05080153 CITY OF CUPERTINO �ysna.�«res aNi- '^''•«" ' ' ;
BUILDING DIVISION PERMIT COIN IR4CT�ORiTNNFO NATION:
BUILDING ADDRESS: CTM CONSTRUCTION P8""No.05080153
1 868 NORTHSHORE SO
ER'S NAME: PERMITISSUE DATE
KEVIN AITKEN & JUDITH HART 2308 WALNUT GROVE 08/18/2005
sNE: SANITARY NO. CONTROL NO.
(408) 554-0198
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION Job Description
4 0 1 hereby affirm Thal 1 am licensed under provisions of CW pwr 9(commencing
with Section 700)of Division 3 of ate Business and Profesaiuna Coda,end my license is
np�
in mu force and effect. REMODEL BATHROOM (2).
2�Z Licence clue Contractor ADD ELECT. OUTLET/LAUNDRY CHUTE IN VANITY
Dom U1.#
ARCHITECT'S DECLARATION
1 understand my plana shall W tried as public Tecnis
0
�0 Licensed Professional
3 OWNER-BUILDER DECLARATION
.<s I hereby affirm that 11. exempt from tiro Contractor's :Any c Law co the
yD O following mnoa(Section Eo s 5.Business and Improve.
do on Cade:Any tiny or county
a$ which tsissuance.
ssrequires a permit to requires
aline Improm,demolish,ri eolr any stlmeum
S° pdarmiucensed 0.also mqn the theapplicant for Connpermit loiixmsele a Lawpned latemcnr
-�< the,be(commsltegwit pursuant 10th)or Divisnaofthe ofe Buuessan ensassion Chapter9 Sq.FI. Floor Area VaIDBt �(](](]
E O (commencing exe cath Sectiaurnand the
basis for
of NCBusinexept Prof win ns Cade)of /
3�
that he h exempt Nem(rom and Om buB far Ne dlcged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects de applicant to a civil penalty of APN Number Occupancy Type
7I one au five hnnmed dollars($500). 31638037 . 00
1. ownerofth property,a my employes wide wages as their into tompenasdon,
will do the work.and the someone is not inuardiaAa offered(o,s*(Sm.70/1,Business Required Inspections
and Pmw n fasa ns Cade:The Cormwon's License ladonot apply m an awns of q P
property who builds or im proses thereon.and who does such wart hi mself or through his
own employees,provided that such Improvements tie notin¢nded or offered for sale.If,
however,the building or improvement is sold within one year of completion.the most, ,
Wilder will have the burden of proving that he did feel Wild or improve for par enx of
ale.1
Qri,u owner of 16e property,am exclusively contracting with licensed commoners to
construct the project(Sec.7044,Business and Professions Code)The Conlrsclar's Li.
cease law data sot appy in an owner of property who Wilds or Improves thereon,and.
who contacts for such pmjecu with a conweoRG licensed pursuant m the ConuacmYs
License Law,
Q lame pt under ccp .B&P C far Nu
r Nom" Dem /{r-w71--s „ ..
WORKER'S COM PE A D LARATION(�l' _ ... .. .. .. _ ... .. . ._...._. . .
I by salon under penalty of perjury as of the following dtclaralions:
I lament!will maintain.Certificate of Conenl Io salf-inane far WM1wesCompcn-
sallan.u provided for by Section 370 of the Labor Cade,for we pmfama.of the
wart for which ab issued.permit is issued.
❑-I have and will mushroom Worker's Compensation Inaurana,as remained by Section
370 of two labor Code,for the pedamance of the weak for which thin permit le issued.
My Workce,Compensation Income,carrier and Polity number art:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tris section need nothecompleted if nhe permit Is forano hundred dollars($IO)
or Mss)
1 certify Not in the performance of we..,it for which air permit Is issued.I shall na
employ any person in any m rwuta Wapme sobjecl to the Workers'Compensation
LawsofctlirsI<
Appllunl_1(14 rZU —
NOTICE TO APPLICANT:If.after making this Cenifica¢of Exemption,you should
became subject m the Woheh Compensation previsions of the labor Corte.you must
., ZO forthwith comply with such provision or this permit shall be deemed pecked.
'Z CONSTRUCTION LENDING AGENCY
'caw 1hemby.M.dal there iuconsuunlon krallrgagoecyl'a the performmwe of
C de work for which this permit is issued(Sec 3097.Civ.C.)
Lender's Name
Z lancer's A ldmas
V O 1 ar ily dal I have read this application and state was the aWve Informmlaa u
is, cared.I agme at comply with all city and county ardinanes and sate laws mlaling to
C)� building construction.and hereby auaorla repmaensativca of this city to enter upon ane
F W slam-mcntiomul property for inspection purposes.
y (Wc)agree m nava Indemnify and hep harmless the City of Cupertino against
y liabilities,judgments.ctau and expenses which may In any way¢csoe agalnn aid City
(„)7 In conaquence of the granting of lhlr pe snit.
FF77 APPLICANT UNDERSTA DS A WILL OMPLY WITH ALL ON-9000INT Issued by:S Date
RCE R' A ON c ��/nI/ C
a/�,�l Re-roofs
o Ppicaruv owicu
HAZARDOUS MATERIALS DISCLOSURE I- Type of Roof
Will the applicant or future Wilding occupant time erhandle hasaNaus material
u dented by dneCupertino Munst ode.Chapter 9.11,and the Health and Safety
c,Section 1553r(q? All roofs shall be inspected prior to any roofing material being installed.
❑Yen u
Will 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
emit hazardous air condeminants u d by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes o
1 have mad the hazsNoesmaserials requirements umlcr Chapser6.95 of ac Califs.
niaHulaBSafety Code,Swd=25505.25533ars125534.1unders Riffs Wilding
nor curmndy he a an that I my rex nibility m rmtify the=owl of the
mm mcnts ' h u pri aCeOfcamoroccup e. Signature of Applicant Date
aravaariy=aa m m All roof coverings to be Class"B"or better