02080011 CITY OF CUPERTINO `++ t^r, Ar...u. .. ae a w.c•+++' gin js-y
BUILDING DIVISION PERMIT eCONTRACTOR INFORMATION.,
BUILDING ADDRESS: PERMIT NO.
22126 CLEARCREEK CT STARBURST CONST CO 02080011
OWNER'S NAME: APPLICATION SUB DATE
ELLIOTT JAMES P AND ELIZABETH 1207 REDCLIFF DR 08/05/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 448-1328
D ARCHITECTIENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�... LICENSED CONTRACTOR'S DECLARATION
Z1 here Mimi that 1 um licensed under provisions of Chapter 9(commencing Job Description
Prat with Section z)ofDivisionSoftheBurines. ml Professions Cale,andmy]loan. KITCHEN REMODEL O �NALE®
is in Sal and a XI
ou Liceve C ms Lic.1
B W Due Contracts, i
0�n ARCHffELT'3
ATION SAN 2 9 2003
g 1 understandy p
mlans,hall be used as lie aaamis
p Licensed Professional
that Int-BUILDE from
the RATION BUILDING
1. 1 hemby.(Stem that 11. exempt fmm the Cessions o e:Any c Law for the
k 3 (allowing mason.(Section]031.3.Businos and ve,de uli Cade:Any city or county $50000
F C which rtqui v issuance.Knoalso re const�ims the
alter,imfor such
tle Permit
t,or repair any sunictusummers C3$ prior.iss nsedom rtquim thownsiocaoffur mohacusts LFile aicense gaw(Clep int
de.hei, wit Sectio to test provision,of the he nude/a Littnmlaw(Chapter9 Oir(,5`ea Valuation
(commencing witht theom7000)m�anofhe basis3orthe Bged ex and Professing Cade) 32 Og ObL1 VV
or Sect he is exempt ttinmrrom esti the Permit
for the alleged the exemption.Any violation
of Section 7031.3 iv any happi undred
cam fora permit wbjecu the applicant ro o civil Penalty �JTD� Occupancy
Type
of not mein man five nunaine.sitars l350p' 101 `4PNFOUN�ATION Occu ane e
❑1,as owner of the property,or my employees with wogs as Iheh,ole mmpenmtinn,
will do the work,and the odc:Th is not inlcnded ere Law for ale(sec. to
n 4:02 PiERS
10 3 - UFER Required Inspections
Business and Proproperty
Cade:The Communist's them .icenseand w law rise,nm apply to a
owner of progeny Who builds.powks.ves n such improvements
ve eats such wait himself
or
or.rough his own employes.p Wilding
that such improt is sol ere not intended or 104 - REBAR
cRcind for ale.IL enbuil a the building ur improvement s mud within one you or
completion,the owncrbuileer will have the harden of paving thin he did not builds 105 - ANCHOR BOLTS
improve for purpose of sale.). 106 - SEWER & WATER
El 1.a owner of the Property.am exclusively caroming with licensed contractors to 202 - UNDERFLOOR PLUMBING
construct the project(Sec.7044,Business and Professions CWa:)The Contwo is
License Law does not apply to an owner of property who wild,or improve,therm., 203 - UNDERFLOOR MECHANICAL
and who contact,fur such projects with a contracmgs)licensed pursuant to the 2 04 - UNDERFLOOR FRAME
Cont m"me,License law.
❑Ism exemprunder Sec. ,B&PC(mrbh inamn 205 - UNDERFLOOR INSULATION
Owner Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
1 hereby ufmm under penalty of perjury one of the following dmlannions: 302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
❑ 1 have vad will rovidein f Cby Secti of Conant to mLaimirm foe worker's 3 04 — ROUGH ELECTRICAL
Comrmanc o he poAf r far by Section 4]00 of me Labor Cade. for me
performance er the work tar which mis pear;,I.lases. 305 - FRAME
❑I have and will armata;n Worker's Campenwtion Inrmaton,a inquiind by Section 306 - HOLDOWNS
37M of the Labor Code.for the perommnce of the work for which this p arrmL I.
307 - INSULATION
issmal M W duce,cwho nation r umnce com1e and Polity number ore:
n;e��PnRay O 17 308 - SHEETROCK
C?RTIPI ATIONOFEXEM ROMW RKERS' I309 - EXTERIOR LATH
COMPENSATION INSURANCE
Gros.'I..need nm be completed if permit is for one hundred illers 310 - INTERIOR LATH
($100)o,less.) m 311 . - SCRATCH COAT
I many that in the parformace of the work for which this permit is Waned,1 313 - ROOF NAIL
shall not employ any person in any manner on m to became subject m the Workers 501 - FINAL ELECTRICAL ENERGY
k Cion,riuum Lows of C.Lfmm..Dom
9 Appli`int 502 - FINAL PLUMBING ENERGY
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
Z Income subject to the Worker's Compensation provisions of the Labor Costs,you must 503 - FINAL MECHANICAL ENERGY
Q forthwith comply with such provisions or this permit shall be timate invoked. 504 — FINAL BUILDING ENERGY
r~n CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
Wy 1 hemby aRmt that them is a construction lending agency fa the pe rform.ntt
A ofthewords far which this pnmitisWood(Sec.J11 .Cm C.) 506 - GAS TEST
fender's Name
Z Leader'.Address 507 - FINAL PLUMBING
U OI cenify thin I have mad th' plicution and nue that the ohave information is 508 - FINAL MECHANICAL
GL carat.l agree m comply with I ty and county nrdide nces and state lawn minting
O toZUdingmnuraction,and re authorimmpresentativesofthis city toenter upo509 - FINAL GRADE
� W the above-mentioned pro r inspection purposes. 510 — FINAL PLANNING
r 6s ", oil see to mnify and users which
ondless mayorthe City of Cupeaft.,at against 514 - FINAL WORKS �� J
z liabilities,'ud std a " ase,whnch may in any way acme assist said
U Ci t r 8mn'g of this permit. r
D SAN AND WILL COMPLY WITH ALL ON.POINT !
S RCE cU n N Issued by: Dale
nawre of lice ontmctor Dat Re-roofs
ARDOUS MATERIALS DISCLOSURE
Wn a pliant mum building uccupatn atone a handle hamdaus material Type of Roof
asdesned y eCupea mdcddlC e.Chaptcr 9.12,.M the Hmhh anti Safety
Cale,Section _ I
°YC, ° All roofs shall be inspected prior to any roofing material being installed.
Will the mahcmt or m an Idmil .peat um equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit bound er cnnmmi nwgdcon )'the Bay Arm Air Quality Management Div.,,7 all new materials for inspection. Applicant understands and will comply with
°YCe all non-point source regulations.
1 have real the but us m erial,requirement,under Chapter 6.95 of the
California Health&Safety Code,S ours 25505.25573 and 25534.1 undemand that
ifthe building does nae ally se atimnp that it is my responsibility to notify the
-,-pant m re ems w ch must be met prior to issuanm of a Cen;Re.te of
Signature of Applicant Date
nr aaeho td co Date All roof coverings to be Class "B"or better
OFFICE