03010109 (2) CITY OF CUPERTINO r -` =,gin
BUILDING mvfslON PERMIT @ONTRACTOR INFORMATION
put hnIN(iAUURFSS: PERMIT NO.
8147 HYANNISPORT DR
OWNER'S NAME: APPLICATION SUB DATE
TONY & DORIS HARRY 01/21/2003
)NF.: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MICH
o E 0 0
WOO LICENSED CONTRACTOR'S DECLARATION
ty—.P 1 hereby ofdrm mat 1 am licensed undc,,romdAo,of chapter 9(commencing Job Description
eZw With Section7(XXB of Division 3Of tharysinessad Promasions Code.and my license is
=� Reandanr°°' "'i Cj��2o }� KITCHEN REMODEL
Z Ltc Class Lia a_ ��r�IL{/LpSY �Y{ [�
oz—' Da COntrachm T��� ��ft�'—M�4 ER-21
�'=y ,� AR Im:CT' \RATION 1�
-rowIundKrs dm�plans ahal�uscd as pnhh=re=mds MAR 2 2003
2OWU `�1
uiei3 n.
lilimedl I
y=D OWNER-BUILDER DECLARATION
C�<p I hereby affirm That 1 am emonlo from the Contractor',Licensc Law for the
�6po following motion.(secdon7031.5.Business and Professions Core:Any city or county BUILDING
m which requires a permit to ennomct,after,improve,demolish,or repair any structure
k.Zr
poor o its issuance.also requires the applicant for such permit to file a signed statement
PxC that he is licensed pursuant to the provisions it(the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $51`34t0tion
tet— (commencing wi th Section70kq of Division 3 Of the Bnsiocss and Prolesdons code)or
y $ Nat he is=umpr therefrom and Ne buil for the alleged eacmptimc Any violation Of
Section 7031.5 by any applicant for a permit mbjecrs the applicant tp a civil penalty of
not more Nan five hundred dollars(5500). :3 5,0NIMilafliietu U Occupancy Type
❑I,as owner of the pmpeny,or my employees with wages as theirsole compensation,
will do the work,and the swcture is not intended or offered for sale(See7014,Business —
Said Professions Cos:The Contactors License Law does nor apply to an owner of 10 2 — PIERS equired Inspections
property who buildsm;mproves thereon,and who doessuch work himself orthrough his
own employees,pmvided that such improvements am not intended oroff=ad forsale.If. 103 — UFER
however,the building or improvement is sold within one year of completion.Neowner-
WilderwillhaveNeburdenofpmvingWthedidnotWildorimprovefarpurposeof 104 — REBAR
sa"')' 105 — ANCHOR BOLTS
❑I.as owner Of the Property.am=adadvclr contacting with teemed conuacma to 106 — SEWER & WATER
construct the project(Sec.7040,Business and Professions Code:)The Contractors Li.
cense law does not apply to an owner of property who Wilds or improves domon,anJ 202 — UNDERFLOOR PLUMBING
who contracts for such pct. uwithamntannr(s)Occnscd pursuant lir the Contrecmr s' 203 — UNDERFLOOR MECHANICAL
License Law, ,B&PCT thism on 204 — UNDERFLOOR FRAME
K 1PENSATION DEC
D.
205 — UNDERFLOOR INSULATION
I herebyIn under Penalty one wig 301 — ROUGH PLUMBING
a m, pa tilt r rthefouu n d am,'SCu 302 — TUB & OR SHOWER
❑ Ihavc and will maintain aCcnificate of Consent self-insure rnr Worker's Compere
anion,as provided for by Section 3781 of the Labor Code,for the performance of the 303 — ROUGH MECHANICAL
work for Which this Permit is issued. 304 — ROUGH ELECTRICAL
E] I have and will maintain Worker's Compensation Insurance,as required by Section 3 05 — FRAME
3](X1 of the labor Code,for the performance of thw
e ofk for which this Permit is issued.
7 kcr:seompensaronoran=ccarrierandPorcynumberme 306 — HOLDOWNS
Policy No.: 307 — INSULATION
CERTIF ATE OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(This section need not becomphrod ifthc profit is furore hundred dollars n1f)(B 309 — EXTERIOR LATH
I reml, 310 — INTERIOR LATH
employ
that in r� ce of the 4 for which this twordhe Workem.
is issued,l shallensa not
employanyr anym�pjssri,rrQncsuhjccuothcWorwricnmpcnauon 311 — SCRATCH COAT
Laws or emir y)�I / TUS 313 — ROOF NAIL
Ap car A
NOT�O�.I U.S(rmakmg this Ccmbeare or Esempbon.you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation prow sions of the Labor Code.you most
0 zforthwith comply with such provisions or this permit shall he deemed revoked, 502 — FINAL PLUMBING ENERGY
z o CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
[-+ IherehyalfirmthatNercisaconswctionlending agency lot the Performance of 504 — FINAL BUILDING ENERGY
x > ework for ichthis
permirisissued(Sec.IIN],Civ.CJ
Lender's
NameNamc 505 — FINAL ELECTRICAL
lt7 l
7 z Lcndc[.sAUdress 506 — GAS TEST
U O I certify that 1 have mad this application and:ate that the above information is 507 — FINAL PLUMBING
W correct.l agree to comply with all city and county ordinances and sate laws relating or
OU buildingconswction,andherebyauthodrsmpresenlativesofthiscitytoenteruMmthe FINAL MECHANICAL
above mentioned Inpcvymremnifyan keep harmless
4
09 FIN
y
(We)agree ra c,indemnify and kapdm City Of Cupertino against
(•+lin liabilities,judgneen0,costs and expenses whjebinay in any way accme against said City 5 G.
U z in above ention,ronec uRhe grty ing of AtU
on
..
APPLICANT f;NpE ' ANANps COMPLY NON-POINT Issued by-5 1 WORKS Date
OURCF. UL TI S/
Srgnamfe ofA pbcant]Co factor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as dcOncd by the Cupcnito Mun'`pal CtWe.Chapter 9.12,and the Health and Safety
Code.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will the applicant r future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit ha amour air cone inents as relined by the Bay Area Air Quality Management
District, all new materials for inspection.
❑Ycs
I have maJ the hai nus materialsre,iiremenls nndc,Chapto6.95nftheC:lonr-
niaHcalthBoSmctycotic. tiro25A)5,25533.d2557N lutle.dlhmd huIfin9
Utes���nuufmy rarymsr iliry m nod( Moce.amorthe
r -nr < cerdficacofa r Signature of ApplicantDatc
uI DowH J All roof coverings to be Class "B" or better