01060145 OF
CI BUILD NG DIIV��ISIONNOPERMIT r CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10455 HENEY CREEK PL BUILD 4 U WELL.COM INC 01060145
OWNER'S NAME: APPLICATION SUB DATE
KEN & CYNTHIA SMYTH 1221 COVINGTON RD 06/26/2001
PHONE: SANITARY NO. CONTROL NO.
(650) 704-0857
Q0 ZO ARCHITECT'ENGINEER. BUILDING PERMIT INFO
no— BLDG ELECT PLUMB MECH
o,set _-
Hi LICENSED CONTRACTOR'S DECLARATION
I hcreb affirm tat 1 am licensed under Job Description
O Y provisions of Chapter 9(commencing
�_FW wi,hsenian]oaolafDivismn3ar,nee¢ainessampmr.ianacave,anamyee=n� KITCHEN REMODELLING.
Y "m roll force an ec „�.?'-_°!,
e z y License azs Lic;Y . `sup fe} „p;•,'
are Contractor
F ARCHITECT'S DECLARATIO
'i uncle rand my plans shall be used as public me s 2� 'f zoo'
.O Oq
0 0 Licensed Professional V L r V 1 L 1
z
OWNER-BUILDER DECLARATION
I,
I hereby af0rm that I am exempt from the Contractor's License law for the
C?< following reason.(Section 71131.5.Business end Professions Code:Any city or In, Q11'L®IN1 S O O O
E mF O sh h q pa it l t t a char Improve demol h, p Y stocaro /IDD VV
,tea-= .p I 1 I ' a ,"'l ,I...st,hpatim,rfl 'b Ir m ,
a3—
buiLl I ' dju ' u 'hii'c"Nam,urha Cal L' LwfCl'pm9 Fr��il Or flied Valuation
(c menemg with Sect nn 9010)of Div sam 3 of the Bus and Profession.Code) 3.4 I t$U 1 O -uU d
or that he is exempi therefrom and the basis for the alleged exemption.Any violation -of Section 703 IS by any applicant for a permit subjects,he applicant to a civil penalty
.or not mom than eve hundred dollars(s500). 101 APN f ATI ON Occupancy Type
°L as owner of to property,.r my employees with wages as their sole compensation,
-
wni'dgmEwork,and the structure is not intended or offered sale(Sea 704P. Required Inspections
Business and Professions Code:The Contractor's m actor's License Law does not apply an 103 — UFER
r of propemy Who builds or improves thereon,and who does such work himself
or through In employees,p 'J d thatn improvements t intended or 104 — REBAR _ _
p dr rlrh t b la g - -p _m mmm�eycaror 105 — ANCHOR BOLTS
c pl f ,he b ld r w ll have the burden of pro. g th r h dd not bu ld or q `
imp far parp., f ) 106 - SEWER & WATER
,OLe ow f ect(Seeny- gosh h,:)TheContr tow 202- - UNDERFLOOR PLUMBING '
License
r thep Sect(S ]Oil B slew d Prof.s ons Code)The Contractor's
L anre Lnw Jaw nmt¢pply,a an owner ar pmpemy who builds or impramea memmn. 203 - UNDERFLOOR MECHANICAL"
.. -. .-and who.contracts for such.projects.witro
.¢commerm)licensed momem or to
Cts , L mucL 204' = UNDERFLOOR FRAME_._. ... . ... ... . . ..... .__. . __.- ----..
❑1 p,mnaesn. e&Pce:.mismna°" 205 - UNDERFLOOR INSULATION
o.;nprDem ' •" 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby atom,under poiu,lyof Perjury,on!bribe fallowing deehraaons: 303 — ROUGH MECHANICAL
4❑ 1 name ad will comblem'a Cerleicane of cmwamm m scif-insore for Work=„ 3 04 - ROUGH ELECTRICAL
Compansarion, as provided for by Section 3]00 of the Labor Code, for the
-- _ - performance of me work for which tis permit m Ia¢
, ed, 305 — FRAME
°I have'rnd will maintain WOAer's C rmhm'ation Insurance,as requital by Section 3 06 - HOLDOWNS
37M of the Labor Cade,rot to pcommu me of the wb k for which this permit is 3 07 - INSULATIONis'mmd.�M an
IC rs C e.a : esu a ce and P I cyn tuberre
a
IN% 'y
(All 308, i-„ ISHEETROCK
T I FEKEMPrIONFROMwoRKE S 309 — EXTERIOR LATH
c
COM ENATION INSURANCE-
310 INTERIOR-LATH
(Thv'secuonneeJ not belc,=do perms be
,f tis for hdintact
d cont .. . .`• Y .
siomarles compun311 - SCRATCH COAT
313 --ROOF _.
;I I ,fy
that
h t'n the
p rf ,<e"'
f to work
f -h I t permit Is issued,l _ - -
sn n , ploy an'
p n any ma . to beco bled to W tont. 501 - FINAL ELECTRICAL`"ENERGY
C mpensat o La t f C l f Dam "
.Apel t - 502FINAL' PLUMBING-ENERGY - - .- -- '-"
.NOrfCE TO APPLICANT—It weer k gtoC milIran, fe pto .you'should 503 - FINAL MECHANICAL ENERGY
becom ubl m, the W k Compensation prov 'ons of rh L ho Cone,you most
O farthwnbcomply
wt hp iamnsa "is
permit
t."Ibe,diene, =.mond _ -. .504 - FINAL. BUILDING. ENERGY _
�,tA '' CONSTRUCTION LENDING AGENCY SOS — FINAL ELECTRICAL I"
Lenders Andy hickffirso this t s con,(Sec
Ie ding ag cY for the peRormande
Ili Il hlhsp t 'iss¢elsc 3097,civ C. "• 506 - GAS TEST
wr oft work for x . ..... ._., .. _ _.. _ __ ._. ._. .._..._..... .
507 - FINAL PLUMBING_i,,,
V'O read "• a 508 - FINAL MECHANICAL
FT+ cot I e t fy that I n ad tis application n,milm that the above maws rah n is
Q.E, rant./ogr=e to emmply.wnn:,l my:ma emupre grdmanes and amt=laws roaring 509 — FINAL GRADE
U wbnilmr,,vcumition.and hereby nuthorixe represenmrives of thiscitymrn,er upon
}. y on b mefinedproperty r inspection poses., 510 - FINAL PLANNING
Fr.G (Wel ng em d n lyandk ph r less the City of Cupertino Flims,
W liabilities judgment, tad xpenses h h may imnny way amore nga ,said 514 - FINAL PUBLIC WORKS
U.Z Cy' y ence fthehoutin ,h pc
SAP ANT VNDCRSTA S A L COMPLY WIT .L 0 INT
r. S CER TIO D Issued by: ate V
igen ra, S - .Data,
Re-roofs
HAZARDOUS MATERIALS bISCL URE
Ni
ne LPpnnant srrutrn bdilamg accapanlsmre rhandie Type of Roof
::wms reared¢/, YP _,......._... . ....__.._. ....__.. ..._....._
arefin by the Chromium Municipal Code.Chopmr9A anate Healtaml Safety
Cod t on 11532(1 1 -
°Y " All roofs shall be.inspected prior to any.roofing.material-being installed. .. __ ...,.,
m 3Vill to appl t f, bu'IJ ng utt p eq p t p.i�x nen! If a roof is installed without first obtaining an inspection,Pagreem remove
mitDistha Ba Area al, Management
e ,hazardous b t
°Yex all non--point source regulations.
pp and will comply with,
au contaminants m.nsY Y Quality
all new materials for inspection. Applicant understands
P g
1 h e read to h tit d us mammals mlpucm,maafir,Chapter,695':6f the
California Health&Safety Code.Sections 5505.35533and 25533.1 smdctomnd,bnt
if,he b' mgdoesnot c rten0y have ,en ntlhat it is in , :'blqu.ntifYthe - --- - - -- - - '- - --
occu of the r ,ieq - ats which. t "prior ba .s e of a Ccho care
of
Oacu ncy.-,
t� D/ Signature_of Applicant Date
mg „ D„n, All roof coverings to be Class "B”or'better
Kenneth D. Smyth • • •
�!0455 Heney Creek Place •Cupertino,CA 95014-0828 •Office:(408)737-6324•Home:(650)988-8085•Faz:(650)988-8035•Email:kend_smylh@yahoo.com
ovember 27, 2001 e.
/O S S 4v/� C�ge
City of Cupertino y Y K smyth@yahoo.com
Allen, Inspection Department
10300 Torre Avenue
Cupertino, CA 94014-3255 p
Dear Allen,
/1//'04//
I appreciate your final review and approval of my kitchen remodel project contingent completing modifications
to the garage steps leading into the kitchen by the end of the year. Thanks in advance for providing instructions
and a diagram of the specifications required to make the proper necessary modifications.
VSh
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