01110007- ..
OFFICE
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OF
CI BUILD
CONTRACTOR INFORMATION:
NG DIIVISSIIONNOPERMIT
BUILDING ADDRESS:
PERMIT NO,
1105 ROLLINGDELL CT
GRACE BUILDERS
01110007
OWNER'S NAME:
JAMES KIM
14333 SARATOGA AVE #18
APPLICATION SUB DATE
11/01/2001
PHONE:
(408)867-6118
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INPD
BLDG ELECT PLUMB MECH
O O U I--1
as
w
LICENSED CONTRACTOR'S DECLARATION
I hereby aRrm Ilial I am liccnad under provisions of Chapter 9lrommencing
Job Desert tion
;Cm
with Section ")ofDivis"n3oftheBusinessandProfess n� yr n
e
i. m fel r.ra ant (�
INSTALL SKYLIGHT IN KITCHEN.
4
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a a G
Licence Class Lic. q l
Data Comrecwr
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ARCHITECT'S DECIA ON
ll used as public recor
1 mab,,le.d any plans shaW ds
a �� ��
Liccnad Rofcssioml
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= I`
OWNER -BUILDER DECLARATION
1 hereby alBnn that 1 am exempt from the Connaact's License Law for the
p
3
D C (� 2001
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E=9
following ream.. (Section 703 1.5, Business and Profcsnons C Wc: Any city or..at,
$1500
which requires a permit I. eonauuct,.],a , improve dl or repair any structure
322prion.iu
issum:ce;ad. "wae. theappltcanlfor such partdt1. file. signed
maha vkhansad pursuant 161111, pimirsmatirf the Ciamietw'e License Low (Chapter 9[•s',.Ft,.e.r.A�
V„lY”-P
Valuation--
3 or the and Profesal.ns Code)
(commencing with Sacuoh170(0) of Division Biome,,
t.Al'Iy .37;3"3 ,tf - - -,
or our he is exempt therefrom and the basis for the alliged aiempuau. Any violation
of Seeman 703 1.5 by any applicant for a permit subjects the applicant to a civil Proudly
t.fnmm..than Eva hundred dollars ($50(l_..
101APNNVIONDATION
lOccupancy Type
01. as owner of the progeny, or my employees wish wages as their sole compensation,
102 - PIERS
10 3 - UFER Required Inspections' ° • '•
will do the weak, and the aructure is "non inunded or offered for sale (Sac. 7(k10,
Business oil profession, Code: The Coal.... s License Law does not apply I. an
owner of pmpary Who build... improves mart.., and who doe, such work himself
104 - REBAR
or them Is his own employees. provided that such. improvements are not intended or
;bRartd for sale. IL tidxevcq the building of improvement is sold witnib one year of
-ANCHOR -BOLTS- ------- _ - ----- ,.�, v
-105 —-----i-�.'"�
completion, the owner -builder will have the burden of proving that he did not Wild or
impmvemrpumoae.fsme).
106 - SEWER & WATER
-— ---
❑ 1, as miner of the Progeny, an `xclusively contracting with licensee contractors..
202 - UNDERFLOOR' -PLUMBING....
die project (sea. 70,14, Buenas and Professions Code:) The Contractor's
203 - UNDERFLOOR. MECHANPCAL' : • : ' `
License Law does not apply to an owner of propeny who Wilds or improves thereon.
.:
_anawh..contmcls for.sueh.pmjects wise.a.eomraerm(a.uauaed_pursu.m to me204--
UNDERFLOOR- FRAME ..._._....
01 wm a ea License law. .
Oraexempt under Sic. � .B&PC for his ream.
205 - UNDERFLOOR"INSULATION
Owner Dae' '
301 - ROUGH PLUMBING
' WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
" Ihereby afiamunder Penalty of Perjury one of the. mnowingdeclarations:
303 ROUGH MECHANICAL
❑ 1 have arm will mamtnin a Cemecmeof Consent to self -insure for Worked
_
3 04 ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the labor Code. far the
-
3 0 S FRAME
_
Performance of the work for which this Permitis issued..
❑ 1 have and will'minum Walkers Compensation Insurance, as required by Section
3 0 6 - HOEDOWNS
'
3700 of the Labor Code. for the performance of the work for which this permits
3 07 INSULATION.
.. issued M W sCompc.sai on.imm aM Pobry nxmber.rt.,
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h vl'4'�.i L.I PuI
_- --•••__, ,,.•
--• _
= 308_ SHEETROCK
Cam CY No
l-4.y;a % i309 l' --i tEXTERIOR.,aLATHt:
' '.ICERTIFlCATIONOFE%BMPI'ION MWORKERS'
...._ .. ,[•COMPENSATION INSURANCE`I. ..._. ..,.
_--...3-1'OT-----I NTERTOR-L"ATH-.--- _. __.__..---- .__.._-_....._.. _--------_--
OL isaion ctneed' not tiecont Iced if the pcemit is one hundred dolls
311 - SCRATCH COAT
(aloof ane...) ... .. t; .., .
. .- _ - .
_.....--3-1-3-----ROOF--NAI-L--._.... _...... . . ....... -
I._
" aenifyman in the fin any are r the work far which this permit a issued; I
shallout employ any perion'in anymunneem us m buses subject i. the Workers'
_
501 - FINAL EliECTR3 CAli- ° ENERGY
C.inpensallon Laws of Paltprriia, Date -
:.
- FINAL PLUMBING ENERGY.
Applicant. -. - ... ...:.
NOTICE TO APPLICANT: If, of,., making this Cenificau of Exemption. you should
.. ..502
503 - FINAL MECHANICAL 'ENERGY -
O
Biconte subject o the Worker's Compensation provisions of the Labor Code, you must
forthwith e.mplyivitbwohprovision, orthispermitshuubcdeamaerevoked. __
_ 504 .-- -FINAL,-BUILDING .ENERGY_ .
...
e 'CONSTRUCTION LENDING AGENCY
SOS - FINAL ELECTRICAL
� �
I hereby offirm that diciek a constraction lending ng y for the liedatmaebe
.:
"
506 - GAS TEST • '
a 0
.rth<warkmrwmm�thtagerpr,:ia.yed(siv.
cc>
Lander'. Name'. I :. ..... ......:..... -.. --._. ,....�.c ..
' -'-
- - - 507' - FINAL PLUMBING
_,Z
Lender's Address.., _ „•,-, _,
_
508 - FINAL MECHANICAL
U-0
W'E
_writ mall. vers.. this application and state that me above information is
Vp
cartci.Iagrenocomplywidtall,cityandcoonry.ordinanwsndsumlawsrelaing
509 ---FINAL-GRADE----- —
O,r,-•)
m Wilding conamaioman9 hereby authodia npresemadvea orthis city to enter upon
510 - FINAL PLANNING
y
the,above-mentioned prropeny for. inspection wma,ax., .
I (We) aSme io two, demaify and keep harmless' the City of Cuperimo'ngainst
in
-
514 ---FINAL PUB C WORKS
In
liabilities. judgments, costa and expenses which may any way a< a .gains_ said
City in consequence of the grv:ting of this permit. cm
APPLICANTUNDERSTANDS AND WILL COMP WITH'ALLNON-POfNT'
"
Issuedb : Date
Y
3OORCB REGULATIONS, I
-
- Stg amrc of ApPlicanUCom dna '.'" - Dae '_
.HAZARDOUS MATERIA DISCLOSURE
'
---Re-roofs- - -
l thdupplic t fI bolding«cpanstore orhandle hal-tdohsmaterial
Type Of ROOF, - ---'--.':--' -
. '
u dcfned by the Cupertino Municipal Cod Chapter 9.12. end the Health and Safely
..
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f - , ,. k • " 7',x '+>; 1 r v t 4
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Cade, Section 255321. , .. ly, • . y „ f , .
❑Ye.' .'" ^��f; _olra,,,,.:: ... ,.
1 Y . > ..♦ v t _ r .
roofing
,,,_`;,.�
ovillda..Ppli ant orr t rem�pa g occupant use equipment ordeviceawhich '
„•.All.roofs,shall.be.inspected.prior_to.any. -material .being.installed._
If a roof is installed without first obtaining an inspection, I'agree .to remove
woo heairdo s r co a as defined by lit Bay Area A Quality Maap ram
District? " -
all new materials for inspection. Applicant understands and will comply with
P _ .. -.
r 'ores , ON. „ -
,. ..-, 'I... �•.., .:
-- - _... , .
all'non-point source regulations_...,.
Theses mad the hmardous malarial require n s'waw Chnphrt'6.95 bf me
Cdifomia
Health & Safety Code: Semon 5505, 35533 and 25534. 1 understand the
if ihowildingdoes not currently have nantnhat it is my responsibil try to notify the
a<upaof the requirements which s be ran p:i to isso.n of a C, . . of
,
Occupancy • -
Signature of Applicant .,- - , _ Date
All roof coverings to be Class "B" or better
Ownn.r authorized again - Data
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OFFICE
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