01080053 CITY
GUOPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22647 OAKCREST CT CUPERTINO KITCHEN DESIGN 01080053
OWNER'S NAME: APPLICATION SUB DATE
GEORGE & STEPHENE TYSON 10562 S DE ANZA BLV 08/09/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 257-4900
O O ARCHITECrIENGINEER: BUILDING PERMIT INFO
wL$DG ZLECf LUM1IB MECH
8 Ho Y alLB,ImCENSED CONTRACTOR DECLARATION
Job Description
°hat,14am lnicencd under provisions ofChapter 9(commencing: ns
REMODEL KICHEN/LUNDRY/ BATH RM 2 .
cLic.a I Bo rad
w 3` an c
c
emr PINALED
< A C ITECr'S DECLARATION
b'�'O J 1 understand my plans.M1ull be umd ua puM¢records
w
Licensed
Professional
ayes, OWNER-BUILDER DECLARATION N 0 V 0 7 2001
1 hereby affirm that 1 am exempt from the Contract.,v License Law for the
F Z a bollnwing recon(Section 7031-5.Businesc and Pmressions Cale:Any city m county, $45000
I F O which requires a permit to construct,alter,improve demolish,or repair any structure
W 5. prior to its issuance,a Lw rotators the applicant for such Permit file a sig,�statement RI III mlhlf- -
a. �r,_p a❑s1s A[ - - -- -
that be is licensed pursu"m to the pmv'.uons of the Cnntmno s License Law(Chapter 4 .Y.3 4,Qf l_ [O J Qp[U Uea,.•.,
(commeraing with Scnion7")of Division 3 of the Business and Profession.,Cale) - 1 SA:Poq Valuation
or that he is exempt thcmfiom'oad the basis for me alleged exemption.Any violation
-of Section 9031.5 by any nppI cot for a permit subjects the appl icant to a civil penalty y mmhhrrrr
ATION
of no,more man five hundred dollar.x500) AIN " Occupancy Type
❑I,as owner of the property.o,my employees with wages as their sole compensation. E'�UND
101
-wiH do the work.and the'sounure-is not intended or offered for vale(Sec.'/0U. —
'Business and Professions Code The Conn.,.,',License Law dues nm apply to as 103 - UFER Required Inspections ,
owner of property Who builds or improves thereon,and who does such work himself
or through his own employers.provided thin such improvement are not intended or, ._ 1 04 -.- REBAR-
__oR}Fd for vale.If,tar.,the building ]it witum-one-ear of ..•.._completion,me owner saddler will have e burdern of prong that he did not year or 105 - ANCHOR BOLTS
proving
improve ter parpaxem"ale.). 106 - SEWER & WATER _
of as owr:er nf.he property. - I- iely< comers withlensed contmchum to 202 - UNDERFLOOR PLUMBING . 'I. .. ..__.
construct the project(Sec.7044 Business and Pmfe.vsmns Coxi The Contractor's
License Law does not apply to an owner of property who builds or improves thereon. 203 - UNDERFLOOR MECHANICAL' '
.} p ceased pursuant ... .. _ .------
0
...__
.and who contracts.(or such Projects with a comranorlal li t m.the
"01 m exempt under
Law. - - 2 04 UNDERFLOOR--FRAME' —
' ' `..`aPerormiareason 205 - UNDERFLOOR' 'INSULATION
°ve 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
i Ihiintfirmander ltyor of the following declaration.: 302 = TUB & OR SHOWER
" a prja'""e g 303 ROUGH MECHANICAL
❑ 1 have and will mam5m a ceniEtma of ConwmSo self-in...c for worker'. 304 ROUGH ELECTRICAL
Compensation. as provided fm by Section 3700 of the Labor Cade, for the
'perfonaance urine work rot which this K7it,i,I...ed.•, 305 - FRAME
01 have and will mainmie Worker's Compensation Insurance u retaired by section 306 - HOLDOWNS
- 3700 or me Lannr Code for the performance or mewo rk for which this permit i. 307 - _INSULATION
I,sue C.Msy Workelz C cope sign rance Insucartmr and�Po}l ryarc
� number .
art cr.� �Iet H' ol cY No Lfi�� _y l. . - 30.8• ,�. . SHEETROCK
'• 'CERTIFICATION OF EXEMPTION FROM WORKERS _ 3O9 — EXTERIOR LATH '•
COMPENSATION INSURANCE ' it, ....
`,' (Tni.:<aiodnc<d'ito,ne<n'npl<talifinepermiterrnrnnenaalreddonat. 3I'NTERIOR LATH - ' ', :•,'.', t, . .,r•..
anal or lass _ 311 - SCRATCH COAT
,
I rem'fy ihn in the performance, f th- rk for:vh ch M per itis ts:ueJ'1 .3.1.3.•.— ROOF NAIL,. ". ♦:r''':} \ . . . .
'shallntenpluyany pc. yman to become wbjedd m,be
' rker, 501 - FINAL ELECTRICAL ENERGY
Compen�atron lives of Cab(om'a.Date; "
-Applicant 502 - '-FINAL PLUMBINGENERGY — — —
rNOTiCETOAPPLICANT:It.after making this Certificate of Exemption.you should - •'"•
yIKenmesubjeci1.heWorker'sC.rnKn.adonpmti.ire, fmcLabor CodeynnmUs, 503 - FINAL MECHANICAL ENERGY
Z ,dhow:ma:mPlywitn.ncnprevi.ionxormi.pnnit.hnn aeet_n<drexok1. 504...- FINAL -BUILDING- ENERGY-_. _. . .._._
-r4n • , - '-�CONSIRUCIONLENDINGAGENCY 505 - FINAL ELECTRICAL
' 1 hcreb affirm that diem is a construction lending for t
E.-
y o g agency he performanc
e
orthe wnrkfar wm<nmiapermRisilweal$ec.]09l.cin.e.) _ 506_ -...GAS TEST . _ .. .. _.._... _. . ._-.. . _.. ._ _.
y:C L`"dn"N'me•,, _a 507 - FINAL PLUMBING
V,Q . lcerifytnmlhavereod,hN
i.v application and state that the above information is 508 - FINAL MECHAICAL
fs. E.. Boriect.1 agree m comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
�_V to M1uiI ingco gmci ion•and hereby amhori is representatives of this city to enter upon
- m bo t mi pro,cmy, i^'pen p,pa' s., 510 - FINAL PLANNING
its (We)a eta de and k ph less the City of Cupertino agatnst
m rt ' 1 h« es use n,hmay,n any y c sa;a,, aid 514 - FINAL PUBLIC ORI{ �yy
V.Z Clyyn nee egmntn Ithis pe 't ` O/
APPLied UYDf STA\DS' .'DRI' COSIPEVWITH ALL OY.Fy)INI' Issued b Date o % /
RC I ❑tN5 ®ic- /is 1 y
-_ nmurc of App omrnao r s ('_Dat�c'. Re-roofs
JefineJlby1the Cu`"nino M1fun CoJe CM1npter 9,12,and Heim -Type
Of'" —
HAZARDOUS MATERIALS DISCLOSURE
pp p nmatme _T e of Roof
x .pa d s rnr .p i r .e, • . _t.l, .
Code.Section
OYei 25 53260 1 pNo ` -
' - . All roofs shall be inspected.prior.to.any roofing.matenal being installed.
• . + I R'lltn p,licannoffat...thitildin,cceripmaaseet p t d a Which If a roof is installe'd'wnbout first obtaining an inspection;Fagree'to remove
emithai,sudim,sucurouninumv.1d,fimal by he Bay Are Q' I'tyMnagmem
District.' . . 1. -all new materials for inspection. Applicant understands and will comply with
op ❑No all non-point source regulations •I ,
I base or the hhavJnuv.ma quiremmn underlChapter 6.95 of the
California Health Safety Cu china 25 5.255?l and 25376,lunderuand ma,� _
tf the building) shale holy have a¢na that.,is myucsponsibil hy'td notify the - - - - - - - --
occupa'of th qui mnu which must m<t prior to issuance of a enific a of.
C Occupancy.' i _ ..8 .. . _. ._ ...
of a Signature of Applicant Date
r aonronaee ag< Date . All roof coverings to be Class "B or better .
.' .. ... .. . . ... .. OFFICE _