02060057 CITY ON CUPEW11NO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:°'<' [M_PLICIff E_
BUILDING ADDRESS: - MI
11047 LINDA VISTA DR 02060057
OWNER'S NAME: APPLICATION SUIT DATE
RITCHIE DAVID M ET AL 06/11/2002
ONE; SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
[_� 0
GCI LICENSED CONTRACTOR'S DECLARATION
�noo Job Description
1herebyion70eft matIam f0,Bdunderprovisionsof Chapter 9(commencing P
wird Section]Igk)of Division J of me Business and Profeuinns Codi and my license is l�nIpII d� p
„ in full fame and effect, KITCHEN/DINING/BEDRM REMODEL 11—tlll`NJ6w"°�LED
0Z
License Class Lic.4
F I Date ContrT'S DECLARATION As Oali Wuse DECLARATION JUL 2 2 2003
I underslanJ my plans shall be used as public records°OyU
t_,p� Liccnvcd professional
y S OWNER-BUILDCR DECLARATION BUILDING i 2 I hereby affirm that 1 am exempt from the Contractor's License Law for the BU 1� 7 R7
m R:0 following reason.(Section 7031.5.Business and Professions Calc:Any city or county
u S which requires a pemtit to construct,alter,improve,demollxh,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed atalemem
@�Z< that he is licensed pursuanuo the provisionsol'On Conromor's License Law(Chapter 9 Sq. Ft. Floor Area $75 U00ation
FdSC (commencing with Section 700(l)of Division 7 of the Business and Professions CodOor
to $ that he is exempt therefrom and the basis for On alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to is civil penally of
not more than Eve hundred dollars($501), bC Occupancy Type
❑Los ownerof Ne property,or my empbyas wird wageatheir wlc compettatirn,
will do Ne work,and the swcmre is Out intended reoffered frri ale(Sec.](44,Business
and Professions Code:The Contractor's License Law does not apply 10 an owner of equlre
102 - PIERS
d Inspections
properly who builds or improves thereon,and who doessuch work himself or through his
Own employees,pmvided that such improvements are not intended or offered for ale.If, 103 — UFER
however,On building or improvement is sold within ate year of completion,the owner. lO4 — REBAR
builder will have the burden of proving Nat he did not build m improve ear purpose of
sole.). 105 - ANCHOR BOLTS
El 1.as owner of the property,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
construct tbe project(Sec.71144,Business and Pfidista ns Code:)The Contractors Li.
cense law does not apply to an owner of property who builds rr hopn)w4 thereon.and 202 - UNDERFLOOR PLUMBING
who conmets(or such pmjecte with a contractor(s)licensed pursuant o the Conlembor'e
License ,103 — UNDERFLOOR MECHANICAL
Law.
O l am exempt under Sec. ,B&PC for this mann 204 - UNDERFLOOR FRAME
Owner Dat 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby Mo.under pcualty orp,,ju,oto oftW fifisming decimations 3OZ — TUB & OR SHOWER
Thaw and will for
mountaimaden of ContinuoCodemumfor WorkersCompere 303 — ROUGH MECHANICAL
anon,a provided fur by Section J]ql of the Labor COJe,for the performance of the
work Rn which this Permhisissued, 304 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,a required by Section 305 - FRAME
7]00 of the Lahr Code,for the Performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Carrier: Policy N., 307 - INSULATION
CCRTIPICCOMAI BPENSATION INSURAF EXEMPTION NCE
ERS' 308 — SHEETROCK
(This section need not he completed if the permit is inside hundred dollsrs($IN)) 309 - EXTERIOR LATH
,it less.) 310 - INTERIOR LATH
I certify Nat in the perfmmance Of be work for which this permit is issued,l shall not 311 - SCRATCH COAT
employ any person in any manner Of as to become subject to the Workers'Compensation
Laws of Califions.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICA NT:If,after making this Cenilicam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Lallo Code,you must 502 - FINAL PLUMBING ENERGY
O z forthwith comply with such provisions or this permit shall be deemed revoked.
O 503 - FINAL MECHANICAL ENERGY
yCONSTRUCTION is acONLBNDINGACENCY
t—i ThemhyaOirmNerriisssued(Sectionlending agency lmthe perhumencenf 504 - FINAL BUILDING ENERGY
C> the Lend, fur which this permit is issued(ScrJ09],Civ.C.) 505 - FINAL ELECTRICAL
tr,O 1<dzs Name
�z LenJer'sAddmss 506 - GAS TEST
U p I certify that 1 have read this application and stat,that the slow information is 507 - FINAL PLUMBING
U. (•' correct.I agree tocomply with all city and county ordinances and state laws relating to
OU building construction.and hereby authuriw represenotiws of this city to enter upon the 5 FINAL MECHANICAL 'y
D.1 ahrvo(W)agreetosivefor demnifyan keep
V9 – FINX4/4W (We)agree re ave,inJcmmfy and keep harmless the City of Cupertino against OUJ liabilities,judgments,costs and expenses which may in any way accuse againstaidCity fjN GV z to consequence of the granting of this permi t.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT Issued by5WORKS Date
SOURCE REGULATIONS,
Re-roofs
Signature of ApplicaDO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or infuture building Occupant,Chte store or handle hafardous material
a de,Section
by the Cupertino Municipal Cala Chapter 9.12.and the Ilcalth and Safety
Code,se yes 2553z(')1 All roofs shall be inspected prior to an roofing material bei,
❑sea ❑Nr P P Y g g installed.
Wit]the applicant of future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
•mit hoardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?❑Yes 0 N
1 have read the haardnus materials requirements under Chapter 6.95 of the Califnr.
.in I Icati& enJ safety Code.Sections 25505,25573 25574.1 understand that if the building
does nut currently hose a tenant.Nat it is my responsibility to notify tbe aoupant of the
requirements which must kc met prior mssua
ince of a Certificate of Occupancy. Signature Of Applicant Date
Owner nr authnrWill agent Dare All roof coverings to be Class "B" or better
CI'T'Y OF CUPERTINO
11611,6INO mVISIONPERMIT CONTRACTOR INFORMATIQN
BUlgDlN04)7Rel1INDA VISTA DR PERMITN92060057
o 1q1E!74K ,IE. DAVID M ET AL APPI.IcATpygs/gDpTf2002
PHONEY SANITARY NO. CONTROL NO.
ARCHITECTIENGINHER: BUILDING PERMIT INr0
BLDG ELECT PLUMB MEC"
�00 � ' , LICENSEDCOM'RACTOR'SDECLARATION
ZP I herehy affirm that tam licensed under provisions of Chapter 9(commencing ,,xn� ,bkion
<U wilh Senion7000)nf Division3of Ne Ousincaa and Prnfessinns Gulc.and mylicene ie ADD 10 SQ. FT. / l•l�L)=iL
in full force and effect.
0}';j: license Class Lic.if
❑ Data Contractor
�uI ARCHITECTS DECLARATION _
�a
[understand my plans shall he used as public records
OyU t
3u. Licensed Pmmnn
ssial
=p OWNER-BUILDER DECLARATION
u�<q I hereby affirm that I am exempt from the Contractor's Idecnae Law for the $75000
i u 00 following rcuxnn.(Section 7131.5,Business and Professions Code:Any city of county
w
ig� which resltives a permit to construct,alter,improve,demolish,or repair any structure
prior tons issuance,also features the applicant for such Permit u file a signed statement
that he is licensed mono menthe prnvsnnsof the Contmmors License Laver(Chapter 9 35:I681ISU(Iii Valuation
y�p
(commencing with Section 9000)M Division 3 of the Business and Professions Code)or
Cy $ that he is exempt dcado m and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penally of iuAPN NEP990ATI UN Occupancy Type
not more than fisc hundred dollars(f5IX). P Y YP
102 - PIERS
❑Lo the work Ne pe fcrr�same mmyemployees with eedfo,their State compensation,
will Pr the work,and the he Comncram not intended Licnse Law do for of a(pcc.TMn,Business
and Professions disoriThc Convector's and
law dnc9 or apply In an owner of 104 - REBAR Required Inspections
own eoployc builds or imamws ch bropr and who shes such work tended orafffar mmugh his
owne t,linebondin orimponwarred that suchamamwmcnes wthin nmearocmpletio ,for
owner. lOS — ANCHOR BOLTS ,
builder thcedil in.burreipinwmenlishat he within year ofcompletion,fr the owner. 106 — SEWER & WATER
builder will hero the burden of pmving that he did not build or improve for pufpnse of
sale')' 202 - UNDERFLOOR PLUMBING
1o'1.as owner of the propertyam exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL
co ufeet the impact(See.70414,Business and Professions Code:)The Contractor's Li.
cerse taw does not apply to an owner of preachy who bunds of imarews therson.and, 204 — UNDERFLOOR FRAME
Lccto
th a commiamr(s)licensed pursuant to the ContractoM1 205 - UNDERFLOOR INSULATION
I
,BP for thu rex� 301 - ROUGH PLUMBING
Daa0302 - TUB & OR SHOWER
'yo snnoN RATION 303 - ROUGH MECHANICAL
who
. I hcschty of perjury one of me following deelaradon:: 3O4 — ROUGH ELECTRICAL
❑ Iham an;twillmaimeineCenificamofCnnsemmself-insure for WurteraCumpem 3OS — FRAME -
satiun,as Provided for by Section 7700 of the Labm
Labor Code,for the Performance of the
work for which this Permit is issued. 306 — HOLDOWNS
❑1 haw and will maintain Worker's Compensation Insurance,m required by Section 3 0 7 - INSULATION
3700 of the labor Code,for the performance of the Worth for which this Wornit is issued,
My Worker's Compensation msmme carrier and Policy number me: 308 — SHEETROCK
Carrier: Policy No.: 309 - EXTERIOR LATH
CERTIPICCOMPENSATIONATEOF IINS FROM
CEORKERs' 310 — INTERIOR LATH
(Thisscctionnnd nutMcompleted iflhe permit is fnronchundreddiallan(St(p) 311 - SCRATCH COAT
fula.s' " 313 - ROOF NAIL
I certify has in the pc formance of the work for which this permit is issued,I shall not 501 - FINAL ELECTRICAL ENERGY
C manner s0 come soh' mthe Wnr smacr
wjoTCa amnia. 502 - FINAL PLUMBING ENERGY
N TOA A eIn niaate t>~.wt Rw 503 - FINAL MECHANICAL ENERGY
biwanc.arbjeet r'Coaxial rn pf amens ofha UN,f Code,youmaxl 504 - FINAL BUILDING ENERGY
0 z fonhwith comply with. ch ovierns or this Permit shall be deemed revoked.
z 505 - FINAL ELECTRICAL
CONSTRUCTION LENDING AGENCY
[-. N hereby 506 - GAS TEST
a ? LewnrkfmwhichthispmilisiuucdlScc.J9],Civ.C.) 507 - FINAL PLUMBING
0. Q 1<ndcr'a Name
U z
Up '.,Address 508 - FINAL MECHANICAL
U O 1 cenily thio 1 has read this application and sate that the above information is 509 - FINAL GRADE
{l. f—' correct.I agree in comply with all city and county ordinances and state laws relating to
Q building construction,and hemhyauthndvcrepreeenalivesofthis city toenter up;mthe 5 - FINAL PLANNING
>` 0.UWi show mentioned property for inspection purposes. 5 4 — FIN C KS
(We)agree In save,indemnify and keep harmless the City of Cupertino against
r h bad lilies,judgments,costs end'ekpenscs which may in any way accme against said City
as
V z. to consequence of the Creating of this permit.
^� APPLICANT UNDERS COMPLY WITH ALL NON-POINT Issued by: Date
3 REGI 11
e-roots
.,anyof`p IIA3 R cDUS MATE0.1AtS DISCLOSURE Dat Type of Roof
Will rheappliaan offutufe building occupant store orhandlc hanrdommatedal
- as defined by the Cujenino Mond Code,Chapter 9.12,and the Health and Safety
e.Section 2svxa)'r All roofs shall be inspected prior to an roofing material being Installed.
❑Yea P P Y g g
Will the applicant or future building Occupant use equipment or deal ceswhich If a roof is installed without first obtaining an inspection,I agree to remove
emit hafardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Di
strI
D Yes , Nn
1 have read me hao moms materials requirements under Chapter 6.95 of me Califon
niallealm hSafny C01t. ons 255)5.]5533 and 25534.1 undersand mat ifine building
dILI n I nt,mal sPomihility m army the OCImi cal of me
ky mcntw u coni: cc nfn Ccnificnte rf(kcuP re of Applicant Date
owner ora tNapa. All roof coverings to be Class"B" or better