03090180 CITY OF CUPERTINO �= a "'`' "x
BUILDING DIVISION PERMIT CONTRACTQI2INFOB ATTON
BUILDING ADDRESS: _ CPAFTSMENS• GUILD INC, PERMIT N003090180
,R'S NAME: 10566 S DE ANZA BLV PERMITEZUEDATE
MOHAN & KOMATHY
PHONE: (408) 366-1000 SANITARY NO, CONTROL N0,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
100 - LICENSED CONTRACTORS DECLARATION O O O
IZ C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
<b with Sectio�s=)).(Division 3of Or Business Professions Code,and my license is
+�„ mmnm eerrerl. . `� ADD 419 SQ. FT. KITCHEN REMODEL
ettZ
'1-0 Date c p
arc Cup or _
yy ARCHITECTS DE RATION
�>U 'it<x and my pl Aas.C.11 he used s public recons
�'oG Licensed Professional d%
S
OWNER-BUILDER exemptDE DECLARATION
/Q
n0 1 hereby affirm then 1 am exempt from the Contractor's License Law for the
p O following reason(Section]113L5,Business and Professions Code:Any city or county
which
,
$ M1ich rcyvircs a permit to cnnsWll,otter,improve,Jemnli&h,Or repair any Structure
:Z priorto iPissuance.alsureyuires thcapplicant for such permit o File a signed statement
�ZG that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
2� (commencing with Section 7")of Division3.(the Ruder.and Professions Cedc)nr
$ Nat he is ee mit thcre0om and the basis for the alleged exemption.Any violation of 35615027 . 00
-
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of pith Number OType
not more than fmhundred dollars(ssoeeu ane 0). '- P Y -r]1,1,as owner of the property or my mmpllyees With wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's Larose Law does not apply to an owner of 1 O 2 — P I ERS d Inspections
property who builds or improves thereon.and who does such work himself or through his --
ownemployee&,provided that such improvements are not imendedoroffered for rare.If, ,103 — UFER
however,the building or improvement is sold within one year of completion,the owner- - ..
builder will ham the burden of proving that he did not Wild or improve for purpose of 104 - REBAR
sale')' 105 - ANCHOR BOLTS
I,as owner of ct properly,,B sines and contracting with licensed convectors m
consumer the pmjcm(Sec.7044,Baseness and Professions Clde:)The Conmmar's Li- 106 — SEWER & WATER
came law docs not apply to an owner of property who builds or improves thereon,and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractor's
License Law. 203 UNDERFLOOR MECHANICAL -
❑Iameaempwndersm. ,B&Pcfor this reason 204 - UNDERFLOOR FRAME
Data205 - -UNDERFLOOR INSULATION .
WORKER'S COMPENSATION DECLARATION ...
I hereby affirm under penally of perjury oda of the following declarations: 301 — ROUGH PLUMBING
❑I ham and will maintain a Certificate of consent to idfinsum for worker's Comped- 302 — TUB & OR SHOWER
safimr m provided mr by Seaian 3700 nr the labor Cnde,far the per(ommnce If the 3 03 - _ROUGH MECHANICAL -
work for which this permit is issued.
❑I have and will maintain Worker's ComjRatudon Insurance,as required by Section _ 3 04 — ROUGH ELECTRI CAL
37W of the labor Code,fo krTFR'llrtnee of the wmk for which this perm is issued. 305 - FRAME
MyW�rkcr'e a e Pa in,and Policy nu berii,� aTnq n� 306 — HOLDOWNS
Came: CE TEOFE%Eh I`yROAWOR ERsR�s• ' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(Thisawtlonneed notbecomplemdifthe Mamitefornnchundreddollars(9100) 309 - EXTERIOR LATH
Itersify 310 - INTERIOR LATH
employ certify that er theinperfonource
neof a,work for which Ibis permit is issued.I Shall not
sofCyifornainanymannerxmmhccommsubjemmthcWorkers'Compensallon 311 — SCRATCH COAT
Laws if California.Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making this Carifian of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker'a Compensation previsions of the Ichor Code,you must
],Z. forthwith comply with such previsions or this Permit shall IN,deemed invoked. 502 — FINAL PLUMBING ENERGY
� 0 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that there is a mnslruction lending agency for the performance of 504 - FINAL BUILDING ENERGY
'1i 7 the work fur which this impair is issued(Sce.3097,Civ.C.)
4Q LendcrsName 505 - FINAL ELECTRICAL
LuildAddress
Z) Z 506 - GAS TEST
J O I certify that l have read this application and stale that the above information is 507 - FINAL PLUMBING
cancer.1 agree to comply with all city and county ordinances and soon laws relating Io
J CF.) building
monawnion,and hereby euthorim representatives of this city to corer upon theFIN MEC CAL
a above-mentioned property for inspection purposes.
4
(We)agree Ire save,indemnify and keep hmmlms the City o(Cupcnino against WF
FIl liabilities,judgments,costs and expenses which may in any way accmm against said City NGin consequence of the granting of this permit,APPLICANT UNDERSTAND OMPLY WITH ALL NON-POINT Issued by: C WORKS Date.
SOURCE RL O
G e-roofs
Signature or ApplicanUCr or Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hazardous mamrial
defined by the Cupertino Municipal Code.Chapter 9.12•and the Health and Safety
.Seaton 2ss3xa)7 a / All roofs shall be inspected prior to any roofing material 'ding installed.
( ❑tion QN
Will the applicant orams a building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air coaamroinants m defined by the Bay Arca Air Quality Management
District? all new materials for inspection.
❑Yes mlsr/
I have real the haaaNims materials requirements under Chapnr6.95 orthc Califor-
nia Health&Sdcty Cotic,Sccdum 25505,25533 and 25534.1 undcnwd Nat if thc building
Jens not cuncn0y ha �Icoamn.jbility m notify the occupant of On
/
en mCcnlri Itoecapancy. Signature of Applicant Date
Owner or aathori a m All roof coverings to be Class "B"or better