02090011 CI soOF BUILDINGDIVISION
OUDPERTNNO
t PER&f CONTRACTOR INFOR ION:
BUILDING ADDRESS: PERMIT NO.
10070 SCENIC BLVD BATHROOMS BY HANS 020$90A07E11
'gf&'MCHAEL A AND BEVERLY A 4986 TIFTON WAY APPLIc09N04
/ /2002
PHONE: SANITARY NO. CONTROL NO.
(408) 978-3053
E g O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a� o o f---u
LICENSED CONTRACTOR'S DECLARATION
tion
0 y 1hereby affirn,met Iamlicensed under provisionsofChapter 9(commencing ))ObDGSCrGpIF
F,yC wnhSenion]0p0p0p)ofDiv'ion nftheBuxincs firofess' Cod, my loom. KITCHEN REMODEL/SKYLIGI INANE®
Y y is in full foss`e'eAd cd_ J" Y tl
04
O i se Lrccnu Cla. CJ -F.i<.M Q Q
t'=Og Ou. ne 1undersond myplans shall heusdaup.blAR 11 icArccoNs TION OCT Aa ZOOL.
Fto-
a.E: Lic<nudProfcssimnal BUILDING o OWNER BUILDER DECLARATION
uai 1 hereby affirm that I am exempt from the Contractor's L,came,Law f ,he
?a follow ng mason (Section 7031.5,Business and Profess,on+Code Any city or count, $15000
F O
which requim a Permit tt 1 Iter Improve,demolish,or repair any structure
63� ..poor in tissuance.also requiresth..Mlcant for such permit o file aagnd suiternsent -- -p,,,.sro p� .. ._. _. _ ..- _ _
hot just 1 enud partum[ the pr .ions ofine Contncm„License Low(Chapter 9 } i3.5`i`t•J'9'W FIgOC(f(gea nil -`` 'If5 Valuation
commencing with Section 700Q)of Division 3 of the Buono and Professions Cade) •�,. v+ • ,..� r
or that he Is exempt therefrom and,he basis for the allegd exemplum.Any violation "
-^M Section 7031.5 by any applicant for a permit subj",the applicant to a civil penalty
e or nor mmm man five hundred did.S500). 10 j APN ftTfWATI ON Occupancy Type
01,os owner of the preport,or my employers with wages as Their We compensation, 102 - PIERS '
"wlll Gut the work.and-the"structure is not intended or offeted'for We'(Sd:700.1'," 103 - UFER Required Inspections. -•" ')""1
'Business and Professions Code:The Contractor's License law does not apply to an
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or though his own employers.provided,ht,such improvements art am intendd or _ _
. -of&rd f _. _... ..._.__ _... .__......-_. __..._._._..._.- _.-
on,the building improvement of proving
within one year of SOS - ANCHOR' BOLTS •:(.�:, ;r 7o,It,•.;
improve,for the owner-builder will have the burden o!proving that W did not Wild or -
improwermrpurpose,orsde.), 106 - SEWER & WATER
_. 20'2--- -'UNDERFLOOR--PLUMBING
t71.as owner f the property,am exclusively contracting w th licensed contractor to 1 s
a rt t m )p t(sea ]len exam and Profession,Cde)The Contractor's2 03 - UNDERFLOOR MECHANICAL I' ' '
Lteeme Law does not apply to an be,of properly who Wilds or irrpmovt,s thereon
1' 7_ 4 _and who contmcu.for such.prolects.with a comru pins)licensed p tura t to the:..-. __.. 2 QGI_.,,_._UNDERFLOOR.---FRAME
..-_ ._ _. .__...._... ....,, __ -..__..__..
Clam ex mprun¢Lw " 205 - UNDERFLOOR:'-I'NSULATION
111 am exempt senders e' T. B&PCfor Nis moron
- ' Ower Dine 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
_ 0 Ihereby affirm undc o K.ofpep ry pgof,Nyrallowngdrewatinro: - 303 - ROUGH MECHANICAL
0 1 b.4tar will mam,ain'a certificate of Crime.,b;self-lmme for Workara 3 04 - ROUGH ELECTRICAL
C..,ma nil, as providd for by Section 3)00 of the Labor Code, for ,he
peffmot r onht wod for rm
,which his prit is is,.d.; r, 3 0 5 - FRAME
ite
❑(have and boll Ma +I Wak sC pen auon In dmrwe as q rd by secti'n EEOWNS
F (5p/ .WORKER LD
3700 f th Law,Cd f th peri rmance of tine ork r n n this pnmu roe
My V r s Coope ton Insurance c icy number are
mdR�' '"� 307 INSULATIONTROCK
308- 'SH
p
'CERTIFICATION ! �.�, 13.09' ''EXTERIOR1.LATH'q': 1
COMPENSATION IN ANCE 4 _
—310 INT'ERIOR-.-LATH . _ . . ---
ITh,isenun'nednmW'rompincJfthepermitisforanehundreddollars 311"- SCRATCH COAT
Ig IOU) rlesl .� 1
3.13.,,.-•...ROOF NAIL__.. . .. .._..._
'si 1 mfyihm'entheperfo yon, (th orki.r.beem¢hN ic,16t;Qt s L6d l 501 - FINAL ELECTRICAE�cENERGY
s 'shell n t employ any person y manner'61o,to aero 5.
b) t r die Workers
Compensation Laws of California Date
502._..__.FINAL._P.LUMBING__ENERGY__.._.__. _
NOTICE TO APPLICANT If,after making his C<nificmeaf Exempt......should 503 - FINAL MECHANICALe'ENERGY
tecome sdbjdnWor
orhe kds Cdnipenm,ion provisions of the labor Cods'you must
C) frith fin ply with inch previsions or this permushdlhednmedmvoked - _ _ 504 - FINAL BUILDING ENERGY
'coNSTRUCrIONLENDING AGENCY - 505 FINAL ELECTRICAL I '
1hrchY.lurathttheres cant , mending gncyfothe,d.irmance 506 - GAS TEST
'Lf th mk for h ch th prnn it u d(Sec J09]'C C) _
m d ,Name'. .' ... _.._ . . 5.0'7._-...FINALPliUMBING _._ .._._.... . __ .. ...___. _ _._._...
. qsZ Land AJ,, i, '�.: ., I[h'L.
U'rp ."''. " - 50' FINAL MECHANICAL
l cxn,ry ma a read,h opM<t rand suite then the W.information is 5 - INAL GRADE
context.I agree m oro I im all, y an J c rye o dmwnce. and ore lows rcl,ams
_.O,'.W to building constutum a hereba,hr re s tativesofihiscity1.cut,,upon 5 0 - INAL P NG
_r� ,he above •mian dpi yfarix ,o ser s ,. -_- --_
^rfln agree o a i demni y p e sth Cry fc pmdm againn 51 - INAL B RKS -
'h liabditi udgme s c is ex n. s x c y a any y accrue against mid
V'Zi-s Orymc uqin
APPue a a i t ! act i 'wrtxALLrTIaoL3T Issued by' Date
son r 1 , s t
t mu a ppl can cmuacb f ' Re roofs '
I HAZARDOUSM ATERIALS DIS 'OS'
r I IyteppliC. r future
, Wtiln occupantdo hautille He Ima¢nd nsp l' any. ._.-.".;•'•._,.,ex ._
as air ythe Cupenm Mun opal Chapter 91 and the Health and Saferyl �'Pe of Roofy
Cdc Se 53 4)?
r V I y,o � o
4,
❑vas If All roof shall bet ectad ionto roofing.material being installed. .. ..
W u,he appri a torfuture buildin o,upant use equipment or deices which If a roof is inst without t t t fining ati'inspectiori; I'agiee'to remove
emit hazardous air conmrmnants as der d b the Bay Area Air Quality Management
P
Disse _ understands and will comply with ..
r ovs a new.m ten s ns eco [canton _
(' all non- i s ser e r gulati f
I
be"
re th h - ou an Is u m ms rd6.95 of the
Cal m H 'hit S. We See, n 8533 and 255)6 I underses d Chet
d Idn due not fly e. t h r t my nepori b'1 tyr not fy the- - - - - - -
re t o e. h h s ,prl ao Issuance of Certificate of.
Oxv b' �� Sire fApplicant _ B'afer� -
':: w e author a agrn, _ ate: All roof coverings to be Class"B" or better
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tn;e 1.� - or alterations ,C-BE
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_f Cupertino.
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specifications J
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V C-Wti -B9& c' the viulaiion of any provi5ia(U j
V Odinenre or State Law,
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5230DC58 Design: 05/23/02
1 411 dimensions 8 size designations THE This is an original design and must.! Scale:maximum Date 06108!02
given are subject to verification on not be released or copied unless Omega Kitchen
job site and adjustment to fit job EXPO applicable fee has been aid or ob Beverly Ryan
I PP p t Cupertino, CAFDesi nerI conditions. oder placed. 0 Abuirbaleh