02010090r
1f
- — OFFICE
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDWGADDRFSS:
PERMIT NO.
604 MILLER AV .
BRAND KITCHENS & DE-ON
02010090
OWNER'S NAME:
APPLICATION SUB DATE
SEAWAY JAN
13715 QUITO RD
01/23/2002
PHONE:
(408)871-8190
SANITARY NO. CONTROLNO.
X00
ARCHITECiENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACT OR S DECLARATION
1 hereby aRem that I am licensed under provisions cdChaper 9 (commencing
Job Description
tum
with Section 7") of Di mn3oflheBualnesandP =asmm,Code.andanylmenY
KITCHEN & BATHROOM REMODEL &
dLicense
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LcenselullClall ff �0 2 4 2 3
Chu Lic. a a
WINDOW REPLACEMENT.
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Data 5DECLC is °r
ARCHITECTS DECLARATION
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g
1 understand my phos shall M used as public records
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Licensed Pmfeatlanal
OWNER BUILDER DECLARATION
MAY 2 1 2002
so
1 hereby .Bunn Licenu Law for the
I am exempt from the Cosions
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ar osc
following mason. ]Section TOTS. Business and Professions Coda: Any oily or county
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whicb rtquhes a permit to conswcl. ahcr, improve. demoli9, or upair any aoucturt
3Q
-
odor to iuiuumm.alsoe 1. the hempplicenl Tor Cionpnml, Lice Law
the ftheCmmalors
qi p prowaioaa (Chapter
thnh law Ch
.-.. - .ti ton
- - -
rAreaValuation
nccenid Section and Pr
Section W) Of the Businessxam, Pm re5ny GOdc)
t s
t e basis for
or Nat He is exempt li an9 the burs for uta Any violation
or the, a 1, aing empt
the uemamt
'
doff Sectionmys, ns, to
mort than fi e n ndrred dopmms (950permit aabl«u the appuamtoacivil °malty
APN Number . Occupancy Type
❑ I, as owner of the property. or my employees with wages as their sole compcnulim.
Will Eo the work; and In structure is not intended or offered for sale (Sec: 7044,
Basins end PrDfesalons Coda: The Contmnor's License law d«s nes apply to a
102 - PIERS Required Inspections
owner of property Who builds or improves Burcon, and who does such work himself
—
1O3 UFER
or through his own employee. provided that such improvements au nes intended or
offend for sale, if, however, the building or improvement is sold within one year of
- - _ . -. -- ... .- .. .. -. .. .. ... -
104 - REBAR
completion, she owncr-buildcr will have the burden of proving INt he did not build a
mproaefor puRmacraale.).
105 - ANCHOR BOLTS
0Latgwncr of the proaey.em exclusively contracting with licensee conoecae 1;
l06 — SEWER & WATER ..
costumer am project (Sac. 7044, Badness mad PmRsaims Cool The Cmmucto, a
License law class not apply to an owner of property who builds or improves thereon.
202 - UNDERFLOOR PLUMBING
and who Commits for,such projects with a aonumemdsl ucanaed Panaam m. the
2 03' - UNDERFLOOR MECHANICAL
'
Ccummor's License law.
❑1amexmTounder Sec. ,B&ICfor this mason
204 - UNDERFLOOR'FRAME
Owner Dae
205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATON
301 — ROUGH PLUMBING
I hereby affirms under penalty or pajuey one of the following declarations:
302 — TUB & OR SHOWER
❑ 1 have and will maintain a Camficam or Consent to =transom for Worker's
3 03 - ROUGH MECHANICAL
Compensation, a provided for by Section 3700 of the labor Calc, for the
performance of the work for which this vormat it issued.
304 - ROUGH ELECTRICAL
O 1 have arta will maintain Worker's Comp osaaeon Insurance, at occurred by Section
305 — FRAME
Doo or the Labor de, res the tr(ymance of the walk for which this permit is
3 0 6 — HOEDOWNS
iuuo. Myr muon Insurance carni rand Pol' teary
..-._._.,, .,..._ .. .. ...
/ .�/'D b.' O
%emm t Policy No
3071..'
..INSULATION
368 — SHEETROCK'
rCERTIFlCATION OF EXEMPT N MWORKERS'
', COMPENSPTION MSURANCE- ..
3 0 9..-=-'- EXTERIOR * LATH
' fmi;' Motion need not hecompleted ifthcPermit isfor one hundred cal1.310
- INTERIOR LATH '•.
(SIDO) or .
3-11 — SCRATCH-..-COAT-
I <mify Not in the performance of the work for which lhis'perrnil is Issued, I
'NJ] Dol cmpby any Persian in any manner. to as to bccomm subject to the Wakcrs'
313 - ROOF NAIL
Compensation Laws of Cebfomia. OremApplint
501 - FINAL ELECTRICAL ENERGY
NOTICE aftermakingthis Cismss, mf fEsation or you should
NOTICETOAPo the Worker
become subject the Worker s Compensation permit shaof the labor Coe, you must
502 — FINAL PLUMBING ENERGY
y
ronnwith<omplywith such vmvieonaormiapmltthanthe a«md moload.503
- FINAL MECHANICAL ENERGY
i l4
CONSTRUCTION LENDING AGENCY
504 - FINAL BUILDING ENERGY
C '
1 hereby riff on that them is a construction lending agency for the performance
oftheworkforwhichthl:Permit islrsued(Sec.3W7,Civ.C.)
505 —FINAL ELECTRICAL
5, q
LeN
Name
506 - GAS TEST
ameam`
Lenders
C
507 FINAL PLUMBING
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Iamitythatlhater=atriaisityandonartasadinthatthedose,law,mmnis
tmarmot. Wild I agree to comply with all city Dna a repts grdmanen arta state lawn uhdog
of thiscity to enter upon
tababidingcon¢med
-
508 - FINAL MECHANICAL`�—
W
W
proindhercinspecorianrtposentalivis
eea pmperry rte inspection dke proposes. ,
the aba(Ws)
509 - FINAL GRADE
w a
'
_
agree st
IWjudgrcctoscost andexpensekhi hmayinan ed
510 FINAL P ING
W
wayaccupengainstno
habdu¢s, judgments. costs and expenses which may in any way ottrv<against said
ini>pctmit.
^
City consequence Oftnegren'in
APPLICANT-UN'DERSTAN OIVILLCOMPLYWITHALL'ON- LNt
5140 IN WORKS
by:
SOUR REG RATION
Issued Y' Date
Re-roofs
igno(Ora of Applimm/Coatr for " te
HAZARD MATERIALS DISCLOSURE
Will the applicant or firm. budding acapwl smrt or handle hiardoa mnerial
Type of Roof-
a defined by the Cupertino MuniNpat Cods. Chapter 9,12. and the Health and Safety
Code, Section 255321a17 l , „
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'
All roofs.shal] be inspected prior.to any roofing material being installed.
Will the applicant or blame building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection ;'I Agree to remove
emit hacndous air conmitimat, a d defir by the Bay Arc° Air Quality Management
Giants?
all new materials for inspection. Applicant understands and,will comply with
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all non-point source regulations.
1 have read the Instructions' materials rig°immcnts under Chapter 695 of the
,
California Health & Safety Code, Sections 25505, 25533 and 25534, I understand that
if the building docs not cum moly have a tenant. that it is my responsibility to notify the
occupant of the requiaemenu .1hictimit be mel prior to issuance f a Cenificne of
°
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owbriftoraamm.edagenl one
- — OFFICE
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END
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