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02010029 BUILDING DIVISION v PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 10927 NORTHRIDGE SQ 02010029 OWNER'S NAME: APPLICATION SUB DATE RANDOLPH RICHARD A AND ELIZAB 01/07/2002 PHONE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO w BLDGLE PLUM EC �<a u — a�yb LICIM1erebyafirmEhe IDam licensed undcR'pS DEionsof CM1�p er9(commencing Job Description r° with Section 70W)of Division 3 of the Business and Prifirnions Care,and my license KITCHEN UPGRADE zm I is in full force and effect. C C 6 License Class Lip,p K o a U Data Contractor wa 00 .S—i ARCHITECT'S DECLARATION F � I understand my plans shall be used as public records r aIn Licensed Professional / X OWNER BUILDER DECLARATION 1 hereby affirm that Dam exempt from the Contractor's License Law for the, F'i a followingreason.a. (anti to c nL5.Buaner, and Professions Code:Any city stcounty O which requires a permit ro conswct,alcor,improve,demolish,or repay any structure $50 ace a3oO •prior to its Vommce,also requires the applicant for such permit m rile a signed statement - - that he is licensed p rommnuo thepro isions of the Contractors License Law(Chapter 9 _ (commencing with Scniom]000)of Division l of the Business and.Professions Code) ! +II�� ❑wlpor n�/`�,ea-, Valuation or that he is exempt therefrom and the basis for the aIle ed exam tion.'An 31 O L 4.J'V U' P g P Y violation ofS«don 7031.5 by any applicabitfor a permit subjects the applicant to a civil pcnalry Ni.� �D�yn�P�r� of not more than me hundred ddlars($500). 1014PN FOUNDATION - Occupancy Type C 1,as owner of tic property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7094; 102 - - Busmess'eHa Professions Code:The Contractors License Law does nor apply to an 103 — UFER Required Inspections owner of property Who builds or improves thereon,and who does such work himself or through his own employees.provided that such improvements arc not intended or .. 104. .—. REBAR .offered for sale,If.However,the building or improvement is.sold wilhln'one yea of completion,the owner-builder will have the burden of proving that he did not build or 105 — ANCHOR BOLTS improve parposem".1c.). 106 - SEWER & WATER Lasownerojecproperty.(Sen.7am excBusiness Formationg ns Caci ed Thaontranctor s 202 - UNDERFLOOR PLUMBING ors t� onsvuct the project Iappl to a.Busincss and Professions Code:)improves ves Contractor i and-whocommzatic Law esnotapplrtoanownwofpropmmand)licsori.pursuathinthe 203 — UNDERFLOOR MECHANICAL and-who contracts far such projects with a<omraaor(s)licensed.pursuant io the Contractors License Law. 204 - UNDERFLOOR' FRAME: _ .. . ._. Cf am exem B& Cfonhls reason owner � 67//pOZ-- 205 — UNDERFLOOR INSULATION ORKER'5 COh NSATION D f hARAiION 301 — ROUGH PLUMBING I hereby affirm under Penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER 303 — ROUGH MECHANICAL Compensation.1 have arta as provided a eby Sece or cons of m seLabor for Worker'sthe 3 04 - ROUGH ELECTRI CAL rformaohe Provided for by genion 7700 of the Labor Code, for the — performana of the work for which this pemtit is issued. 3 05 FRAME C 1 have and will maintain Workers Compensation Insurance,as required by Section 3 06 - HOLDOWNS PW of the labor Code,for the performance of the work for which this permit is issued.My worked Compensation Insurance carrier and Policy number are: 307 - INSULATION Carriei '' .r : : 'Policy No.: SHEETROCK . CERTIFICATION OF EXEMPTION FROM WORKERS',' t 309 — EXTERIOR LATH _ COMPENSATION INSURANCE' : ..........:. . ..... 'fThis seetion need not Mcampincd if the permit is for one hundred dollars '3107*_ INTFRIOR- LiATH . (Mamoness.) 311 — SCRATCH COAT I certify the,in the performance of the work for which this permit is issued;13 13 - ROOF NAIL - - shall not employ any person in any manner so as in become,subject to the Workers' S O 1 - FINAL ELECTRICAL ENERGY Compensation Laws of Califm omia.Da App`'""` — 502 — FINAL -PLUMBING 'ENERGY NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should Z became.subjectmtheWorker'sCompensationprovisionsslimLaborCode,youmasf 503 - FINAL MECHANICAL ENERGY Zforthwith comply with such provisions or this permit shall be deemed revoked. 504 — FINAL BUILDING ENERGY h CONSTRUCTION LENDING AGENCY a7Iherebyufhmuhatthereisaconxwctionlendingagencyfortheperformance 505 - FINAL ELECTRICAL of the work for which this permit is issued(Sec 3097.Civ.C.I .506 GAS TEST Lenders Name Lender's Address Names- 507 - FINAL PLUMBING v Q 1 certify that 1 have mad this application and state that he above information is 50 8 - FINAL MECHANICAL Git Fy comet.1 agree m comply with all city and county ordinances and state laws relating 5 0 9 — FINAL GRADE O r, to building construction,and hereby authorize representatives of this dry w enter upon y the above-meotionedproperty for inspectionpuMo.es. 510 — FINAL PLANNIN Fs 0. (We)agree msave.indemnify and keep hatmlcssthe City of Cupertino against to liabilities,judgments,costs and expem.which may in any way came against said 514 - FINAL LI V. Z Cl y c0 quence of the granting of this pe ' t••' Ar'LIC C1' c. NOSAND 'J_ r. ..IPL)WITH ALLNOV-P P cul Issued by: Dale 1 si uturc 0 ApplicantlContractor „' Date Re-roofs ' HAZARDOUS MATER ALS DISCLOSURE Will the applicant or town,building occupant sore or handle hazardous material Type of Roof .. . . ... _ as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety _ Code,Scz imn 25532(x'.. ' ❑res All roofs shall be inspected prior to any.roofing material,being.installed. Wi 11 the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove mit hazardous air contaminants as de tined by the Buy Arca Air Quality Management 'District' all new materials for inspection. Applicant understands and will comply with • [3 Yes _1;e1c all non-point source regulations, 1 haveread the hazardous materials requirements under Chapter 6.95 of the California Heulrh d,Safety Code,Sections 25505.25533 and 25539.1 understand that ifthe Wingdm,wdcurcntlyhcvca tenant that' Izmy responsibility to notify the ace av of the requi emems which rto issuance of a Certificate of o up' Signature of Applicant Dale nerwau tizedag!I Date All roof coverings to be Class"B" or better -'- OFFICE