01050108 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10425 FARALLONE DR STEVENS INCREDIBLE KITCHEN01050108
OWNER'S NAME: APPLICATION SUB DATE
CRAWFORD PHYLLIS A 11520 AIBA RD 05/11/2001.
PHONE: SANITARY NO. CONTROL NO..
(800) 374-5279
M RZZ ARCHITECDBNGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
Fa
-ICE SH15 CONTRACTOR'S DECLARATION lob Description
O =C I heresy.11' a that I am decowd under proo mm of Chapter 9(commencing P
r^o,_; ,with Section 7000)of that
3 brim Businessland Professions Cmle,adria,manse
2,,�� istnfallfnrccandcRe /¢�IOQS
sya hiccnsacm. Lie.# __11JJ''II 11 KITCHEN REMODEL.
w 3 t N IYac —II Commnor _
rw0 ION
ARCH]'1'I!CT'SDECLARATFINALF�
1 undanund my plan.shall be used m LAR TION
cee°'
R5 p v0 Llcenwd Po,mc,io of -
is o OWNER-BUILDER DECLARATION JAN L 6 ZOO2
I hereby affirm Law that I am exempt fmthe Conctor's License w for the
1-z 6 following mmoh.Sent,.7031.5.Ilusina,s and Pualleaons Calc Any city or cowry
D which require,a,crmit It,canter,altar,improve,demolish or repair any ambient
ci Prior ill issuance.also requires the applicant for such pem,iuo file°signet%memen,
that he is liremedp,maant tthe provisions aide,Ctmmamors License Law(Chapter9 reit Valuation
(commencing wish Seaton 700(hal Division 3 of the Business and Profession.Code)
or that he is exempt therefrom and he basis for the alleged exemptidn,Any violation �' �Nm�
of Sadler 70315 by any applieam for n perosi,,tibFaulty the applieam to a civil maty Occupancy Type
orm,t tare man we hundred doll;...S500). APN Number
Q 1,as owner ofbc pmpeny,nr my employees with wage,is their sale ern 0p1 171171
will do we work.and lie.trurture is.1hl Intenrkd or d1cmd for sale(See 7144,
Bmidess and Pmfe.sions Code:The Contractor.License Law does not apply h an Required Inspections
r of p,,,,by Who build,or improves thomon,and who dues such work himself
err
owner
bis own n,tpiny.<..pr:wided watt.nit,impm.emmt,are not imandad,a 101 — FOUNDATION
offered for sale If.however,the building or improvement is.old within one year of
completion,the owner-milder will have he nmdea of proving that he did not build or 102 — PIERS
improve ter putpo.o ofnale.l.
01,ns owner of the proper,am asAasivaly cohtm,ting with nerved eommetorsu, 103 — UFER .
mHe,theprolanee
fs .7044,Baaan
Basin— .dnsContractor's 104 — REBAR -
License Law does not apply to an owner of pmpeny who builds or impnwes thereon,
and who contract%for such projects with a cormanods)licensed pursuant to the 105 — ANCHOR BOLTS -
Commct o',License Law.
❑l am axemprtrrder Sea. B d PC for this roaad. 106 — SEWER & WATER
ncr Date .202--- UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL _
I mmhy afrmt trade,panall,of periory are ofnhe rdlo-on,declarmia"s�. 204 — UNDERFLOOR'..FRAME LII have rad will mai mnia a Cenlrcahe m Consent to.elf-imnre for Worker.
Comidn,ition, a. pra —
vid,d far by Seedoo 37811 of ha Labor Cefe..for me . 205 UNDERFLOOR INSULATION
perornionce of the work Ibr which this cumin:.issued,
301 — ROUGH PLUMBING
olhave and whor Code.n rthe pelocep<•mmif tework e,a. hic fired by Sort 302 — TUB d� OR SHOWER
37(lo or ata Lunar code lar ma parn,rro:o,ee of the work lar sumer m'ts iter nit is
.ad.blyWorkers Compensation insurance carrier mad Policy number am: 303 — ROUGH MECHANICAL
Coric4 Policy No,
304 — ROUGH ELECTRICAL
CERT IIICATION OF EXENIPTION FROM WORKERS'
COMPENSATION INSURANCE 305 FRAME
I Ibis sectlor,head not w completed if me permit is far ane hundred dollar. "'06 — HOLDOIJIdS
(SIB(Borlcs.) - J
I cenil'y ho in the perfnm,unn;of he ark for which his permit i,ismad,1 307 — INSULATION r
.Hall tot emptor any person in am n,an a.m near neat to me workeer 308 — SHEET ROCK
�m
Cmnpansatlon latws of California.1) VU1
NOTIAppliCE 309 — EXTERIOR LATH
NOTICE TO APPLICANT.If,aI¢r g ,i.Crnificatnd Excmptmn.yuu should
Z become..T.,ma,eW kc-Co pcnsniion.rovtmn.ofit,Laborcodeyou ino,r 310 —' INTERIOR LATA
Z C farthw9w cont ply with such IF on orthis •roti,shall h teemed revoked.
? 311 — SCRATCH COAT
V1 CORS'TItUCI'I INC.ACGNCY
> I hereby auind that there is a enmmteron landing ngeney far me parfornamee 313 — ROOF NAIL
w
of the work
A Lather's Name mo for wMrnthis p�tti.i..aed(see.31w7.cin.c.) 501. ---FINAL ELECTRICAL ENERGY
61
'] Z LemmrsAddress
U0 502 — FINAL PLUMBING ENERGENERGY ,
' 1 certify that lh read application J tate that the h f t
C) U
correct.ngc t ply r b mit J county r � and slide laws 9 rs's 503 — FINAL MECHAN�ENERGY
V toWld building construction, Jae all
th representatives fn city come ups'.
a t= mean df pchyr :p r p r 504 — FINAL BUILDI I I ERG`/
[.. A. (w)alti save,indemnifymalkeep limbless theCtY of Cupertino prt
UZ) liabilities.judiromrs.costsJ es,ow,which mayinamy way iteent, i said _505 — .FINAL ELECTR
',Z Cor,n a,mcqua if he gmnung Janis Ixrmn. _
APPLICAMI' :R STANDS ANDwILLCOMPLYWn'Ii ALL NON-POINT = }Cas
-'OURCE RI q'I'ION . Issued by: ` v �- Date
sal_ - -
Sit rcoIA ,nt)Corametor Date Re-roofs =
IAZAROOUSMATERIALSDISCLOSURE 508 — FINAL MECHANICAL
w,B m, lam or Entire building occupant%hm or handle hm,,rdous mat Type of Roof 509 — FINAL GRADE
as defined by ore merino Mnmripal code depter?J2,and are Health and Sorely
cola.Section zss32(al^. 5.10 — LIF LNAL PLANNING
°Yes All roofs shall b 1ns ccte ¢t-1 R� P 1 r PLANNING }�+1'1y,Q4mg installed.
Will the licont or more naddir ' 7191T te1X1y$1. ai I jPQy kk
pp g`°'up°"rtasaequipmentaWe°ie°.whit" If a roof IS install iibou rill Zal l b �II H1s UUUffflll 1 a tee to remove
emit hnzvJoi.air mnmminart,as Jefi y that Bay Area Air Quality Management P ('
Own,,'' all new materials for ins ection' Applicant understands and will comply with
❑Ye. N., P PP
all non-point source regulations.
1 have mad the by Co1c.marmots 505.25„mts under ce:1 m eros of the -
California Health h Safety Colics Sectlom255a5.,it is and 25536, unJertanf that
abropeim uilding Juesn carrn which m,t a-un,, i,is my,aameai if aymnotiry the
ueaapam of he r cots suntan t„nst nit me,prior to aaomee of a camre,te..T
Ocetrp:mey.
Sri ,U Signature of Applicant Date
Pnrser —"I,or d�g m DoleAll roof coverings to be Class`B" or better
OFFICE