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CONTRAC�TORiyINFORMATION
FCITY
DIVISION PERMIT
.
DING ADDRESS:
K & M DEVELOPMENT INC
PERMIT 5003050004
R'S NAME:
1060 WEST
HILL CT
PERMIT ISSUE DATE
GNANAP
"E
(408) 253-9787
SANITARY NO. CONTROL NO.
ARCHITECrIENGINCER:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
LICENSED CONIRACfOR's DECLARATION
Job Description
1 hereby affirm that I am lixaved under provisions of Chapter 9 (commencing
with Sectiop ]fAMI)of Oiviaion3of Nc Dust it Poor cssionsC Je, and myliccnse is
�n1efc^l�nredand often B Limon( FiJ'/�
Dam cont. - e'-ai-'e
ONE STORY
IVING SPACE
NEW SINGLE FAMILY DWELLING
3175 SQ. FT CSE Q. FT.
oF�aly yy
ARCHITECTS DECL ATION f ✓
1 unJ rsmnJ my plan II W uxxft� uh is records
��ss �QQYfFJJI
. JUN 2 1 2004
Licensed caa2iisl
OW - UILDER DE ARATION
1 hereby affrm Oa11 am mgt from c contmcmr's License Law for be
sc
following reason. (Section 7031.5. ' ese Pmfeesions Code: Any city or county
which m,.I. a permit to Pnnstmct, alter, improve, dcmoliah, err repair any structure
prior m its issuance. also ¢quires the applicant for such permit its rile a signed statement
Nal he is licensed pufsmnuo the provisions Of Me Contractor's U.M. Liw(Chapter 9
Sq. Ft. Floor Area
'a�t-gry000
(commencing with Section 7000) of Division 3 of the Business and Profession Calc) or
Nat he is exempt therefrom and tie bases for the alleged escmption. Any violation of
32WB7Qt"crO0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more Nan five hundred dollars (5500).
,
❑ I. u Owner of the pmpeny, or my emplOyccs with wages as their sole compensation,
101
Required Inspections
p
FOUNDATION
will do the work, and the swcmrt is not intended or offend for sale (See, 7W. Business
and Professions Code: The Contractor's License law dices not apply m in owner of
progeny who builds or improves themon. and who does such wart himself or through his
-
nemployces,provided that such improvemenuare not Monocled or offered Bosom. If.
102
— PIERS
however. the building or improvement is sold within one yes of completion, the owner.
builder will have the burden of proving Nal W did not Wad or improve for purpose of
103
— UFER
sale
104
- REBAR
1, as Owner of the property, am exclusively conoacting with licensed conoacmu to
consumer the pmiaet(Sec. 7044, Business and Professions Code:) The Conumaor's Li.
105
— ANCHOR BOLTS.
cmc taw dors not apply to an owner of propeny who Wilds or improves thereon,and
106
- SEWER & WATER
who contracts for such projects with o contmemr(x) licensed pursvnuo Use Common's
202
- UNDERFLOOR PLUMBING
Limmuc aw.
❑I.m exempt ander Sep. .B&PC for thisrcasnn
203
- UNDERFLOOR MECHANICAL
Dare
204
- UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
205
- UNDERFLOOR INSULATION
Ihm,byoffmtendmKfinhyermidtirymmarftOnfiwingdeclxadnas:
301
— ROUGH PLUMBING
(haveand will maintain a Cenificam of Consensus self -insure for workers CumIum
..tion, as provided for by section 3]W err the labor Code. for the performance of tW
302
— TUB & OR SHOWER
work for whim thes permit is issued.
303
- ROUGH MECHANICAL
1 have and will maintain Workcr's Compensation insurmttt, as requirtJ by section
naooftheLa�Wncode, for the performanceoftheworkhrwblchthisWmilisissued.
304
- ROUGH ELECTRICAL
Am
Lssdlnsmance alrtierP mr,trp�-Sri-�Zo _Lo
305
- FRAME
Car%`�
FROM
3O6
— HOEDOWNS
CA i OF EX EM PTION WORKERS'
COMPENSATION INSURANCE
307
- INSULATION
(fhbxetim seed notWcomplcted iflhe Permit is foronchundred dollars(5101n
308
- SHEETROCK
1f 1Cs5)
309
- EXTERIOR LATH
1 certify Nat in We performance of the work for which this permit is issued. I shall nos
employ any person in any manner ser as to bocome subjecuo the Workeri Compensation
310
- INTERIOR LATH
Laws of California. DaleAppi
311
313
- SCRATCH COAT
- ROOF NAIL
NOTICETO APP LICANT:IL after Ccninof of E
NOTICE TO
Cdyou Should
Commetingthis
Labor
Wcome subject m the Worker's s Compensation previsionsithal or the reed w)kc you mum
mnnwimcomply with mchpmaisipnanrOil permisxhalheeeemedrewrked.
501
- FINAL ELECTRICAL ENERGY
502
- FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
hereby thattherei isaamrtmctlnnl,gency l'nnW Performance of
503
- FINAL MECHANICAL ENERGY
the work fur which this Permit is issued (sec. 109], Co.Civ. CJ
which
Lcadcr's Name
504
505
- FINAL BUILDING ENERGY
- FINAL ELECTRICAL
end=d1A°°.
1 ttniry that 1 has read this application and sum Nal the above information is
506
- GAS TEST
yancity and countyordinancesOf and Cute laws Cromraisingupom
cuildin lagrte to comply with
cn,andhcrchyauNonp rposes. ativssofNiscitymcnmrupOnNc
FIN PLUMBI G /(
ahowngcptioned
ahovn(We)
O8
FIN L
Fee1.saw.Iproperty
munityanpImpho
(We) egme x uve, indemnify and keep hasmless Be City of Cupertino Against
liabilisies,judgments. costs and expenses which may in any way accrue against said City
5
A /
z In consequence ufilm gmmmg fthis permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:5
I///
NG Date
SOURCEREGs. d0 "39
_
Re -roots 6 2
- OOF PLYWOOD NAIL
Dat
App n ARMS ATERIALSDISCLOSURE
Type of R43
- ROOF BATTENS
Will the app Odom,OcCdpam,mm Or handle havuduus mmerial
defined by the Coperoom Municipal Code. Chapter 9.12. and IW Hml r and safety
604
— ROOF IN—PROGRESS
C. Section 25532(a)7'�/uilding
All roofs shall be inspected prior to any roofing material being installed.
nYcs o
If a roof is installed
without first obtaining an inspection, I agree to remove
Will the applicant or fuwre Occupant use equipment or which
it Wvardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials
for inspection.
District? /
C] Yes ANO
1 have read the ha,ardomss materials requirements under Chapter 6.95 of the Calder.
ilia Hmlth& Safety Cade. Scene. 25505.25533 and 25534.1 undcmmtd ohm if the Wilding
docs era cunendy have s nant. that it u my respovibihly to nouly the oecuPant of Ne
mgodmments wI pm x met poor to isausime of a cenifieam of ¢Pane
Signature of Applicant
Date �
All roof coverings to be Class "B" or better (�
re
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