01040068 CITY 10ENUPERTNNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT'NO,
2103 STGGK6MEIR GT 14 1 fA4 10062
OWNER S NAME^ APPLICATION SUB p7Z
t10NE; - SANITARY NO. CONI ROL NO,
Q O O ARC111'IECI7ENGINEER: ✓ ISUILUING I`ERMIT'INTO m_ BLIK IiLIiC' PLUMB A11i
u
I•J 1.I l _I --a l
Goa
S v 5 f...that
I it CONTRACfDR'g Ur:CLARADON Job Description
0%.,O I heathy afar That 1 Iuu lifiha B,ina,Provi.inrv,of I,Cadr,am!at license
caws_-w is in Section foreland ofect. un3ofahe ltusinex,nnJ l'rofc..inn.Coda,unJ myliccnxe
ca'--- is in full fume and effect.
s6a ueca"Clb,x Lic." KITCHEN REMODEL
%%O o Date Conlucmr
eeOh ARCHITECTuse DECLARATION
a. FINALED
W..
g 1 under.dnJ my plan,,hall he u.wJ m PUNic rca,d,
W
p O Liean.ed Pmfex,innal
OWNER-BUILDER DECLARATION NOVV r+ 9 200'
W= 1 hereby altirnn that I a exempt from the Coutomr
e ,Licem,c Law fame
!"a a following reason.(Section 703L5.Business and Pmfcx,iom Coda:Airy city or county
e�F O which requites a permit to construct,alter,improve,dcmolixn,or repair any structure,
prior it,1..0Enter,ul rcyuirc.the upprcunt loruch pari file u,igned,iaapaaI
cont he ix ran.eJ rarxaam In the pmvLi,m,of me Contractor,l.iecnxa Law(chaplcr 9 Sq. Ft. Floor Area I IILDING Valuation
(ammmamming with Salim.70Cx)1 of Division 3 of the Bu.ite,and Pnnex,ionr Coda)
cur that he is exempt Iherelrnm and the busts for the alleged exemption.Any violation
nl Section 7011.5 by any applicant for it permit,abject,the uppllcanl le a civil anally
of matmom than roe hundred dollar.015001. APN Number Occupan'
❑1,a,owrm,,fuse pmpw nr my ampleyew,with wage,as hvir"'In em,q,en5aaon.
will do the work,and the,lunare i,not intended or offered for sale(See.7044, 'M 709024 0
Basins,,and Poalea,ion.Code:Tac Contractor',License Law does not apply or as is ,red Inspections
of property Who baikk or imprn e, henan.and who Joe,awn wars hi:nxelf
nr through tin own employee, pn,mded that such improccownu are not intended or
offered for sale.If,however,the building or in,pmvemenl is wild within one year of 101 — FOUNDATION
fmNnion,theawneinluicierwillh:vethebnmenafpmvmgthatheiidnotbuimm - 102 — PIERS
prose purpuu•o-
[; awn r of the pmparty,um exclusively contracting with licensed contractors to 103 — UFER
rostrum the pr Jttn(Sec 7144,B:ninn,and 11 deux.,..Cm1r:) I I,C.moacmr'n
Laramie Ww does ma applyto vatnwher f,,,.pony who build,to im,i flumon. 1.04 — REBAR
cn . -r sawn prajeel,with true.,,)licensed Pursuant m the
onarcon,d who arm. 1, ° , 105 — ANCHOR BOLTS
❑lmaexeml anr IT `C to,mixre..on 1.06 — SEWER & WATER
Dx 'aI'oef_- 202 — UNDERFLOOR PLUMBING
'ORKE WS C( `I N, N :LCL RATION
hereby amnn aadcrp , ydlxrien era ad ma r,uewing acnma,;,,n„ 203 — UNDERFLOOR MECHANICAL
'a 1 have and win normal. a CeniBwme ar Consent to.elf-inane for Werke:. 204 — UNDERFLOOR FRAME
Compc,ation, its ptoiald for by Section Tax) of the Labor Code. for the O5 —
pcd' naa
ornermawerklorwhol,mi, cnaili,l„ued. �0UNDERFLOOR INSULATION
❑I base and will maintain W leer's Compcn,mion Imuuncc,as required by Seen.. 301 — ROUGH PLUMBING
37x)of he Labor Cede,ha the pedormamr,d the were for which ad,permit 302 — TUB & OR SHOWER
i..am.My Workers Compcn...ion Imwace csonar and Policy amehef are:
Cut e,: PeliryNo.: 303 — ROUGH MECHANICAL
CEKIIFCAt[ON 01;EXEMPDONFROM WORKERS' 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE
(na,section nem not the a,n,plcted it the,,wail is for one hundred dollars 305 -- FRAME
nlnnmles.) 306 — HOLDOWNS
I ecrJfy that in the se,I usaee of the w...k for whiehl his permit i,i....d,1 307 — INSULATION
shall nm mnploy any,,cram in say mannc,.,,a,to hemon,s.bjc,,as the Wo den' 308 — SHEETROCf'
Compensation L:nxv of C.lifnmin.D:nc 5
APrh`a,nl bna1J 309 — EXTERIOR LATH
NOTICE TO APPLICANT:If,star making this Ccnincme of E cau,noo,you
hea,me ti...the Worker,CnmPemrlion pmvi.ium of the Labor Code,you must
bamwihr comply with,uch pro,kdens e,nit,parnht shall be deernI:I revoked. 310 — INTERIOR LATH
CONSTRUCTION LENDING AGENCY 31.1 — SCRATCH COAT
1 heathy affirm but nacre i,a con,tmnic.landing ugcncy bathe p dommore
of the work furwhich his pam,it'I, ,mal(See YN7.Co.C.) 313 — ROOF NAIL_
7 Z
Under,Name 501 — FINAL ELECTRICAL ENERGY
Lalldcr',Addaux
UO Iaanifythat Wavemadthi,application rant watcabalthe abaweinformtionis 502 — FINAL PLUMBING ENERGY
a.. E. ca rnct.I agree to comply with all city and county onlirunea and Stam laws retaaing 503 — FINAL MECHANICAL ENERGY
O V Ion ll A ,.ration II hY the pman—of' thi it, t..up.,I
y then por,anyf specti prart 504 — FINAL BUILDING ENERGY
.�y L (W)agree to save,indemnity ads,harri mewl fC pan ,ugmmt p�
Z I:Ihrr. J p .w, 1 nI r :Iffy r a sm,t.wd Oe 505 — FINAL ELECTRICAL /
V L City in co nc of the gl-enung el mi, h.
APPLICA, ON 'RSTANDSANDW OMPLY WIT ALLNON POINT Issued by: 506 — GAS TEST Date
S UNCI: Is Y'
/Sign-4m,
ofApplicanaconl 'tor Daae Re-roofs
IIAIA )oUSMAEHRIALSDISCLOSURE 508 — FINAL MECHANICAL_
tori(me apprwama Injure budding occupant store or handle mar:,mna.Iutcd:a Type of Roof
a,dcfined bythe Cupertino Municipal Code.Chapter 9.12,and the licallh and Safety 509 — FINAL GRADE
Code.Scatter 25532(u)P
0 Yc. 0 N All roofs shall be 54)ELted pFidlP* Anyli4folAll#+f> t1E5rial being installed.
Will the applicant or fvmm building occupant use equipment or des ices which If it roof is instal lettli$rilthout Irrr:INMtLinift'$JgUil$ed`7@vFeree to remove
emit humolou,ah conhar..ona,m Jefned by the Bay Area Ai,Quality Management
Di...o? all new materials for inspection. Applicant understands and will comply with
0 ye, C3No all non-point source regulations.
1 have read the havardua,materials reyuin:memx under Chapter 6.95 of the
California Health h Safety Code,Scant u.25505.25533 and 25534.1 umkremnd that
Ed hail g ,not currentlYI enant th it h i,my rcpomihllay to roudy the
cupid n c equirnmmts whi n I he Incl prior nlLrme nl a Ccnilicule ul
MLuPa Signature of Applicant Date
r er aamori.m ager — Daaa All roof coverings to be Class "B"or better
OFFICE