01030049 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
HUI LDING ADDRESS: PHRMI'INo.
P1710 NR KITC EN EXCHANSE01030049
OWNER'S NAME: APPLICATION SUB LATE
HOMESTEAD R 03/09/2001
PHONE SANITARY NO. CONTROI,No,
I 40A J
C m z ARCHITECDENGINEER: BUILDING PERMIT INPO
k O O PLUG ELECT PLUMB MIdcH
W—
U I=1 I�I CI I=1
F N
7' LICENSED CONfRAC OR'S DECLARATION Job Description
Z—p I hereby anion that I am licensed coder provision of Chapter 9(commencing
�yCw with 5cninn 7(Xq)of Dlvisiun 3oltha ltu,inesand Prnfecaon.Cwlc,and my license
in tulllirrcr and aitB
��< Liven, cm„ iaa KITCHEN REMODEL
M
d D Date.�„-�.I Cantmam .1_
3 a RCHI'fF;Cr'S DELLA A ,
F-rN��O lundersand my pha,shall twosad w.f,,hit,record, FIN,1 LED
u�i�•p a Liccowd Prnfmsiunal
OWNER-HUH.)ER DECLARATION DEC 0 5
1 hereby of ica that I um exempt from the Contractor's License Law for the 200
C Z,6 following tens..(Seeiun 711.115.Itu,iaa,and Poole,ion,Cn lu Any city ur county
cex�o ,loch rayuirc a permit n,cnnswn,mors impmvc.Acnn,lish,m,epair any structure
i3x prior to its issuance,al,orequires the applicant for such permit or File a signed statement
-
that he is leaned perwannn the provisions or the Cont,-.w,nr.Li«nx Law tempter 9 Sy. Ft. Floor AreaBUILLAIN Valuation
_ (commencing with See,am 70(0)ol'Divipion 3 of the business and Professions Code)
olir that In,h exempt themfwn and the load,for the alleged e,eutpflim Any violntion
f Saaion 1031.5 by any applicant faro Irma nobject,me appllc:ml o a civil family
ofnn,more it,..rise hundred dollars(SNU). APN Number Occupancy ype
❑I.ns...c Drina pa,,,ty,or an,employees with waged nit meiraule cnmpcnmtlnn.
will to that work.and the,im,a a Isrf intended or nnervd for sale(See.71144.
Ho,me_„and Pnorc,sim,.Cmlc:'rhe C;ntracto.,Licanse law doe,not apply 1a an - Required Inspections
incaner of pmpery Who buildsor ma,,,,marc a.and who docs such work himulf
through hi. cmployea,peoulea that such impruvcnmm,are amt intended ,, 101 — FOUNDATION
offered for stile.If,howe,the molding or improvement is Fold within one year of
im,mpFel an.thr ow,a,halide,will lava the burden of ymving ma,he did Dot nada m 102 — PIERS
prove for farrow,or sale.).
❑I.as owner of the pm,,arx am exawavely contracting with licensed cmtmemr.m 103 — UFER
Lnp1...I the rodeo(see.9W.Bmioxa and I'mfe„ion,Codd:)The Cnmmcur', 1.04 — REBAR
icrme Law does nn,aptly ,,un owns+nt prnPrny who baso—,improve,thereon,
and who coname,is for such projeets vim a cormmum,d licensed pur..uant to the 105 — ANCHOR BOLTS
Cnmracmrs License Law.
❑I am exemft ander See. .B&P C for this reason 106 — SEWER 8' WATER
Owner Date 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION
I hereby affirm ander firmly r rmly, perjury one or the following declarations: 2103 — UNDERFLOOR MECHANICAL
204 — UNDERFLOOR FRAME
❑ 1 have Dal will ro iidein a Cby Scar ill'Consent a, Lal,o, ILr for
cnmfersthm,. a, pmvsaca rot by saan,n n,M w and Ir'Mr ewa rnr me 205 — UNDERFLOOR INSUI_RTION .
performance or the work for which this femur is issued.
301. — ROUGH PLUMBING
❑1 hoveand willr Cade.
Worker',Coniance(it t ework h rs Ilich eJ by Srai is
3100 of the Ialxrr cauda.Int run nern,r,r,anar nope wort rot wbiah oris norma t, 302 — TUB 8� OR SHOWER
i.wed.My�Wmkaa,,Compensation lnwreaeaaarir nil "he, no •r 303 — ROUGH MECHANICAL
Carrier: /• C �f< I'olicY No.: O V ` 4�,
CeFYrNFCAIION Op 2xrMrrl ON FROM WORKERS 304 — ROUGH F_LECTRICAL
coMPENsnriONINSURANCE 305 — FRAME
md,woinnnenl no,IN completed if the permit i,rnr one hundred dollars 306 — HOEDOWNS
(51(X1)err Ias.l
I verify that in the 1'admanuou of ase wok fur which this permit i,issued.l 307 — INSULATION
shall not employ any pnw,n in any manner m as to become subject to the Workers 306 — SHEET ROCK
Compamation laws of Califomie.Data
AF,p°po11309 — EXTERIOR LATH
N(yflCE TO AI'PLICAN'I':II;after staking this Ccrrfamc of Cxrmptiun,you,loulA
Zbecome%objait,the Worker's Compersadamprovisions ofinelvh,rCoca,>.amost 310 — INTERIOR LATH
O O hmhx ith comply with such provision or this permit shall I,deemed,nvokeel.
FCON STRUC11,N LrN DING AC,ENCY 311 _ SCRATCH COAT
> I thereby upon that thea in a caa,lmcfan lending agency for the ferfornatnce 313 ROOF NAIL
erIf the work bur which this .it i,issuaJ(See.3097.Civ.C.)
y $ LarlvC,Name 501 — FINAL ELECTRICAL ENERGY
Larder',Address
D O 1verily that lh:oaraadmna,heminnaadamahat,tire above imlonnnranis 502 — FINAL PLUMBING ENERGY
D. [.. comae,.I agree m comply wim Ill city and county announces and state laws whiting 503 — FINAL MECHANICAL ENERGY
O fJ ,o building construction.and hereby amhomiu represenmrivn of city to enter upon
y he.above.,nemanedpm,dy forim,a„ionrv,m,"a,. 504 — FINAL BUILDING ENERGY
it. (We)ag,ac to save, nacnmi l y and keep hanale,s the City of Cardona again ,
!A liabilitia,.jndgmmnu,cosh am expenses g,,; which,Day in very way rat mgainm sail] 505 — FINAL ELECTRICAL �1
UL CicyIncanwyamaranhe .,n,mgmmiIpamdt. Ol_a/
AP ANTUNA[iRST N S ND ILL COMPLY WRfI ALL NOWPOINT Issuedb 506 — GAS TEST pate
3iynaw nf507
npphan✓ oanma Re-roofs
BnznRDf IN M,T dG,,S DISCLOSURE 506 — FINAL MECHANICAL
X911 the applicant ur more huildimg occupant mom to handle nvunam,material Type of Roof
aefmd by that cap,rdmi Muairipal Cut,clnptr,9.12,mom,avoid,and Safety 509 — FINAL GRADE
Coda Seetion+55320)4
nye• 0 N All roofs shall be MAPeu d p�rfAlh���nyrT �1��3 Sul being installed.
Wit l the applicant or future building occupant use nryip,nem or devices ,bion If a roof is installef5iv,khcmt to remove
•int hanminna c,eoac nrionns a,dafned by It,any Area ill each Mnmgemem
aDlstdatp all new materials for inspection. Applicant understands and will comply with
Oyes 0 N all non-point sgurce regulations.
I have read the hamnoul materials mgmir,mems older Chapter 0.95 of the
Cithia,,iu llcalh&Sm9ty Coda,ScoGon,255f1.5,25533:od 25534.1 inl...It Wo .-- _
if the builAir,does not conically have o tenme.tout a i,my ra.po...lai,to notify the
fund of,he as,fimmcnswITbh are, nal,prior it isnoance of it Certificate of
Oce 4ney.
aJ Signature of Applicant Date
own - - —s.t[)are h•1 All roof coverings to be Class `B”or better
OFFICE