making m,s Cenificam of Exemption.you should X308 — '
O Gbecome sabjeeuo the W''rk Is Compcnsauon provisions ofthe LuMr Cale,you mus
firravvith comply with such provisions or his ficon, hall be,deconed resolved. 30n9, — EXTERIOR LATH
F .CONS'IRUCTIONLENDINGAGENCY 31.0 INTERIOR LATH -
1 hnehy s(Iirtn that there is a construction lending agency liar the perfinnance-
i Gr ofthe work for which this pem,h is issued Isec.3097,cis.e. 31.1. — SCRATCH COAT
pZ Undr'sArlJrtcx 31.3 — ROOF NAIL
U 1 certify that lhave readthisepphcatn,nanF.xnwetwl eanaveinramatiantx 501 — FINAL 'ELECTRICAI_ ENERGY
Fit �s" correct.1 agree I,comply with all city and county rndimmces and shoe laws relating
O U to holding construction,and heebyanthainorePrescmaavesofthis chyInenter upon 502 — FINAL PLUMBING ENERGY
:6 meabove(We)ao.tovitmed pve,adrnfvx ad keep
503 — FINAL MECHANICAL
a (We)agreemsmonshad wiry sol which
hon,in im,City talsom Lia s, aid _ ENERGY
V, City yin consequence
casts apo granting
of t i w n Inay m any wry same against said 504 FINAL BUILDING ENERGY
ICE REGULATIONS, Issued
WILL COMPLY WITH ALL NON-POINT.
SOURIssuedby. . 505 FINAL ELECTRICAL Date
Signamrc ofnpplicanVCnnunwor" Dam Re-roofs
HAZARDOUS MATERIAI_S DISCLOSURE }507 — FINAL PLUMBING'
Will the applicant or comm wilding nnotter t zImc or handle bomandois material Type of Roof I
as defined by the Cupertino Municipal code Chapter 9.12,and the Health and Safety l — FINAL MECHANICAL
Cale,Section 25532(x)? -
oyes *"° '. All roofs shaR%?ir7peFt��,*)1 rLG�Rsf1�P�E{ofinGgwmaterial being installed.
Will the applicant m future building occupam ase equipment Lir devices which. If a roof is i55PFrfled-wiFhJtH lltst Wuwt1N�I1NWSpection, I agree to remove
emit hazardous air comaminundv as defined by the Bay Arca Air Qualhy Management g '
°Soma? all new matd5114for irffpbNJIIt . EaPLunj4gj#* and will comply'with '
0y. XNm all non-point source regulations.
I have read the hazardous motorists action Iachi s under Chapter 6.95 of the ,
Cnliforniu l lmdtb&safety Cede,Sections 25505,25533 and 255Jq.I m,d,,vand ion -
IfnhebuilingFoesnitcurter aveamnan6lbw it is n.yrespamibility to notify the -
.swupand of a of naran ieh muss w mel prior do issuance sal'a Certificate of
Occupancy. Signature of Applicant Dale
Owner ua,orizeF ,n• ,wDo All roof coverings to be Class "B"or better
OFFICE