02010095 BUILDING DIVISION PERMIT UUNTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
22647 OAKCREST CT CUPERTINO KITCHEN DESIGNS 02010095
OWNER'S NAME: APPLICATION SUB DATE
GEORGE & STEPHANIE TYSON 10562 S DE ANZA BLV 01/23/2002
PHONE: SANITARY NO. CONfROLNO.
(408) 257-4900
O�1RCHITECT/ENGINEER: BUB.DING PERMU B.FO
&m BLDG ELECT PLUMB MECH
IJ L—J L L_J
H Z LICENSED CONTRACTOR'S DECLARATION Job Description
tz�S Ihereby� m
rmthatlafihie
eed.iduprovisla,aChapter 9(command, BATHROOM REMODEL p
w 1-m with Sectio,100))of Division 3oftho ss
Bumm ,nd Professions Code.and my license
�y5= Islnfullfomevo pact, p_yJail� �
!O.< Liceme Cla s_ Licit 1100 O0 tVJ`"'�L
Dote Cmmranor
i v,06 II- 3t7 C7 H�CfS pG gRAT10N
X31 sstand ydamshallk u II<nmN FINAL
a o Lisena d P MAR 2 2 2002
o R OWNER BUI% DECLARATION
= I r by affirm that I am emoba from the Contractor i License law for the
�?a following reason.(Section 7031.5.Busimssard Profession Code Any city or $150 O
unry
2 S C which requires a permit to consuuct.alter,improve,demolish,or mpa'v any swcwrc
�G3$ pctm to iuimaree.also5cquimstk applicant fm satdapmv,mRlea signed ssvemmt -
— Wbho in littered Pomont tothe pecdmas of the Conomtofs License,Law(Chapter 9ms' pp,,t��rtBs�� alUatlOn
(eommercing with Section 70,W)of Division 3 of tho Busin ssmal Professions Code) _S� i•3`4L'.4D �.,:L' u
m thu M k ea<mpd thamfronfan4ihe osis rm the Dies ampdoo.Any violation
ofSmion7031.5by any applica, orapermit mbjecbthe applicant macivil penelry
of not more than five hundred dalan(sspOl. 10UN NOONDATION Occupancy Type
0I,u owner of the property,or mymadoyecs with wages m,hoir mlc competamion, 102 - PIERS
'will-do the work,and the arunure is not intended m offend for all,(So,.7Ga L.
'Bumniand PmfesdernsCastle:The commate,aLianeeLaw does net apply toass 103 — UFER Required Inspections "
net of property Who builds or Important.tlmrecn,mel who dors such work himself
or to %his own empbyeas.,Provided dost such improvaments are not intended or 104 — REBAR
oBriid for toile.If.hawith
ve,. e bull in,a tmpm vrmnt b sold within one year of .. - - . . ... . .. . ...... .. ._ _
constriction.theowncr-bnHderwinhaetnew,danof 105 -ANCHOR BOLTS
o p poving that k did a,Wild or
imprrw nor parprsearmle3' 106 — SEWER & WATER
'01.inuwma,ofthe prepare,am er<iudwh'conuaclbq with uccmed contractors ie. . 202 - UNDERFLOORS PLUMBING
construct the pmjmt(sec.70a,Business and Preles:ion Cade:)The Cannan«s
Lice2 0 3 — UNDERFLOOR MECHANICAL'"�
License Law does Lid apply to m owner of progeny wk builds or improves nascent. - '
am who commucu for such projects with a contractors).li«oaee.pursuant to.thc204' — UNDERFLOOR FRAME—
Conuae«s License law.
_ ❑1unsaemptunder Sm. ,B&,PCfor this rw»n 205 - UNDERFLOOR' 'INSULATION
owner et 301 ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby all under peashynrpes;uryamofdue roaowingdeclarations: 303 — ROUGH MECHANICAL
T 1 0 I haw and win maintain .Certificate of Content to saB-imam fm warker', 304 - ROUGH ELECTRICAL
)4 Comprnmtia, u provided fn by Section 37W of tk Labor Code, far the
,err thewankroewhichthispeamnisisama. 305 — FRAME
o w and wan maintain wieder•,Canpmsntimn Irsmrame.es ngaited by section 306 — HOLDOWNS
.. 3700 err me Li bm Code,r«tk perfmmama of the wort For which this permit is 3 0 7 — INSULATION
issued.My Workers Com,coo
mn I..carrier and Policy number ase:
CC�� �-l'C�1 —o z. . � 0 '; =�: SHEETROCK
Canritr.5•r��rTAM1 Polity Na.: kiln.
' CERTIFlCAT10N OF EXEMPTION FROM WORKERS',, � 309 — EXTERIOR LATH'
COMPENSATION INSURANCE- "'
.-. . _ - 310 - :INTERIOR LATH"
(Mil samion need and be,er.pined if,k permit is for no hundred d.11. 311 - SCRATCH COAT
(71 W)or less.)
I cartery that in the Fair«mane er,the-work for whim rout permit is iss�ued:I � ROOF NAIL, -� • ' - -
shall hot employ any powotrt
ninanysrnarsoasinbecomemnjest tothoWorker: 501 — FINAL ELECTRICAL 'ENERGY
Compensation Uws of Cahfomet.Dam
Applm.n, .. 502 FINAL .PLUMBING ENERGY
NOTICE TO APPLICANT)IL aper making this Certificate of Esempuon,you should 503 - FINAL MECHANICAL 'ENERGY
bacome subject to the Workers ComPenmtiun pmvisiom of the Lotter Code,you mum
Zronhwlit comply With such prolimanoorthis permitanal hoEeamede<vokad. 504 - FINAL BUILDING ENERGY
E, Z) CONSPRucnONLE_NID!NGAGENCY 505 - FINAL ELECTRICAL
7I hereby off,hat them is a consuu<tios lending agency for the pedormance'
of the work for which this permit is issued(Sm.3O7,Civ.C.) 506 — GAS TEST
;D z LLe ne,sAdidms S07 - FINAL PLUMBING _
UO I«nirythatln,ten,athia,ppkafmnuMautedhathoaw.einrm,n,doni, 508 — FINAL MECHANICAL
W (✓ forme.1 agree to comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
'O (� to building conswnion.and mrabymtkritcreprosentaivesolthiscity to enter upon 510 - FINAL PLANNING
.} ta7 the.hove
. eMiagd Property fa imxstion purposes.
e)agme son,iMemnify aM kap harmlesstM1e Gry of Cupenino.gaina _
rp o mea,jadgm us.crust and e,, asE:u h may m any way secrac against said 514 FINAL PUB I C WORKS
V z ny in conn y ee of the gee i6g of(bit, t.
_ APPLICAN ,NDERSTAY SANDW' -CONMLYWRHALL 'ONIPOINT Issued b r
SOURCE ULATIONS 2_4 aL y Date
sin pPlica
HAZARDOUS
Dat Re-roofs
Will Hal Tutu US MATERIALS DISCLOSURE
the applicant nr rmme wilding mcuhapinme or and
the Health an Safety .Type of Roof
an dchned io the Cupertino Municipal Code Chapter 9.12,and the Hdth and Safety
lode,Section 255321017 / ,
oven Q3� ...All roofs shall be inspected prior to any roofing material being installed. .
Will the appr<ant or rumor building occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,'I agree to.remove
emit hazmdas air contamimnn to de Bned by the Bay Arca Air Quality Marra,mend
District? �� all new materials for inspection. Applicant understands and will comply with.
!f °Ycs ` - - all non-point source regulations;
a: i home xad the hausel materials mquimmenh under Chip Us 6.95 of the _
+;ulifom bit&la(ny Code 2550121511 Ind 25534.1 urohmtood that .
Sir din ms mtcu yhoma asp thaI'd is my responsibility to notify the
cupont offlo mquil nn which be rnm to issuance o . an Cut'of
r acnpan<y Signature of Applicant Date
n or authorized agent Dide U All roof coverings to be Class"B"or better uw
OFFICE - '