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02080108 CIBUILDING DIIVIISIONNO PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 21628 FLINTSHIRE ST THE REMODELING PROJECT 02080108 APPLICATION SUB DATE °LK AYNICZ JOSEPH B AND ELEAN 724 BERRY AVE 08/20/2002 PHONE: SANITARY NO. CONTROL NO. +, (650) 969-2555 p`mi O O ARCHITECT/ENGINEER: g BUILDING PERMIT INFO m q BLDG ELECT PLUMB MECH a z m 6 LICENSED CONTRACTOR'S DECLARATION z 5 H- I,mreb Kq.f that i am licensed B ander oro ofcha r .and(commencing Job Description oz—ne r provisions p" g .RFVTCTCIN--IN HOUSE USE ONLY p ad I j with Sectio=and afect. on J of the Business and Professions Cade,and my license �mY< minox CIaveand effect. (ORIGINAL $#02060019) NO NEW PERMIT ISSUED z�a License Clazx Lic.p w 3 a U Date SContractor DECLARATION ARCHITECT'S DECLARATION t=0 ej 1 understand my plans shall be used az public rernrds x O O Licensed Professional s z OWNER-BUILDER DECLARATION l m1 Hanby.faro the,I am exempt from the Contractor's License Law for the t=Z a following massa(Section 7n,Canonici. repairsw L5.Business and Professions Code:Any city county R m rn as c, which requires a permit n .alter,improve.Demolish.or repair any ewrc to pr, tots'castrance.abso req.res theappi cant far such .it to Bleasrgncd statement - - _ _that he r ied.parsman,l Chep nsisnsofmaComaaonLcenuLawlCM1apmr9 r ,Sq. Ft.FloorArea ,,� q Valuation (commencing with Section 7000) f Division J of the Business and Professions Coast { { I,t c .t a. YJ'•. :1 i j s 1St r ,�';) 7I or Nat he is ewmpt therefrom and the basis for the allegel exemption.Any violation '" of Section 9031-.5 by any applicant fora permit subjects me applicant m a civil penalty or or mare than fire hundred Wllmxs(S5W). APN Number 'C,• . .. Occupancy Type El T.as owner of me property,or any emplsyces with wageam their sole compensation, 101 FOUNDATI N will do the work,ane the structum is not intended or offered for sale(See.70ar, 102 — PIERS Required Inspections' Buiiness and Professions Code:The Contractor's License Law does not apply m an mer of property Who builds or improves thereon.and who does such work himulf 103 — UFER or through his own employees.provided mpa,such imnveroenm are oat intended or _ oder,,ibr sate If.however the building -improvement-. 1n,within one y.of - 10 4 REBAR compleion.,he owner builder will have te burden of proving that he did not build or - improve for purpose ufsale.). 105 — ANCHOR BOLTS ownerorth poprtr. m exclusively contracting ''a�aioRio ----106 — SEWER &—WATER ❑I:ax contract the project(see 7DMe,Business and Pmfeaxions Code:)The Contactor 2 02 — UNDERFLOOR PLUMBING License Law does not apply m an owner of property who builds or improves thereon. - - and.who_ditinatx.far Such pojects.wnh.a.comrunodx).licensed puramanttothe Contractors License Law. 2.03 _ UNDERFLOOR'—MECHANICAL -- _.__._.... _....__._._._......__.. - ❑I am exempt umler Sec. ' ' ,B&P C for this reason 204 — UNDERFLOOR FRAME.' !:' owmee Daae 205 — UNDERFLOOR INSULATION WORKERS COMPENSATION DECLARATION 301 - ROUGH PLUMBING I hereby alrmt under penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER ❑ 1 have and will maintain a cemrca,e of Consent to reit-marc for workers 303 — ROUGH MECHANICAL Compensation, as provided for by section 37W of the Labor Code, for the mt perfoanceoftheworkforwhichtmxpermitisissued. 304 — ROUGH ELECTRICAL ❑1 have and will maintain Worker's Compenmion Insurance.as regioned by Secdnn 3 05 — FRAME 37W of the labs;Coda,far the perforaanc<or me work for which his firm,,is 3 0 6 — HOEDOWNS issued,My Worker's C pen i Insurance tamer and Policy number arc 307 — ' INSULATION .NOFEX M No' Y '" Iss 3:OS"_=)S HEETROC K'T`t f .'.1 CERTIFICATION OF EXEMPTION FROM WORKERS' s COMPENSATION INSURANCE' " _..... - 30'9 --EXTERIOR--.LATH." _.. _ .. -._ ._. . . .........__ ' (This vccridn need m,i x enm l and T me 310 — INTERIOR LATH (SIW)or 1<as.) p permit is for one hundred dollars ori fr frim in the performance f m k f wbohm pe issmea i' - 311....— SCRATCH•"COAT shall not plor'anY person in any matter so as in become.,abject to the worker, 313 — ROOF NA I li'"' :1 Compensation Laws of C 0ih moa.Dam " Applicant. 501 FINAL_ELECTRICAL ENERGY _...._.. ...__. _.. . NOTICE TOAPPLhe ANTWorker s Coupensffor atiohisovisios m of Exemption,you should 502 — FINAL PLUMBING ENERGY' " h.. z become subject to the worker's Comprnsation provisions of a.gehn.ecyLabor h.C_e opde.er._.f oyro-mu.mus, forthwimolywithsuch .isioorispei,shaetacavoked . ..FINAL._MECHANICAL _ E_N._E..R..G._Y CONSTRUCTION LENDING AGENCY SO4 FINAL BUILDING ENERGY' W 505 FINAL ELECTRICAL -Lender's Name LemderxAaercsx _506 '_— GAS TEST__ _ _ - VO e 507 FINAL PLUMBING- '�' l� s 1 certify that 1 have read this applicator,and shim that the above information is correct.1 agree,o comply with ail city and comity onrnancea dad stare laws mlmlvg 50 — NAL MECHANI CAL f,_i m building construction.and hereby authorize representatives of this city to enter upon y:W he abovcmenumncd p openy for no"'t on purynses. S 9 — ONALDE - `.a, Iwe)agmemsavgindcreno!yaMkeepharmlc£s,heCiryofCupenimiugainst 51 —btics,jadgmam,costs and expenses which may in any way accrue against said City in consequence of thegramingalibispermit5514 RKSAPPLICANT UNDERSTAN'DSAND WILL COMPLY WITH ALL NON-POINTSOURCE REGULATIONS. Issued byi Dale 7. Signature of Applmam/Camaam Date Re-roofs HAZARDOUS MATERIALS DISCLOSUREl r.. , Will m pplic r f, building c p r.mm or handle Wasol us m m l T e of Roof autsex nernedh me Bay Area y g If a roof is installed"Without first obtaining an ns ection; I - - as defined by th Cupertino Municipal Coe Chap, 9 13,and the Health and Safety . Cod S.lrW 255J21a) n, 1 44 (, fEiN t t E F rAll roofs shall be ms ected. nor.to.an roofing material being installed 1 Will the ireapplicant fit Wildingoccupant iequipment d amil mm e em r oar moms air ebnr r r Amar, Marta<mem, g P � agree to remove District, new materials for in, IT Applicantunderstands and will comply with. t o Yex - ❑No. all non-point source regulations . 1 have read,he h yardu-mamials requirements under Chapter 6.95 of the re 'Cal foa Health Si&Safety,y C le Sections 25505 '2533 and 5534.1 understand that if the building does not currently have a tenant.that i,is my responsibility to notify the - - " ' - - -- ... .... occuparn of me mquimmen,s which must be met prior in issuance of a Cenibcam of ,occapancy. Signature of Applicant. . _ _ Date `owner nr aam�r.ed ag�n,, Date All roof coverings to be Class "B"or better ._...._ ' OFFICE