03070051 crrY or cur> trrtNo
BUILDING DIVISION PERMIT CONIRAC'"TnR INFORMATION _d
w: 'n Thr x...dm�.r3's
BUILDING ADDRESS: BAY AREA CUSTOM CONSTRUCTI SffllT ND03070051
-"rER'S NAME: 365 KYLEMORE CT. PERMIT ISSUE DATE
KE
PHONE: (408) 978-4766 SANITARY NO. CONTROL NO.
ARCHITEC V ENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
0 0 0 0
I O Zp LICENSED CONTRACT'OR'S DECLARATION
w❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�i- with Section 9IXM))of Division 3 oftx Business and Professions Corr.and my license is
>nZLieuumroaand effect. ADD 290 SQ. FT. & GARAGE 462 SQ. FT.
j"2 Ucull f class Lic.p
=moo Da Contractor CONTRACTOR: BAY AREA CUSTOM CONSTRUCTION
tJa ARCHITECTS DECLARATION
I m< 1 understand my plans shall x used as public records
yy0
t; Licensed Pmfcssinnal
,g OWNER-BUILDER mDECLARATION
a P 1 hereby enio affirm on 1 am exempt from the n.,CContractor's c:Any
Law for the
p O (Mowinguires a Permit
t ]construct,
Business and improve.
do Profession.,Codc:Any city or roomy
m
poor
irM1 myuima a permit re mastitis,paltio plicaimpmrc.de Permit
m repair any structure
S_i triton its issuance.p also requires the applieant for satch Contractor's
to fiu sesigned w(Cha mem
2sp that he is liccnud pursuanuothc pmnnoits nr the Commcmr's Liccnu law(Chapter9 Sq. F[. Floor Arca VahlljL�I 000
til-$ (enmmenci ag with Section 7")tl Division 3 of the Busi mo.s and Professions Code)or v
c _
that he is exempt therefrom and the,beau for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant to a Civil penalty Of 3 20V!3N0t�'@er0 0_ OCCU ane T e
not mom Nan fire hundred dollars(5500). -- P Y P
❑ Laaownork.the pd Staranc or mycmntendes with wagauNei(See.compensation,
will Pr diedwork. ode: he Cotta tors License
LaOffew
it forsale
apply tooin,B Owner
- Required Inspections
ess
and Pnywh obs Code:improves Contractors License Law docs not apply to an owner of 101 — FOUNDATION
P 9
propcny employees
Ids m d that uch imps and who are
doessuchin work or offered
pr through his �f
howown ever,the buildinprog or host such improvements iss id within
uinore ear of ded
completion,
thefor owale.r.t. lO2 — PIERS
builder,the building or improvement is sold within one year or completion,Ne dile of
builder will hare dee burden of treeing Ws x did not build or improv for purpose Or 103 — UFER a
sal`')' 104 — REBAR
0 1,as owner of property,am exclusively contracting with liccnud contractors to
-construct the project
ct(sec.7044.Business ofaandrty who Wide or
The s,themon,l3 10 — ANCHOR BOLTS
cense Law does notapplyplr roan with
of property who sed prorimpto the
Nemon.and 106 - SEWER & WATER
who contacts for such projects wish a conuamor(s)licensed pursuant to Ne Convacmr's
LicenseLaw. 202 — UNDERFLOOR PLUMBING
1 exempt untie c. B k P C for this moon
x er� 71nn..� Dare cffi1G3 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME
I brreby afRrm ander Penalty of parjur,nz of the fouewing dralwaenns: 205 - UNDERFLOOR INSULATION
❑ I bee and will maintain a Certificate ofcon,em to relf-insom for workers Compen- 301 — ROUGH PLUMBING
saran,as,provided for by Section 37W of the Labor card,for Our Performaned of the 3 02 — 'TUB & OR 'SHOWER
work for which this ycrmh is issued. 303 — ROUGH MECHANICAL
C]I have and will maintain Worker's Compensation Insurance,as required by Section
37W Of the Labor Code,for the purformarecofhework for which this emilisissued. 304 — ROUGH ELECTRICAL
My Worker's Compendminn lnamened carrier and Policy numher aa: 305 — FRAME,
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS306 — HOLDOWNS
COMPENSATION INSURANCE 307 — 'INSULATION
(This section accord not x completed if the permit is for one hundred dollars(S H10) 308 — SHEETROCK
Ishonlyr less.) 309 — EXTERIOR LATH
employ certify Nat in rbc p anymanre of the work for which this permit is ra Com sons nut
Lawor California
i Usey manner as aswxcomc Subject to the Wortrrs'Compcmatinn 310 — INTERIOR LATH
Laws hrnrni,.wlr 311 — SCRATCH COAT
Appueanr
NOTICE TO APPLICANT:If.after making this Ccni from of Eumption,you should 313 - ROOF NAIL
become subject to the Worker's Compensation provisions of dic Labor Code.you most
]Z forthwith comply with such prnviainnaormisPcrmhshall xAecmmmv.kcd. 501 - FINAL ELECTRICAL ENERGY
? O CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
I hereby affirm that mart is a construction lending agency rot M performane,of 503 — FINAL MECHANICAL ENERGY
Y the work for which this permit is issued(Sec.3097.Civ.C.)
y'F). Lender's Name 504 - FINAL BUILDING ENERGY
ndcrsAddr s
Z) Z 505 - FINAL ELECTRICAL
J p I certify that I have read this application and sate that the abate information is 506 - GAS TEST r
y torten.I agree to comply with all city and county Ordinances and sou laws relating to
Z) U building construction,and hereby aloomizzrepresentalivesofhis city Ioenter uponthe
FIN PLUMBI G
1.q abovomemmed property for iupecdim purposes.
_ a (We)agree to save,indemnify and keep hannleu the City of Cupertino against 0 8 F I L
N liabilities,judgment,costs and expenses which may in any wayecemeagainstsaidCi7 5 7—
j Z in consequence or the grand ng of this perm it. 7
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON-POINT Issued by:5 NG Date
LrEREGyyuLnTlo" �� PUBLIC WORKS
i r� (i� �t ti 9 k/c5 Re-roofs
Signamrc ApplicaHAZARDOUS MATERIALS DISCLOSURE nl tor Date Type of Roof
Will Ne applicant or future building Occupant store or handle hazardous material
as defined by the Cupeninn Municipal Code.Chapter 9.13,and the Health and Safety
-e,Section 2ss3z(x)? All roofs shall be inspected prior to an roofing material being❑Yrs pro P P Y S g installed.
Will the applicant or future building Occupant use equipment ordcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardtus or,contaminate as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
p Yes p'No
I have read the hazardous materials regciremene under Charter 695 of the Califon
ma Health K Safety Calc.Sections 25505.35533 and 25534.5 undestand Nat if the building
does not cemouly hart a tertan4 Nat it h my responsibility m notify the uecupenr of our
�Iu�emenewnirp,nuatxrnrtt,isauenddnracdrdoralr coy/j 3 Signature of Applicant Date
Owner Norivdd agent Doc o 'B
(s` All roof coverings to be Class " or better