03060016 CITY OF CUPERTINO st" :° % �'�->x,�' s
BUILDING DIVISION PERMIT CONTRACTOR�INF RMr1,TT ONr.
BUILDING ADDRESS: MARVIN DAVIS CONSTRUCTION 1ERMITNr03060016
21142 PATRIOT WY
R'S NAME: 1450 KOLL CIRCLE PERMIT`StTJ' m2/2003
CH HAROLD L
NE:
(408) 975-0200 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTORS DECLARATION Job DOSCITpIIOn
I hereby afOrm that 1 unlicensed under provivnf oof Chapter 9(commencing
who Secvon 70110)of Division Sof the Bu and Professions Codeand my license is
inmRfomnw Offset. REVISION--KITCHEN REMODEL
5�z Lmenw cl .«
Date cantsqo {-NO NEW PERMIT ISSUED, ORIG. 403030060
cxREt.TSpacuc re ods
I u nJ IMw—d9 public recartls
36
5 sea Licensed Prof summ _
OWNER-BUILDER mDECLARATION
a O I hereby Maso .]Erre that 11. exempt from Ne Cssions o License c Law for the s
gpO following moon.armit t 7031.5,Business and Improve,
deroRcaar:Anycity or county
u�$fYi which n:9uima a pcmmit w coesMe alter,improv,dcermiti m.,Air any antrcture
L-ZLA tmt m liar naumaniquirnthowionotfm such Con=mitm Eleasigred w(Chsemenl
qF< tMtbeisliceneW punuantmthcprovisiouoftieContrutor'sLicemmselaw(LTwm9 Sq.Ft. Floor Area Valuation
KZs (commcnringwithSertion]000)ofDivision3afmheBusineusndRofwionuCodc)ser $25000
that M is exempt Nuefrom and de hands for de alleged cumptlon.Any violation of
Section 7031.5 by any appimsnt for a permit subjects an
the appbct to a civil penalty of APN Number Occupancy Type
not more than Rw hundred dollen(M). 32653003 . 00
0 I.u owner of the pmpeny,m my employcn with wage u lheb wle mmpewaon,
will do the work.and destruction II not intended oreRered fundmisec.7044.Business
and Profession Code:The contractors License law dead,not apply to an owmer of 101 — FOUNDA�nKd Inspections
� p
pmpeny who build,or improv thereon,and who does such work himself ar through his
Own employes,provided that such improvemenu art not tnmordend uroRered(mode.If. 102 — PIERS
however,the building or improvement is sold within one ysu ofmmplcdm.the owner. 103 — UFER
builder will have Ne burden of proving Nat he did not build or improve for purpose of
axle.). 104 - REBAR
0 1,as Owner of the pmpeny.am eacle inly contracting with Iicerued contractors to 105 — ANCHOR BOLTS
continues the project(Sec.1Oa4,Business and Profession Cade)M Convectors U.
cc=Law dna not apply to in Manor ofproputy who Wilds or improv thereon.and, 106 — SEWER & WATER
who contacts for such pMjwm vehis a contractor(()licensed pununt to the Connors 202 - UNDERFLOOR PLUMBING
License Law.
0 lamaempitamm'Sec. .B&PCfo WnnUmmn 203 - UNDERFLOOR MECHANICAL
Or Dae 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
IherobyaM.muds,punity of perjury one of the foUnwmng declanamu: 301 — ROUGH PLUMBING
I have and will MainWn.CenlBam ofConsemto ml6mmure for WMIOU'ACTepcm 3O2 — TUB & OR SHOWER
cation,as provided for by Section 3700 of the labor Cade,for the performance of the
work for which this permit is issued. 303 - ROUGH MECHANICAL
0 I have and will msimam Workers Compensation Insurance,as mquimd by Section 3 04 — ROUGH ELECTRICAL
3700 of the labor Code,for the perfmmwa or me work for which this permit is issued. 305 — FRAME
My Workecrs comp"
aon ln,vence caviqy and Po l' numkr sec:
.f �,.tV`dPait 6:(00M9�-tea 306 - HOLDOWNS
ERTIFI A nFEKEM F'ItoAWORKERS• 307 - INSULATION
COMPENSATION INSURANCE
Mussocdon need notbccomplewd if the Permit is foronc hundred dollars(SIM) 308 - SHEETROCK
mless.) 309 - EXTERIOR LATH
1 century that in the performance of the work for which this Permit is issued,I awl not 310 — INTERIOR LATH
employ any person in any manor an u m become subject to the Worken'Compnuaaon
Laws of Cslifomia.Dau 311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT.IL after making this Ceniricase Of Enreptian,YOU Should
313 ROOF NAIL
become subject to the Worker's CompeosWon provisions of the Lahor Code.you must 501 - FINAL ELECTRICAL ENERGY
,Z foMwith comply with such provisions or this Permit Nall he dcomcd revoked.
i o 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY E503 FINAL MECHANICAL ENERGY
IhemNn
by affirm them is
rtaconuuucann lending agency for the performance Of
4> Me work for which this permitis issued(Sec.309T,Ch.C.) 504 - FINAL BUILDING ENERGY
W^q LsnderaName
LendersAaaress 505 - FINAL ELECTRICAL
7 Z _
U p 1 certify that I Mw read this application and sum that the show informatlun is 506 - GAS TEST
CormeL 1 agree to comply with 01 cit and count ordinances and sum laws rtlatin m
OOU building construction,used hereby sumonmmpresenutivofthis city tocamuponthe 5 FINAL PLUMBING
W sieve•mentioned properly forimpecvon Puryotos O$ FIN MEC CAL
UJ (We) Z.to raw,orindemnifyiecdort keep hannleu the city or Cupertino against
i..m rat
liabilities,judgmcns,coN and expenses which may in any way acme against said City FIN E
U in consequence of the granting of this NMI,. SZ NG
rte• APPLICANT UNDERSTANDS AND WILL COMPLY WI'm ALL NO PO NT Issued by Date 17
SOURCE Ric LATIOrryB�
� ���i�r/.r -- 2 '�7 Re-roofs
Siiln odrt ofpp AcarCo manor Doc
vv HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant arm or handle haurdenus material
1c.defines by de,Cupertino Municipal Code.Courser 9.17.and the Health and Safety
Section 25532(07 All roofs shall be inspected prior to any roofing material being installed.
0 Yes _EZNu
Will the applicant or forum building occupant mtn:equipment or device,whichIf a roof is installed without first obtaining an inspection,I agree to remove
t lmArdous air contaminants u defined by se,Bay Arta Air Quality Management all new materials for inspection.
rict?
CYesI have mad the huaMnus materials requimmenu under Chapter 6.95 of the Calilm,
Health&Safety COM,Sectors 23505,25533 vul 25534.1 understand thislithe building
not cusently hew e seemitis my remoosilubty to.61 occupant of the
iremcn wnichMust a,missuancearecrnifkaear gnatureofApplicant Date
ns umhorized age D, d All roof coverings to be Class "B"or better