06070064CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
G.A. KAIN, CONTRACTING
PERMITN006070664
10123 HILLCREST RD
OWNER'S NAME:
PERMIT ISSUE DATE
ftJOHN WOOLFOLK
15551 LOMA VI51A AVE
07/1212006
:
SANITARY NO. CONTROL NO.
(408)356-1400
ARCHITECTYENGINEM:
BUILDING PERMIT INFO
BO EO PLUMB MECHO
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
1 bveby afRrm wt 1 am licensed under provisions or ChaPcr 9 (commencing
with Section 7") of Division 3 of Ne Busineu and PrafessioM Code. aro MY limme ts
T
mmuformand Pct 3
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HALL BATH REMODEL ELECTRICAL, PLUMBING, CABINET
LI"nm cl cLil,omr achur
Dam Can
G.A. KAIN RENEWED BL 7/12/06 - 01000015028
As DELL Oi
Ds
public
I understand my plats Mall M used u public rmnNs
hall
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby alum that I am exempt from the Conuumr's License Law for the
following mason. (Section 703 I.S. Business and Professions Cade: Any city at county
which requires a permit in cnnnrom alter. Improve. demolish, or repair any sbuctum
prior or its issuance. also requires the applicant for such permit ro Ne Asigned statement
U... law 9
Sq. Ft. Floor Area
VaIU 000
nor thCommerce, (Chapter
that he is licensed Paramount m anthe provides um
(commencing with Section 7000) of Division 3 of the Business and ProfesdoM Code) or
that he is esempt therefrom and the basis for the alleged emmpdmn. My violation of
,(��p )T� u be[
Occupancy Type
Section 7031.5 by any applicant for a permit wbjttu the applicant m a civil peeshy Of
.at mwe than Rw hundred dollars (SSW).
3 L OO V7 . 0 0
❑ I, so awnerofthe property. army eroployceswlth wages artheireahcompenmtion.
Required Inspections
9 P
will do the work, and the structure is not handed .,ORered(..We(Sm.70a4, Business
and Profession Coda: The Conkaetwl License Law does nut apply m an owner of
property who builds or im proves thereon, and who does ench work himself or tiuough his
own employers• provided thins ch Improvements am ant intended ornRemd for sale, B.
however, the building or Improvement A sold within oro year ufecroptetion. Ne oweer-
builder w•i0 have the burden of provin6 that Int did rot build or improve far purpose of
sate.).
j
❑ I, as owner of the property am exclusively contracting with Demand conoanon m
construct the Project (Sec. 7044. Business so ProfeVlons Coda:) I= COMAraemrs LI•
eeMe Law does not apply man owner of property who builds or Improves them., and
who contracts forauch projects with a ormrmmr(s) licensed porus., in the, Commences
Limme Law.
O
p l am mumpt wrier See . B At P C fes this reams
J
6
Mr WLL
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I Aave and will nowhooln a CeelOcam of Camoom mself-insure for Wariones Compen.
salon, ss provided fes by Section 3700 of the Labor Code. for the Performance of the
work for which this permit is issued.
❑ I haw and will maintain Worker's Compew0on Iwuanes. a regsdmd by Section
3700 of the labor Code, for the performance of the weak (orwhich was permit is issued
,
My WorkeesC Madam�°°R� nrtivandpolirynu be are.
S R
Cartier. 1- PaH No.:
CERTIFICATE OF EKP.MPITON FROM WORKE S'
COMPENSATION INSURANCE
Cn s stolon reed cos be completed If the permit is formic hunNeddoBati (51007
or lest)
I certify that In the performance of the work fes which this permit is Lssned. I9Wl nes
employ any person in any Moroccan as to become subject to de Workers' Compensadan
Laws of Califomia. Dow
Applicant
NOTICE TO APPLICANT. If, afar making this Cewfsesm of Esempuon, you should
become subject in the Warkees Compensation provisions of the labor Code, you most
: forthwith comply with each provisions or this permit shall be domed mveked.
ON LENDING AGENCY
CONSTRUCTION
dem le coMuwOnn tending agency for One Performance of
1 hereby Is a c
s
' the work for which NB permit Is issued (Sec. 7097, Civ. C.)
cha(finseMi pe
'
Undoes Name
Lender's Addmm
1 certify that I have mad tiffs Application and sum that dro above information is
' coarecl l agree m comply with all dry and county oNinsnms and sum laws muting m
building convection, and hereby authorim representatives of this city to enter upon rhe
abovemenuorml property for iMpecuon purpaaes
(We) agree to save. indemnify and keep homeless the City of Cupcnino against
liabilities. jMgmems, costs and expenses which may in any way amrme, Against mid City
in conseq ice mf the grmtinH (this permit.
' APPLI UNDER A III COMPLY WITH AL ON INI
Issued by: Date
SOU REG, TT ,� /Z 0(_
Re-roofs
Type of Roof
ignarumof Appli n DOUSMATERIALSDISCLOSUR ate
WIII the hamtloasdecrial
Wilding mmpmer
Cupentorforum
9.1orand th
M dcRncd by tie Cupertino Municipal Cade. Chapter 9.13. and the Health and Safety
section 33333(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ YM m
If'
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building centime use equipment or devices which
emit ha amnaa air corMmiMnu ss by tie Bay Area Air Qualhy Management
all new materials for inspection.
District7
❑Yes Nu
I have mad the hmmrdnMmatedals requirements under Chapmr6.95 ofthe Califor.
nia HMW&Sri aria Smdm25105,35533a 2.5534.1undemmMdwifde building
doestet mre I eve i m that u ma ihility m ratify the occupans of the
regolmnm m ar.Cetireamnram
Signature of Applicant Date
7 UG
All roof coverings to be Class "B" or better
Ovlacr or authodrad agent I f proto