00080081CITY OF CUPERTII
BUILDING DIVISION
BUILDINGADDRCSS:
2233'.
OWNER'S NAMH
RNDR
^s�D DR
"'
PERMIT
RANCHO DEEP CLIIDR
LICENSED CONTRACTOR'S DECLARATION
aRrm that I am licensed undo ryrvisions of Chapter 9 (commencing
force tad eKt.
e
e Class Lia #
1 unde mm! my plus shall be used as public ecords
Llcrnxd Prof ssionel
OWNER -BUILDER DCCLARATION
1 besets, aRren test 1 am exempt from ted Contractors License Law for the
folloving roam. (Section 7031.5. Business sed Rofessrans Cade: Any City or cou ly —
which fryunes a permit to co swtt slier, improve, demolish, or repot MY structure
prior to its issuance, also inquires the applicant for such Remit to file a signed statement
that he is licensed purtumto
the provisions of the Contractor, Lt... Law (Chapter 9
(commencing with Section 7000) of Division 3 of ted Businw and Pro easiom Cade)or
that he is exempt therefrom and the buts for the alleged extempore. Any vielsum of
Secdon 7031.5 by any applicant for a I., subjects the epplicannn a civil feral, of
not more Nan Eve hundred dollars ($500).
❑ 1, as is of the prowny. m mY employer with wage a mebsde comprmssim.
will do the work, and the slomme is rut intended oroffmd for We (Sm. 7614. Business
W Pmfesaiom Code: The Convamor s Liceve law des m4 apply to an owoer M
propcny who Wilds or improves thereon, ad who docs such work himself or through
his own employees, provided did such improvements ase not intended or offered for
We If, however. that, Wilding or improvement is sold within use year of completion. the
owner -builder will have the burden of proving mat In did net Wild Or improve for pn-
roac of We.).
0 I, in owner of the property, not exclusively contracting with licensed emsactnn to
construct the project (Sec. 7N4, Business and Rofessions Cde:) The Conuacmrs U.
mose law does net appy to an owner of property who Wilda or improves dhueon. and
who contracts for such pmjecu with a mmsactof(s) licensed pursuant to the Coneracmrs
Limens law.
I am exempt under Sm. .B A, PC fo )his won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirms under penalty of perjury one of the following dectara4ohu:
CI 1 have and will maintain a CmiEcata afcomenuo Weinsum rorworker. Compen.
sation, as provided for by Section 3700 of the Labor Code. for the performanec of the
work for which this permit is issued,
FI I have ad will maintain Wallets Compmsuion lmursee, is tattooed by Secllm
3700af the Iahel Cade, for the wrformarum of to work for which Ill;, permit is mMW
MY Worker C m rn artier end Policy nymbr tgral t (_#ao
Cam Policy tic 66 [�f11O0
.STI ON FROM WORKERS'
t C/ I'C MPENSAl10N INSURANCE
(This verion need nm he completed if he cement is torose hundral dollars (5100)
or It.")
1 certify that in the perfoomance of the work forwhich thispemtit is issued. ) shall
not employ any permit in any manner so as 10 laments subject to the Workers' Compcn-
sa0m laws of California. Date
Applicant
NOTICE TO APPLICANT: If. Mier malting this Certificate of Exemption, you should
became subject is me Workers Compensation provisions of the Labor Code, yon most
fothwith comply with sorb provisions or this peal, shall be deemed evokd.
CONSTRUCTION LENDING AGENCY
1 hereby uRrm that mere is a construction lending agency for the performance of
the work for which this permit is Issued (Se. 3097. Civ, Q
Lader. Name
Lader. Addre,a
I certify run 1 have orad mi, application and nom that me shove infomhation is
correct.) agree to comply with all city ad county ordinances and sure laws relaung in
Wilding consuucdon, tad hereby ambe iem representatives of this city In enter upon the
ebovementismd property for inspection purposes.
(We) agree to save. indemnify and keep husmle w the City of Cupertino against
Rai judgmema, moss and espenms which may in my way accrue agsum, said City
in conequenc, of me granting of this permit
Anus ICANT TIN DFRS I'ANDS AND WI I.I. COMPLY WITH ALL NON -POINT
9 -defined by the Cupertino Municipal
Code. Setion 25532(07
❑Yes C3 No
will then awlicans or more Wading compact on equipment or devices which
emit bessrdous air mesunirunw as defnd by me Bay Armor Ab Quality Managemet
nimin7
❑re. No
10 1 have orad its huardon, nexa ids re9ummome, under Chapter 6.95 of de Cd1*
fomu Healm & Safety Code, Sections 25505.25533 and 255)4.1 understand that if the
building does not currently have a tenant, that it is my responsibility m notify me occupant
agent
SHOWCASE KITCHEN
NIC CONTROL#
12333 SARATOGA—S NY qL RD08/ 11 /2000
( 408) 253-0412 'BULDiNG PERMIT INFO
Job Description
KITCHEN BATH REMODEL
Area
101 — FOUNDATION
1.02 —
PIERS
103 —
UFER
1.04 —
REBAR
105 —
ANCHOR BOLTS
106 —
SEWER & WATER
202
— UNDERFLOOR PLUMBING
203
— UNDERFLOOR MECHANICAL
�3
204
— UNDERFLOOR FRAME
�Q
205
— UNDERFLOOR INSULATION
301
— ROUGH PLUMBING
302
— TUB & OR SHOWER
303
— ROUGH MECHANICAL
304
— ROUGH ELECTRICAL
305
— FRAME
306
— HOLDOWNS
307
— INSULATION
308
— SHEETROCK
309
— EXTERIOR LATH
31.0
— INTERIOR LATH
311
— SCRATCH COAT
313
— ROOF NAIL
501
— FINAL ELECTRICAL ENERGY
502
— FINAL PLUMBING ENERGY
503
— FINAL MECHANICAL ENERGY
504
— FINAL BUILDING ENERGY
505
— FINAL ELECTRICAL
506
— GAS TEST
507
— FINAL PLUMBING
Re -roofs 'VJtl — r 1IVHL_ ITIMU 3HINIl_HL_
Type of Roof 509 — FINAL GRADE
510 — FINAL PLANNING
All roofs shall beag )egted �r tV6 fp 3 posterial being
installed. If a roof IS nstafle airlhouCfirsio ,ming an inspection
I agree to remove all new materials for inspection. Applicant
understands and will comply with all non point source regulations.
of Applicant
OFFICE
Date
All roof coverings to be Class "B" or better