02040146 CITY
I BUDNGmESIONO
BUILDING NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21405 HOLLY OAK DR CUPERTINO KITCHEN DESIGNS 02040146
SUB DAM
lUbY 'KURT AND RENEE 10562 S DE ANZA BLV APPLICATION 04/26/2002
( .'HONE: _ (408) 257-4900 SANITARY NO. CONTROLNO.
MOO ARCHITECT/ENGINEER: a BUILDING PERMIT INFO
t BLDG ELECT PLUMB MECH
g i
gi LICENSED CONTRACTOR'S DECLARATION Job Desc C
0 Z— 1 hereby arm Nm 1 am licensed under provisions of Chapter Samorrmencing ADD 6 8 4 SQ. FT. IG
QY wiNSeci n] )of Division the Bys 5,and Pmfc...on,CWe,and license
C is in full f an `LJ(f
Lien MAR 0 4 2003
m .
O A CHI I'[Cr5 D• ARATION
g ad stand m;0j shall be use s public records
la� D O Lic f al
OWNER-BUILDERexemptDE the ComTION BUILDING
L4,
_ I hereby affirm that 1 1, ,business
from Inc C Profession,
oat License Law for the
F•Z< following ims a Permit
]consumer.
Business andmp Professions Code:Any city s county $150000
D
which requirespesmiunmmathepplicimprove,h Permit,or repair anysoucwre
$ -tpoor Wi:h slissuance,als req N p .for Commarmamicesm Law suuntym
IW+he ilia sed pars' uo Ne previsionsof the Con (Chapter 9
Bmiros LmemeLisimisode) Qts p ��,se�, u / Valuation
m nemgwnh Serf Tmandf he basis
the"lltradoload PrnfAnyvi Cede). ('y,+\ x.36 10f$tO 1�^Y"' �..•s,jF�A 11.)• (,
or Nol Ne is exempt Iherefroo and the Waris for Ne alleged exeNpuum Any violation
.f Scclinn]031.5 byany,pli.ht far.permit,objectsthe op uniat.ocivilpcnalry-
�.fnn metre Nm eve hundred d.gars($500). l O lAPN NOUtMATI ON Occupancy Type
❑I.mowoecof Ne property o mr employee with wages as lheirsole compensation, 102 PIERS
-'will'do'the work;'ead she structure is hot intended or tdr rcd for sale(See:'](fab;' 1 O3 — UFER Required Inspections'•
Business and Professions Cede:The Contractor's License Law does not apply to an q "
owner of property Who Wilds or improves thereon,and who does such work himself 104 - RE BAR -
or through his own employees.provided Nat such improvements are ml intended or
-g p - y _ .. 105 _- ANCHOR BOLTS
:.Bmcd f6i slat If,however,the W iave he
im or of .a is that within one year of y
completion,the owner-Wilder will have she burden of proving that he did nm Wild or
improve for p.rp.se armee.). 106 - SEWER & WATER
o Q:: ear we. . ... _ . _..... _....... . .. . . ._ - ..... .._ .202 - -UNDERFLOOR'-PLUMBING_-„,-__,.,_L_. _.._..._-
property,nm exclusively cottoning wiN IicenuJ comrecmrs m '
consumer the pm)rst(Sec.70”.Business and Pmfexsions Code:)The Contractors 203 - UNDERFLOOR MECHANICAL' '
License Law does not apply to on owner lh property who .Ids or sed polove.s Hereon,
_and.wM10 contracts ror such.pn+jma wm.a c.mrsm.r(s)YcenwJ ptrrsnam.m.the __. ..... .- .204 .__ .UNDER'F"LOOR'.FRAME-.._. __.. _.. ..___, ._. .- .. ., ... ..
Colin./s License Low,,
❑tem excmFls ume Sec:' f' _ ,B&PCImtbinrcason 205 - UNDERFLOORI'•INSULATION
owner "Date 301 - ROUGH PLUMBING
+ 'WORKER'S COMPENSATION DECLARATION 302 — TUB be OR SHOWER
Ihereby affirm under Penalty ofperjury one ofdo,following declarations: 303 - ROUGH MECHANICAL
i_ O I have and will maintain a Cenifcate of Comenl to self-insure for Woroi 304 - ROUGH ELECTRICAL
s:•• Compensation.as provided for by Section 3700 of the labor Code, for the
'pedtmama or Ne work f.r wnich Iris rK!mii is issuee.
305 - FRAME
❑1 have and will otinum Worker's Compensation lasuran&,its required by Section 306 - HOLDOWNS
']]fq of the L.W,Code,for the performance of the work for which this permit is 307 - INSULATION
. ;. 'Cs tar RTF a onii>;surancc J. u��xI�. 0.13 �. 308 ..
p lyy SHEEFROCK ..
CERTIFICATION'OFFX<;MMP'1'IONFROMWORKERS!' - - 1-� t' ! !309• i':SEXrtTERLOR%')LATH* V 1
COMPENSATION INSURANCE - ._-- , INs+ERIOR._.IIATH. s,` - . .
310 , -- -- - — -
eo (Th+ssectimnaceda.sbeWropleledifshePermitisforonehundmddollars 311 SCRATCH COAT t
(S[Wo m less.)
- ' 313. _ -ROOF--NAIL-:
r I<mfY Na(in fire perf'ria ncc of the work f r.wh ch the pcmnt Is issued'1 - - -
shall not employ am person n any manner t as to became subject to the wmker - 501 - FINAL EL'ECTRI CAli' ENERGY
cmApplicant oal.1 fcrr ia.•naty' 5,02 -. ..FINAL...PLUMBING._ENERGY_.....". _ .._
)'NWICETOAPPLICANT:If;nf¢r making this Cenificme of Exemption,you should 503 - FINAL MECHANICALENERGY
O Cbecome sidject the Workei s Compeolauum provisions of the LaborCosta,you must
'Nm nn'comply siN suchprovisions othis Pernartshallbedimmed mocked504 FINAL BUILDING_ENERGY
CONSTRUC'NON LENDING AGENCY 505 FINAL ELECTRICAL
F^ 1 he by tiffloo flood N it construction lending agency far the performonm 506 •+
�'.7 'of N work for which du pemul is issued(Sec 3097,Co.C) — GAS TEST
E lendersName t - - -� _- - " ' _ "" -"507' -- FINAL* PLUMBING "- '-•' _. ._.///y/�/7. .._ .__..
Led Addle s - - V
U O 50 FINAL MECHANICAli�
I endy Nas i have read this application c t and sure Nm IM1e above information is
k+!['�'. `to Wil I agree t comply a with all city and county ordinances and slaty lows rclai ng 5 - INAL G DE
Bove-uarlumding niomandfar imuoctimi urposemetivcs ofthis ciry to emcrupon 5 0 - INAL NG
theb Im.coproperty f aspen purposes.
'���.yI y - lwei'geemsa d ' Ily and k<phartnless the City fe pertin.Agalnsl S1 - IN RKS
s L.h'I t 1 d encs costs and expense. which may in any y gm sl sold
Q.Z Cityl rice of the grunning of this t
SO lit ,VDnOTAV05 WILLCOMPLY WITH ALL NON POINT Issued by; Date
Will,
o um Applicm✓Conmenor• Data Re-COOP$
HAZARDOUS'MATERIALS DISCLOSURE:' Type Of.ROOF-
qNdapplicant o future .cc
Wild a'.or handl hmlNons muerial .. _r. .-- , _•. ...-__
- astl fined b)the Caperfirm Municipal CW Chapter 9.12,and N Health and Safety
CodSection 5532W - - s i .tet}'
❑Y. C�N. i',,; h , +. -All roofs shall be inspected-prior.to.any_roofing.material.being.installed..,. ...
WB t ircontaminants
mi r t asfifl ng.«e I s°eq p tdevices
high all non- pint source re ulahons.., 'I'agree to remove
emit n ll e.. n nl. asAefinWhyNeB uses ArQuality evices mem If a roof is installed'without first obtaining an inspection,
District? pp and will comply with -,
oY � all new materials for inspection. A hcant understands
P g
I have read he hazardous momriils rcquitemeats trader Chapmr 6.95 of the
California Health&Safety Code.Sections 25505,25533 and 23534.1 understand that
if the Wilding does not currently have ammon.shat it is my responsibility 10 notify the -
t occupam tArviptimmimp, ich must he mel.prior to issuance of a Certificate of `
_. 1' Occupmm ,
- of A Signature licant . ' - . „-- . _ , , .,Date
g._ PP. -
'o he dii agent Date All roof coverings to be Class"B" or better-
.. ... .... :... . .. _. . . _OFFICE.. . ..... ... - .. .. ... . . ... . "