04060115 - 41
CITY OF CUPERTINO ' ' """'I' Tr '41 '
BUILDING DIVISION PER MI h,CONTIZACT�( RINFOR„MAi'�
...
BUILDING ADDRESS: MARTIN & JENIFER PARRY PERMIT NO04060115
697 GALWAY DR PERMIT ISSUE DATE
OWNER'S NAME:
MARTIN & JENIFER 2ARRYSANITARY NO. CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
uuZ LICENSED CONTRACTOR'S DECLARATION
0 0 .. Job Description
inC I hereby affirm that 1 am licensed under prov,smns of Chapter 9(cnmmc«ing
U with Section 7")of Division 3 of NC Busine and Professions Code.md my limens,is
mfall fame and effect. BATHROOM REMODEL
q
License cissa LimJa
ORIG. #02040005 EXPIRED
—, DOW LnI
Z
^yI'-w ARCHITECTS DECLARATION
Y g.i I undcrstanJ my plans shall be used es public records
DyU
u Licensed Professional
u'Dg OWNER-BUILDER DECLARATION
1 hereby affirm that I am
exempt from thvn
e Coneor's License Law for the
O O following reason.(Section 7031.5,Business and Professions Coda:Any city m county
ti$6�. which requiras a permit m cmwmn,alter,improve,demolish.or repair any structure
."^ prior to its oemore.also requires the applicant far such Permit to file asigned statement S F[. Floor Area Valuation
that he is licensed pursuant m the Provisions Of the Contractor's License Law(Chapu,9 q• Y i 0 0 0
yFm (commencing with Section 70)0)of Division 3 of the Business and Pmfessions Code)or
ou $ But he is eumpt Therefrom and the basis for the alleged,untption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
..I.am Hm five hundred dollars(utw). 3 6624030 . 00
p 1,m owner of the property,or my employees with wages as their sole compensation,
will dothcwmk.and the swmureisnot{nRon dod or olife It,d fossale(Sec.7014,Business Required Inspections
and nnfesssiom Code:The Contractor's License Law dote not apply t.ea owner of
property who bu ilds or improves Hereon,and who does sur h work hi mse11 or through his
own employees,provided that such imp,avroom stir not intended.,offered for sale.If.
however,Ha building or improvement is sold within one year of camp)ohm,the owner
builds,will have We burden of proving Nn he did not build m improve for puryme of /
sale.). v
❑1,as owner of the property.am exclusively contracting with licensed contactors to
construct
the project(Sec.7044,Business and Professions Cade:i The Cs themon,and.
e
mnu taw docs not apply to an owner of pmpertY who bolds or improves Hereon,and G.
who contracts for such projects with a convecm,(s)licensed pursuant to the Conmcme.
S
L'mnu Law. 0�
eacmpt do .B&PCrot this
RI. un
reason
Data f, /11L4
/ORKER'5 COMPENSATION DECLARATION
1 hereby aRum under penalty of podury one of He fall. decimations:
❑I hm and will maintain a Cen ritu se of Consent to self insure for WorkersC.mpen-
satim,m provided for by Section 37M of the tabor Cade,for the performance of Be
woh for which this permit is issued.
1 have and will maimdn Worker's Compensation Insurance,as required by Section ,
37W of the tabor,Cods.fm Ne performance of the work far which this permit is issued.
My Worker's Comp,mak on Insurance carrier and Policy number am:
Cartier. Polity No.:
CERTIFICATE OF ESEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis amain.mord not be completed if the permit is form.hundred end.($1013)
or lmeJ
1 ccNfy Hot in He pednrmance of He work for which this permit is lassoed,1 shall not s
employ any person in any manner sec as.become subject the Workers'Compemmbut
Lawsof Cslifprpi§.4,tn f
Applicant 1Ct/'
NOTICE TO APPLICANT:If.mf.r making this CeMdm=of Escmptto.,yno shoulJ
become subject to the Worker's Compensation mvisions of the tabor Codc,you most
,Z foMwiH comply with such provisions or His Permit shall W deemed revoked.
Z O CON lmlUCr10N LENDING AGENCY
�-. 1 hereby affirm that Hem is a construction lending agaey for that Performance Of
W> ft wish for which this permit is issued(Sec.3097.Civ.C.)
W A Lenders Name
tt, Lender's Address
V 1 ccnify Het 1 have read this application and state Hab
at Inc out ormts aeon is
lL— correct 1 agree to comply with all city and county ordinances and state laws misting u
Q U building co).,.a to and save.
Oo mufy and
eep harmativm e this -1 to C-Pnte,upon the
move-mentioned pmperty for impcction purposes r
(We)agree la seta,indemnify and keep harmless He City me against
against
N liabilities,Judgment,costs and Cape
which may in any way aeeme regains saidCity
C) z in con cc of the grand,of this permit. Date
'+ APP}y. NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SO{IR R LATIONS.
46L-16'
.v I
f V Re-roofs
a
n -rc o o m Contamm -
HAZARDOUS MATERIALS DISCLOSURE ata Type of Roof
Will the applicant or future building occupant score or handle haamdous material
as defined by the Cupenino Municipal Code.Chapter 9.12.and the Health and safety
Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym Na
Will the apPl'to" or f core builJing«cupam esu equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hanmmus air c.numinan'u as defined by the Bay Area Air Quality Management all new materials for inspection.
Owner' 1f1n�7^
Yes
I have mad the hu'Lous materials requirements under Chapter 6,95 of t.Califor
ni HealHg delyco Seetons 25X15.M533 and 25534.1 understand Hat lfthe holding
do-s not rte M1 crank that it h my responsibility m n.uly th arse ant of the
mai ems primtoias.anm,nracemfim.ur11 �n�ra� Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner.,abt mi r d agent Dat
Pt
Q. coy
I'epc 410 Sk.4it RFN►A!N
t,c 7f 41V l
pkonz-
SUBIWITIAL
APPROVED
TN ACCORDANCE WITH THE CRY OF
?ERTI DES,4ND _
� ORDINAN(,F�
'
j'!
fi l t
-cl of Planl�na sPecifiralions MUST he
�n the;ch all IimWS ane it is unlawfU to -
t
�'N Manges or alterations on Sams
w± t^mlfv: pemli5agn from d*
__-
r?t f„lupertino.
JI Thls Plan and OPOckaffons
,CU' ca heia to Permit a to w an
a! or ;he woiet!on of any prwsons of
or St,Zte Law
•
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CO NTRACTMIINNFO MATIO,,,
BUILDING ADDRESS: MARTIN & JENIFER PARRY PERMIT N0.04060115
1697 r�ATMAY DR
OWNER'S NAME: PERMIT ISSUE DATE
MARTIN
E: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0�p /0�g 0 0
u0, LICENSED CONTRACTORS DECLARATION Job Descriptio VUMALEm
u 1 Even,affirm sun I am Iiaused Eimer provisions of Chapter 9(commencing t��
wit Section 7")of Division 3 of to Business and Professions Code.and my license is eexv
7L E, mmn oroeamdeffa'' BATHROOM REMODEL
i Z IDacmn eClasa core ter JUL 2 / 2004
ORIG. #02040005 EXPIRED
^� ARCHMCTS DECLARATION
zI undmwnd my plans shall be used u public records
BE.
Licensed Professional
BUBLOING
G OWNER-BUILDER DECLARATION
3 1 hemby oRrm tan I am excmps from to Convector's License taw for the
a0 fallowing recon.(Seeman 713 L5,Business and Prefessiuns Code:Any city Or county
S f which requima a permit no construct,alms,impmw,demolish.or repair my suuctu,
or prior mins issuance,dw myuims to applicant forsuch permit to file a signed+u chicas ValUa
��< that he is licensed purwanuo the P OVlsiou of to COURROm Shama law t$oiI(Chapter 9 Sq.Ft. Floor Area 4�0 0 0
are (comrmcing wit Section 7")of Division of to Business and Professions Code)or
M R 9 tat M u asempt tearoom and the basis for the alleged exemption.Any violation of
Sector 1031.5 by any appileam fora permit subjects;Nc applicant to a civil penalty of APN Number Occupancy Type
not mom tan fan hundred dollars(SW. 36624030 . 00
❑I.uvwmer of the ptepeny,or my employed wish wagasutuev sole ampewmw.
will do to wo&end to wuctum is not intended or offered for age(Sec.9004,Business Required Inspections
and Pmfesaiona Code:TM1e Convenors License law does an,apply m wrm
an 9s of q P
property who builds or improves Lemon,and who does+uch work himself or trough his
own employees,provided that uch impmwmenu art not intended ora@sed forsek,if,
however,to building or improvement is said witin one year of completion.to owner-
builder will have the burden of Proving to he did net build or improve for purpose of
ale.).
❑1.as owner of to ptepeny.am exclusively contracting wit licensed contractors u
commum the pmjce,(See.'/0a4,Business and Ptefesdans Code:)The Cootracur's Li-
canoe Law dors not apply m an owner of property who builds or improves Lemon,and
who contncu for such ptejecu wit a comossio if j licensed pursuant m tk Comtncur's
�LL�fee�nge Law.
l am exempt uncle .Bh PCfar this rtuan
Dam O
Urm ORKER'S COMPENSATION DECLARATION
1 hent,afBmt under penalty of perjury otm of to following declarations:
have and will maintain a Certificate of Consent m self-insure for WorkersCompcn-
on,as provided for by Section 3]00 of to tabor Code,for dm performance of the
work for which his permit is issued.
1 ban and will meinuin Worker's Compensation Inwrance,as oduirtd by Section
]100 of the tabor Cade.for to performance Ef to work for which tis parotin is issued.
My Workaeg Compensation Insusan=artier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section seed no loccmnplemd if th permit isfarone hundred dollars($100)
or lass.)
1 certify Las in to performance of to work for which this Permit is issued,l shall not
emPloy any petsen in any manner an as in taome wbjacuo the Workeri Compewtion
Laws of calif yyrp i en
Applicant IM
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject m to Worker's Compensation provisions of to tabor Cede.yon mwn
�,Z foMwids eamply wit such provisions or his permit shell ba deemed revoked.
?O CONSTRUCTION LENDING AGENCY -
[-. I hemby affirm tat hem is a conssrucunn lending agency for the performance of
C4 > to work for which to permit is issued(Sm.3091.Civ.C.)
W QLunch's Name
G Landces Address
V O 1 minify but 1 have mad his application and sou tet to above information is
D.— comma I agree m empty wit all city and aunty ordinances and state laws misting to
omUldwo
r upon
0 km`U Wilding eonwueni n,and wLowhe¢byautorixep haryiesstofCity of mamano age the
W ahove-mentioned literally for insfecuot purposes.
C (Wc)agme m Eve.indemnify and keep harmless dm City of Cupertino against
N oabilitias.judr,. dre SERIOUS uxpcnsrs w,I. may in my way umuc againstssid City
t.)z m can see of tc Ranting of tis pontis' Date
n. APP NDERSTANDS AND WILL COMPLY WITH�}LL NON-POINT Issued by:
50 R R LATIONS. m
v l U Re-roofs
no oscaduCoRommon `1 HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
LIE to applicant or future Wilding Occupant cam or handle harasdow material
Ed defused by he Cupartmo Municipal Code.Chapter 9.12.and to Health end Safety
ode,Sccuon 255328)? All roofs shall be inspected prior to any roofing material being installed.
�Yas No
will be applicant or f vert building aeeupant we cyvipmcnt ter devisers which If a roof is installed without first obtaining an inspection,I agree to remove
it hovardnus air conmminanu defined by the Bay Arca Air Quality Management all new materials for inspection.
strict?
❑Ycs
I have mad to huandousmaurials requirements under Chapter6.95 of to Califor-
nisHaltfmyea Seen.25505.25537 and 25534.Iundcommi tniftc building
�
does nun h teanwk tar it is my nommoboty u onan
lyt cu t Of he
time eta E,t metpirawiasuanaafac�,ma�f�an�a� Signature of Applicant Date
Owner or arise agate
2�Bam All roof coverings to be Class"B"or better