01030025 CITY OF CUPERTINO I " '
RUILDIN6 DIVISION PERMIT CONTRACTOR I4ORMATION.i
BUILDINGAUDRET0401 PLUM TREE LA PERMIT NO.
01.030025
WNER'S NAME: APPLICATION SUB DATE
RESNICK DAN AND YVETTE 03/06/200
PHONE: SANITARY NO. CONTROL NO.
Q 0 ARCHITECT/ENGINEER: - BUIL G P RMIT FO
BLDG E P MECH
IF- LICENSEDCONTRACIOR'S DECLARA11ON lob Description
ZO L=Q 1 M1emby nlfutp that 1 amlicuaed uathr provisions of Chapter 9(commencing
to with Section 7M))of Division J of the Busincuard Professions Codefndmy license
a , 'sin full fume end eff
Liven cess - Deg ? _ NEW CRBINETS & FIXTURES;
�° ❑oto Cnnu:mbu
A]Cl13
HIF-CTT DI:CLARA NEW PANEL;
c
°g Iundentialmyplan, h.11beusWaspublicrea REMODEL KITCHENS & BATHS.
r
aLicensed Professional I "
OWNER-RUILDER PECLAR ION
-9' I hereby aflino that I xm exempt firm the C Lieco. a IIF
foils Ingre. (Section 70315 Businessan I Prof n, aAny t
F p
which req perm t to construct.alter,improve. if, reY swelu
a$
prionto itsI. requires the inflictor f - Ill fl �tot
than I : ip :altar thep v: free c I {yChr9 t. Floo Valuation
(nioneurneing t1 Sect 700(bof Division i l le,B . ty1yn e)
or that he is exempt the f n ane the basis lot the allege)a emp 1 1.Agwitoo
ofSminn]OJLS by any applicant fora permit subjects the appliel a civil ally
offset more man five hundred dollars(5500). N Nu bel Occupancy Type
01.its
owner otthe prpe
orty.lir ity employees with wages as their sole compensation,
will do the work,unit the structure is not intended or offend fill salt(See.](144, Re UII'ed IQCt10DS
Business and Professions Code. Me Contractor's License Law does not apply to on q TIS p
caner of property Who builds or improves thereon,and who does such work himself e o
or through his own catpluyeee.provided that each improvements are one intended or 31 633022. 00
offered for sale.11;however,the building or Improvement is sold within line year of
completion,the ownerbuilder will have the burden of pmving that he did not build or
improve for purpose of sale.. 101 — FOUNDATION
01,us owner of the property,em exclusively contracting with licensed contractors to 1,0'�3 — PIERS
instruct the project(Sea 7844,business and Professions Code)The Contractor's
construct Law a«x not apply to an owner of property who builds or improves thereoo, 103 — LIFER
and who contracts file such projects with a contrsetor(s)licensed pursuant to the
Contractor,License Law.
104 — REPAR
❑I vat exempt under Sec. .B&P C for this reason
Owuct nate 105 — ANCHOR BOLTS
WORKER'S COMPFNSXHON DECLARATION 1.06 — SEWER & WATER
Ihereby aM.under penvhyofperjaryone offull owin,declinations: 202 — UNDERFLOOR PLUMBING
0 I have and will nrmrton a Ccrdfieae rf Crisco, to self-toxon her Worker. 203 — UNDERFLOOR MECFIRNICAL
Compenmtion, as provided for by Section 3700 of the Lohot Cade, for the
penummnceonhe work for which dtix N.it is honed' 204 — UNDERFLOOR FRAME
M1ove and will nminmin Workers Compensation Insurance,as icquied by Section 205 UNDERFLOOR INSULATIONt0
of the Labor Code,for the performance of the work Iia which this permit is
issue I hly Workers Col" ,.l:, ore carrier and Policy number a re: S 301 — ROUGH PLUMBING
er. 1�w!Is oYo,ktyNn.: [I� 71 302 — TUB & OR SHOWER
CEN'TIIICROM
COMPENNSSATIONIN INSURANCE FTION O KERS' 303 — ROUGH MECHANICAL
(This section need not becompleted it the permit is for one hundred dollars 304 — ROUGH ELECTRICAL
(5laune
ors.) 305 — FRAME
I certify that in the perfoimmnce of the work for which this permit is issued.I
,boll nm employ any person in any nature,so as to Iwcome suhj.t ,,the Workers 306 — HOLDOWNS
Appliccum a,afun LawxorcaBromw.Date
A 307 — INSULATION
NOTICE TO APPLICANT.IL after making if i.s Certificate of Exemption,you should
M;come subject In the Worker's Compensation provisions of the Labor Code,you must 308 — SHEETROCK
Z O fonhwim comply with pmvlsloth m this permit shall he Jecmed revoked. 309 —
Z vJ EXTERIOR LATH
to CONSTRUCTION AGENCY
f nENIhrrehyaRrtnthatthcrcisaronswdinnicn6ngagencyfmtheperfotmence 310 — INTERIOR LATH
of the work for which this permit is issued Ser.3097,Civ.C.) 311 — SCRATCH COAT
Lcialcr's Name
j z Lermcr',neem., 313 — ROOF NAIL
C 1cenifythatIhavecalthisapplicationundstumthnuheaboveinfnnmatlonis 501 — FINAL ELECTRICAL ENERGY
W E. corona.I agree to conimein
ply with all city and county ances and state laws relating
C CJ to bidding construction,and terribly authorize representatives ofithis city to enter upon 502 — IAL PLUMBING NG ENERGY
. Iy (Wel agree to save,indeinnify and keep harmless the City of Cupertino against eJ� —
fA liabilities,j egmenrs,costs tore expcnus which may in any way attmc against said F MECHANICAL ENERGY
U zz City' con eyuy le hegaatingof. i nail. 604 — I B I_DING ���I�����RGY
AACAURCI Irl tTl POS n5 A111� .0 WITH ALL NON Issued ISSUCd Illy: •PJB tf'
Million..It 'ca vector / Date Re-roofs SO .r — GAS TEST
ALARDOUS MATERIALS DISCLOSURE
Will the applisyn or futum building occupant stom or handle Intrusions tsm¢riul Type of Roof 7 — FINAL PLUMBING
as def red by the Cupertino Municipal Code,Chapter 9,12,poll the Health and SafdY
code,Section zss7z(a)^. SOB — FINAL WMECHNIC�LOVex ❑Na All roofs shal pecte r ognC nal being installed.
Will the applicant orfuture building occupant use equipment or devices which If a roof is inst wItho�t tns eetion, la ree to remove
nit hazardous air cntnominrent,rix defined h the Bu Arco Air Qaallt Mon ent — t�[[�� pp gishicto Yex ❑Nr g all new materia o inspPCt�dt 5tpAmands and will comply with
all non-points repIJFIIAIALC WORKS
I have read the hvzaMo e,material.requirememe under Chapter 695 of the
C.1houniu Health&Safety Code,Sections 25505,25533 unit 25534.1 understand that
IF
the huildo,does not currently have a tenant,that it is illy regmnsihil ity to unify the
nice pan of the a cats w as[be amt He,to issuance of it Certificate of
ls� / Signature of Applicant Date
ownero n r. agent — nota All roof coverings to be Class "B"or better
OFFICE