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04070178I 3z z F^ W� lY � U C UC D- F �a U CITY OF CUPERTINO ' ���!^7777- BUILDING DIVISION PER eSCOt\fl l�[1CTll IL�1 �ATIV,N.w - 4 BUILDING ADDRESS: ,PERMIT "04070178 00407017B 7419 OWNER'S NAME: FERMITISSUBDATE ELAINE PETERMAN ONE: SANITARY NO. CONTROL NO. ARCHITEC ,ENGINEER: BUILDING PERMITINFO BLDG EIPCT PLUMB MECH = LICENSED CONTRACTOR'S DECLARATION lb Description oP 1 hereby affirm that I am Iimnnad under provisions of Chapter 9 (commencing wits Section IF").( Division 3 of the Businesses Profesdnns Co e,andmylicenx is in run Tarte ffat. /— Lice re c tie. x v '_0 e REPIPE MAIN WA CONTRACTOR: AL G LMNG ARCHITECi'SD An N 1 understand my plans shell he used as public records AUG OL 2004 Licensed Prorass...I OWNER -BUILDER DECLARATION I hereby aRrn Nat 1 am aemp, from the Cimm moes License law for the following reason. (Section 703 1.5, Business and Profusions Code: Any city Lir county which nations; a permit to construct. alms improw, demolish, or repair any swetum ,Her to its issuance, shot requires the applicant freshet Permit o fl.a.igncd is m um Out he is licensed pursuant to line provisions of the Contrutur3 LlCh0a Law (Chapter 9 Sq., Ft. Floor Area Valuat 500 (commentlng with Section 7000) of Division 3 of dee Business and Professions Crede) or ' Nat he is exempt therefrom and the bash for the alleged exemption Any violation of APN Number Occupancy e y �P Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not mon roan five hundred dollen ($5M). 35932032.00 1, as owner of the property, on my employees with wages as deeirule compensation. Required Inspections will do the work, and theswmure is not Inanded oro«ered (.,axle (Sec. 7W, Business and PmGasions Code: The Carlrer:rori Lialue Law deco not apply in an owner of progeny who builds or improves thereon, end who does such work himself or through his own employees, provided that each improvements are not intended mo«ued for sale. If, however, Ne building or improvement is old within one year of completion, the owner. builder will have the burden of proving the he did not build or improve for purpose of tile.). ❑ 1, as awrter of the property, am escltnively contracting with licensed contractors m contract the pmject (Sec. 706x. Rusiness and PmfeWons Code:) The Contmemr's Li. come law does not apply m an owner of yropeny who builds or improves thenar, and, who convects for such projects with aconuactor(O Raved pursuant Be the Contnclofs License law. ❑ 1 am exempt under Sec. , B J, P C far Nit noon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury aro of the following deelantlov: I haw and will maintain a Certificate of Consent to selGinsum for WorkolaCompen- Boom. as provided fm by Section 3700 of One labor Code. for Be performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance, a required by Section 3700 orthc labor Code. for Ne performance of the work for which this permit is issurA. Myworkerls�c9co�per/Wdon l/yunna 1artier and Policy number rte: Ca 'en >fyC fCPoIiM CERTIFICATE OF EXEMPTIO WORKERS' COMPENSATION INSURANCE mw auction wed not hecomplemd if the permit is Boom hundred dnilats ($100) nr less) I amfy Nat in Ne performance of to work for which this permit h iuwd. I shall not employ any Nixon in any manner so as to become subject to the Workers' Compevadon Laws of California. Dau Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject in the Workers Campenntion provisions of Ne labor Cade, you must forthwith comply with each provision or Nu Permit shall W dam ed ranked. CONSTRUCTION LENDING AGENCY 1 hereby a(Iirm Nat there its construction lending agency for the perfom arm, of the work for which this permit Is issued (Sec. 3097, Civ. C.) Larches New Lenders Address I anify dear I haw read this application and mute drat dee above information is ' Correa 1 agree to comply with all city and county ordinances and sum laws relating on building convection, and hereby authodn repnsenutivcs of this city to enter upon dee ahove-mcntioncd property for inspection purposes. (We) agree to saw, indemnify and keep harmless the City of Cupertino against lobilitiesjudgmenu.emu and exphnsa which may in .,way save agelmtuid City in consequence of to granting of this Permit. APPLICANT UNDERSTANDS AND WILL MPLY WITH ALL NON -POINT Issued by: ate SOURCE RE NS. Re -roofs Type Of Roof _ reol'AffpHemViZoinumenor Dam HAZARDOUS MATERIALS DISCLOSURE Will Ne ... liant m (mon Wilding occupant enamor handle huat doue material as defined by tse Cupertino Municipal Code. Chapter 9.13, and the Health and Safety ode. Sweon 25532(.)7 ❑YG U All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant Liu equipment or Jcvlca which mil hitotrdnus it cmmormanu an; earned by the Bay Area Air Quality Management all new materials for inspection. ❑Yes (k. I have now the hexudousmatcrials requirements underChepter6.95 of the Calirar. ria Heald ✓E SafetyCode, Smoora 25505.35533 and 25534.1 understand than f the Wilding does not current y haw a rant. Nat it h my mmunwihillty to entry the occupant of Oc ntmorrmnts which melptiormitsu horaceNamofar cy. Signature of Applicant Date ` All roof coverings to be Class "B" or better Dear r a .rim sent Dam • �; y Community Development 10300 Torte Avenue ' - Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPERTINO Building Department • I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followine information: JOB ADDRESS: / •901 PERMI BUSINESS NAME OWNER'S NAME: <G e vtvhu PHO Cabinets & Millwork GENERAL CONTRACTO FAX # • I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followine information: Zy/r/Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering ' Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Zy/r/Contractor Signature Date s CITY OF CUPERTINO WREPIPE/SEWERS/MAIN SERVICE CUPEI�TINO PERMIT APPLICATION FORM 00701 ?8' APN # Plumbing Permit Issuance Date: 3s a© .2 m� Building Address: Bldg. Permit Fees BUILDING c o PLUMBING Owner's Name: BPWSVCS Phone #: PLUMBING 22, Sewers Contractor: Phone: License #: 76®�( 3 PLUMBING BUSLIC Business License Contact:� Phone: Cupertino Business License #: �1 c ti as s- _ -s— ���s Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: I 2e e0e rK c.l k Residential ® Commercial ❑ Cost of Project: Cir Qty. if Auolic2 a Fee ID Fee. necrrintinn Fee Crnnn PPERMTI'FEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING # y 7-r 3��. 573