05070051 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR�TIVUI2MATION '
BUILDING ADDRESS: PERMIT NO.05070051 5070051
1 0410 MTT.T.P.R AVE
OWNER'S NAME: PERMIT ISSUE DATE
Aft CAROLYN BOWKER
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO EO PLO MECH
O
jOp
LICENSED CONTRACTORS DECLARATION JobDescri tion
F 1 hereby affirm that I am licensed under provisions of Chapter 9(commercial, P
with Section 7011(y)or Division 3 of the Business ofesaiuru Coda.admylicensc is
amu T=11 nee ADD 4201 (MS BEDRM/BATH) &
uceme lase L'c.w
J D.m Ommmwr 'REMODEL KITCHEN & DINNING RM/WATER HEATER STORA
ARCHITECTS DECLARATION
IuMarmnd my plam)WI he teed As public remuls CONTRACTOR: S. P. CASP Yr . ONSTRUCTION
yGLicensed Pomfcainna1 9
t
y Oat I am Attempt fr DECLARATION
0 I hereby affirm that 1 1. Attempt from the Cssionsc License Lew for the 4' ,•J jfp D
DO which remoon.emelt t Icon L5,Buafer.aim noreWum Co dc:my city or county
$ which mquhue ,alsoteuires construct.duepith,Wpmve,demolish,Ire a sirMy edtremae !`
"NOisliauuWpursu requires the pre prevision
for suehpennitte flmLawdsatemat
sFF< Naheulitt with
0apmrivomofNeCanuawYlJavelaw(Chaplu9 Sq.Ft.Floor Area ?QQ6 Valuation
S$ (cat he is
(commencing Section 7 and the
basis f r the
the Busalleged
ca and on.Any=
w $110000
3
that he le mumps Ihem(rom end foe half for Ne cella{ed cumplimn.Any violation of ///qqq rY-
Sudor 7031.5 by any'•ppliumt foe.permit subjects the applium w$civil penally of APN Number Occupancy Type
not mom ma(ho,hundred do1Ws($508).
❑I,As mmur of the property,or my employees with wages as limit sok compensation,
wiudo thework,wd meawauun isnntinandedwortemdforatk(Sm.7wd.Busirm Re aired Ins ecl10DS
and Professions Code:The Com Bares Llanse Law des unot apply 0 an owner of r P
property who builds or impnmas thereon.and who does such work himself or through his
awn employees,provided that stch improvements are,notimended or offered foram.if,
however.the building w improvement lasold within oro year of completion.the ownes.
W ildw will have the Wrden of proving that he did Out Wild or improve for purpose of
a.]..).
0 I.as owner of the property.Am conclusively contracting with Reamed mnaacmr i to ,
wmtru n the projem(Sec.7014.Business and Professions Code:)The Characters LL
cemn Law does not apply an an owner of property who Wilds or Improves common.and
who contracts for such projects with s comr¢mr(s)Ilcemed puaunt to the Contractor's
Lleensa raw.
❑lam munp,antler Sec. .B&P C for this mann
Owner Data
WORRER9 COMPENSATION DECLARATION
I hereby affirm seeder penalty of perjury we of the following declarations:
I have AM will main Wn a CeNfiate of Ca..t m self-insure Thr Wmtefs Compcn-
W ide,As provided far by Somme 3700 of on,tabor Cede,for me perform..of the:
Arms for which this pcnnll is issued. ,
❑1 have and will maintain Worker's Compensation Insurance,As required by Section
3700 of the labor Code.for me performarce of On,Arms fwwhich this permit is issued.
My Work ompepa{tlon base nee carie ad Policy number art: I
Garner. Paliry No.:
C FlCAM OF•% MON FROM WORKERS'
COMPENSATION INSURANCE
(Thissecti on need not W comphcted if the permit lareranc hundred dollar$(5100)
or kat.)
I certify that In me performance of the work for which this Permit 4 issued.I shall not
employ any person In any mannerm As Is hecome subject to ft Worker'Compensation .
Laws of Catifomla.Date
Applicant
NOTICE TO APPLICANT:If. net making this Certificate of Exemption.you should
become subject in the Worker's Compensation provisions of the labor CMB.you maw
.,O forthwith comply with such provisions w this permit Nall W dammed revoked.
.Zi i CONSTRUCTION LENDING AGENCY
1-t I hemhy salon that them is a construction lending agency for led parformarce of
a
the work for which this permit is issued(Su.3097,Civ.C.)
aQ lender',Nana
7 x Landers Addax -
U O I modify that I have mad this application and sate that the above imfutmatme Is
un cormeL 1 agree in comply with all city and county ordinances and sum lawn relating to
p building construction,and hereby authorise representatives of this city to crier upon the
N7 slmvcmentioned property foe inspection purposes
(We).gree to ave,indemnify and keep hamlets the City of Cupanino against
rr cm liebllldeajudgmenu,ensu and expenses which may In any way ecc=against said City
U in consequence of the turtling of this Permit. _
APPLICA RST.NDS AND WILL COMPLY WITH ALL NO b DINT sued by: Date (f—"—
so 2�i.-vel
UR S.
Re-roofs
Stgnaum of pp11wHAZA US MA RIALS DISCLOSURE D.te Type of Roof
Will mm appliam m future Wl g wcupatlmm or handle hasrdou mncrial
As defined by tie Cupertino Muni' at Cede.Chapter 9.12.atl the Health And Safety
Code,Semon 25532()7All roofs shall be inspected prior to any roofing material being installed.
❑Yu No
Will the applicant at mtem Wilding=open%use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
'malt bessomm.,it,mm muntana a $fined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ye. u
I ban mad the hasrdoua materials requirements under Chapter 6.95 of the C$lifor.
nim Health cess etyCedc,Sections 25505.25533 And 25534.1 understand lou ifine Wilding
does mot c have a Whom,that It Is my responsibility in modify the oceupat of the
rcyul mem h n met iuuancc cera ccnillea oma Signature Of Applicant Date
Ow r t nsed ngem mW All roof coverings to be Class"B"or better
C_