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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFOitM�TIO �;.°,
BUILDING ADDRESS:
FRIENDLY CONSTRUCTION INC
PERMIT N005060084
L0301 E ESTATES DR
WE R'S NAME:
PERMIT ISSUE DATE
JOSEPH & GERIANN SHAW
1774 41ST AVE
2005
PHONE:
SANITARY NO. CONTROL NO.
(415)681-1681
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG EIECr PLUMB MECH
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LICENSED CONTRACr0R'S DECLARATION
o
Job Description
I hereby affirm Nn I am licensed under provisions or Chapter 9 (commencing
P
with Section 7") of Division 3 of the Business and Profession Cede. and my license is
mfull to= and effect.
REMODEL KITCHEN & MS BATHRM
License Class Lic.0
Dam Contractor
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
(� tl (� '
/j (tgfl
Licensed Professional
OWNER -BUILDER DECLARATION
IUY' �'llA
E
1 hereby .(foss that 1excmpl from One Contractor's License Law for the
SII
��j1r(.•�.—',
It[Itr^, 1(k117
ltd
oiu Coo,: Any city or county
maso 7031.5. Co
following mason. Business and Proimprove.
strt. do
which requires Permit to cnwmcL eller. impmw, demolish, or repair any amom u
$30000
Sq. FL Floor Area/ j O yfl K
EUOJ
Valuation
n pact
prior to its iaoanm, ane nt to t e the applicant for soon permit m 01e a signed aummem
Nal he escinu Purmaut torte of theeBusinesYLicenalaw(Chamr9
of Dimon
(caroms it Section Division the Businessand CMe)ur
7
oPropositions
tat heels excmpl thcm(rom and the nolo for the alleged cmmption. Any violation of
exempt therefrom and O
M.
EC -t If!
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of
than fm hundred dollars (S500).
not mom
❑ I, as owncrofla propeny, army employees with wagesasdu:keric compensation,
I a•
It �+s+t•�J 11
I
Required Inspections
will do the work. and the swnum is not intended or offered for sale (Sec. 7044, Business
and Professions Cade: The Contractor's License Law docs not apply to an owner of
progeny who builds orimprovea thereon, end who does such work himselfor Ismaili his
own employees, pmvided Nm mch improsemmu are natintended orattend for ale. If,
however, the kidding or improvement is mid within one year of completion, the Owncp
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
,�_I, as owner of the progeny, am exclusively contracting with licensed cantrumts to
construct do, project (Sec. 70aa, Business and Professions Cade:) Ilse Conumter's Li.
cons, law don set apply to an owner of property who builds or improves thereon: and.
who contracts fors such projccu with a conuactor(s) licensed punuam to the Convector's
License Law. /r
❑ I am excmpl under - .B&PC far Nis won
Or
-
W ER'S COMPENSATION DECLARATION
1 her�by affum under penalty of perjury one of the fallowing declarations:
1 haw and will maintain a Certificate of Catucnuo self -imam far Wmk,YaCampco-
sation, a Provided for by Section 37M of the labor Code, for the Performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the labor Cade, far the perfatmance of the work far which this Permit is issued.
My Workce, Campeaanrn Imunim a artier and Policy number are:
Comer. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This acorn need not be completed if de permit is forone hundrad dollars (5100)
or less.)
1 certify Out in the perfoyrmance of the work far wnicn this permit b issued. I shall not
em Ploy Cy'N anjo}n,kumne'! tp,lkegoma�mbjmcttathm Wm1,c.'Compensation
Laws of Califrmfa,.D \'1t \\"��YL
ApPlkam
NOTICE TO PLI ANT: making this of Exabor o you should
rsafter
of
become sunj t m the Worker's Compensation provisions of that fanny COde, you must
previsions d
forthwith comply with such provisions or this Permit shall bu deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat Here is a construction lending agency for the l crrumu maa of
the walk fat which this permit is issued IS., 3097. Ci, C.)
Lender's Name
Underi Addw
I cmify that I have and this application and sum that da show information is
correct. 1 agree he comply with all city and county ordinances and state laws totaling an
building construction, and hereby auNome mpresenutises of this city to enter upon the
above-mentioned Property for inspection Pupases.
(We) agree to ave• indemnify and keep harmless the City of Cupertino against
liabilities, judgments, coast and cxpcnaa which may in any way scene against said City
in consequence of the gaming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGUUAONS.
Re -roofs
Type of Roof
alb .1. iA,)I
Signature ofApplr ICantrector ' Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occuPML SEOM or handle hanardous material
.fined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
. Stearn 25532(a)!
❑yes ,�Na
All roofs shall be inspected prior to an roofing material beim
P P� Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air mnmminanu as defined by the Bay Area Air Quality Management
all new materials for inspection.
District'
❑Yes
I nave read the haaaNnus materials mquimmenst under Chapter 6.95 of the Califon
nia Health&Safely Code-, now 25515.25533 and 25534.1 understand that i(the building
does not cutmmlphn tenant that it is my responsibility to notify the occupant Of the
mquimmcull chstbumapriortuimu «o(aCcrofcat Of&CUWcy. (
Signature of Applicant Date
/I,\�
All roof coverings to be Class "B" or better
Owners '
a ndagent Dau