05090090 CITY OF CUPERTINO
BUILDING DIVISION PERMIT tl�CONTRACTOR INFORMATIOON '
OUILDING ADDRESS: SARATOGA KITCHEN & BATH PERMIT No.0 5 0 9 0 0 9 0
10442 N
R'S NAME: PERMIT ISSUE DATE
LARRY CROSBY 140 LEWIS RD. 1 09/13/2005
NE: SANITARY N0, CONTROL NO.
(408) 281-9250
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uOp LICENSED CONTRACTOR'S DECLARATION O O O O
mC 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description q
<W with Section]0fo)of Division3rfthe Business ayyggpp��pp"f"essiuru Code,and my license is Itg I.l
m� inmBmmearderre� /a17J3 o BATHRM REMODEL-SHEETROCKJPB"IING)
'_gg Date g FIXTRUES�ELECT�FAN D dgr is );=�'�®
F❑ Dare unit
A ,r
V I unticrwnJ my phos all be used u public re orris
[
C o� Licensed Professional
/ 29" 2005
OWNER-BUILDER DECLARATION
2 I hereby affirm Nat I am exempt fmm the Communes License Law for the ERA
is p
i.oro D following mason.(Section 7031.5.Business and FoRx iom Code:Any city or county -f S 4��x1,`"n
3_ which requires a permit to cut.,,a3ue improve.demolish,or repair any structure I,y� A+ \C\
_Zt priorm its issuance,alse requires the applicant forsuch permitro filea signed statement
Flo
Out Wis licensed purmanuothe Provisions ofthe Conuutor'sUccnmLaw(Chapter 9 Sq. Ft. Floor Area Valu m19000
X t-3 (commencing with Section]000)of Division 3 of Ne Business and Professions Cock)or
that he Is exempt therefrom utd the basis for the alleged exemption.Any violation or
Section]031.5 by any applicant for a permit subjects Oc applicant in a civil penalty of ppN NumOccupancy Type
not mom 0.five hundred doll.IS300) Number 32647054 . 00
barp y yp
❑I,as owner of the pmperty,or my employ=with wages as their sole eompenution,
will do the work,and the amtcmm is not intended or offered for sok(Ste.7064,Business
and Professions Codc:The Contractors Liana law d=not apply m an owner of Required Inspections
progeny who builds m ireproves thereov,and who docs such work himeaI f or through his
own employ=,provided mat such improvements are nminmnded oroBered for sale.IL
however,the building or Improvement is sold within one year of o mpkfion.the owner,
builder will have the burden of proving that he did not Wild or improve for purpose of
talk.).
❑1.as owner of&property,am exclusively contracting with licensed aneracmrs to
construct dm project(S.C.7014.Business and Professions CWe:)The CmInult rs Li.
came law it.net apply to an owner of property who Wilds or imporss thereon,and
who contracts for such pmjects with a contmetor(s)licensed pursuant o the Conlaetor's
License law.
O limit..ptunder See. ,B@PCfmdrhmuon
Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the following dectrationc
LI himiud will maintain a Certificate.(Consent gulf=
Insure for Workers.ofCompach.
,
salon,as hick Oil
for mi Section 3700 of dre LaWr Code,for the perfrnnana of the
ork for which this permit is issued.
have and will maintain Workch Compensation Insurma.as required by Section
A00 of mLater ter Code,for dm performance of the wow=h4which mix permit is issued.
My Work c Com tion ln/y'yancc carrier and Policy numberare /f (,
Cartier: Lcl.4 a tic,N.5-2-6C YF 393`4
CE IFICATE OF EKEM ON FROM WORKERS'
COMPENSATION INSURANCE
milt.cur.need not tecompleted If be permit is forme hwdmd doBam($10U)
or kss)
I caNW Out in the performance of the work for which mil permit is issued,I shell not
employ any person in any manner an u in become subjceuo the Workers Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject In the Weac s Compensation provision of the Lahr Coon you in=
.,O feMwith comply with such provisions or this permiuhall W deemed revoked.
z y CONSTRUCTION LENDING AGENCY
(-+ IWmbyaRBm that fmiso cooswctinm kndingageray for the perfurmmwer
C' Oc work for which this permit is issued(Sec.309'1,Civ.C.)
fy A fenders Name
5 z Lender's Address
U Q 1 certify ren 1 hire read this application and state that the above information is
ILi F correct.1 agree In Comply with all City and county onfinNas and stare laws relating to
0 U building Consunction,and hereby suthorim representatives of this city to enter upon este
LU
Above-mentioned property for inspection puquub
(„I pyo (We)agree to save,indemnify and keep harmless IW City of Cupenino against
I,IZ in
es.qunceof ogranting expenses which may in any way acrotic against said City
U z APPLt consequence NDERSTANDfthispm WILL
1�
'-' APPLICAl UNDERSTAND ND WILL COMPLY WITH ALL NONPOINT Issued by: Dale �—
S4 GUt.ATI
—L/' Re-roofs
Sigduurt of APPhcanOCon for Date Oau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sem or handle hagardrus material
u defined by the Cupenho Municipal Cuke.Chapter 9.12,and me Health and Sarety
❑Yes
.Section 35332(a)? _ All roofs shall be inspected prior to any roofing material being installed.
1 will Ne applica t or future Wilding ottopam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ehmardnus nir contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Ycs N
1 have mad the hasardousmaurials requirements underCWpur6.95 of the Calilm.
ria Health de Sxfcty Cade,Sections 25505.35533 and 25534.1 undersand Ourifthe Wilding
d=nee curtentI hoe atem t.that it is my responsibility in notify the occupant of IW
Mluiaments �ustee mnpissuance aCertificate ofOea Signature of Applicant Date
9pl�s
Own er ranmoriacdagent / DareT— All roof coverings to be Class "B"or better