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00030084 CITY lGl OF ➢ ION o BUILDING VISPERMIT CONTRACTOR INFORMATION: BwlD ICKSBURG DR FERMI rNo 00030084 o"'CRAIM: FRANK T AND DORA K APPtlWT41tWoo � ON E: SANITARY NO. CON'IROI.N0. C z iARCHITECf/ENGINEER: BUILDING PERMIT INFO 'y W 0 BLDG ELECT PLUMB MECH v= LICENSED CONTRACTOR red,,,S DECLARATION Lob Description iZ=e In70alfiof is 1 i3nheBvarierpratPr.feofChapter9ndmmenemg KITCHEN REMODE� itef_; with Seen..force and fnclvisinn3nl the Business ane Profersinns Code.and my license is i e full farce end office. Oa.U License Class Lit.p Dam Ar 1 u C ARCHITECT'SS DECLARATION .! 1 understand my plans snail be used as public records 3 M E O Lis...ed Professional 1 5,c y OWNER-BUILDER DECLARATION / W-v 1 hereby affirm that I am exempt from the Conlmctor's License Law for the F z a followins reason.lSo,,ia 17031.5,Business and Profession,Code:Any ri,y ar emumy l/ $20000 E x e which requires o permit to construct,alar,improve,demolish,or repair any nruaum (� i3m prior to its issuance.also requites the applicant for such Permit file a signed indention - - -- — - thinheislieenadpunannuo the promor;ofthe Con.,.r.Locia,Law(Chapter 9 9&pl©t6D9,afkp,.. Valuation (commencing.ith Section 9000)of Division 3 of the Business and Professions Code) I ''t r i r _ or Nat he is exempt fl ertfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any anthem,No a penis subjects the applicant to a civil pcdairy of net more man rive hundred dollar,Y00) 1 PN-NFj T ON Occupancy Type 01,as owner of me propany.or my employees with wages its,their sole compensation. 102 - PIERS wilydo the work,and the'structure'is net intended or offeree for sale ISec.7044 'Uj; Business and Professions Cede:The Contractor's Licemc Law does nm apply to _ Required Inspections' owner of property who Wilds or improves thereon,and wino does such w-ark himself 104 — REBAR or through no own employeesprovided has such improvemnol are not intended or forame.Ir:however.are naBa,n . . . t i.sem w'in'd ave year ar - ... 10 5 - ANCHOR '�BOLTS -- offered _. ... .. _ . ... ... . . g or,mpm .. . omplmlon,me owner-builder will have the burden of proving tom he did not build or 106 - SEWER & WATER improve for purpose stands.). 01 ssowne�dlnc�n�perti[a���aea.mero�aal�d,nswLnrak�aramrarmrsm - 202- - -UNDERFLOOR PLUMBING : . r onatmrt the project Soc.7044.Basmeas and Pmfrourna Cade:)The Contractor's 203 - UNDERFLOOR MECHANICAL. S License Law dues not apply m owner of property who builds or improves thereon, dna wna.rommu.rat mj earn praens.wan ,romrarmds).nrrnsell.parsuam In die _. _.. 204. .=...UNDERFLOOR FRAME_.. ...._ ..-. .. ... . Contractors License Low. 205 - UNDERFLOOR INSULATION ❑1 am exempt under Sec. B&P C for this rtamn 301 - ROUGH PLUMBING owner W'ORKEft'SCOMPENSATIONDECLARATION 302 - TUB & OR SHOWER . : I hereby ofrm,ander pcnm,y of ferny rine of me following dedinaliana: 3 0 3 - ROUGH MECHANICAL �.. 1 have and will ;PP main a Cenifieate of Consent to self-insure for workers 304 - ROUGH ELECTRICAL Compensation. as provided li,r by Section 3700 of the Labor Code, ler the 305 - FRAME performance of the work for wn,h this permit is issued. 306 - HOLDOWNS ❑1 have and ,It main fin workers Cmurvensa!m meuransc,as....irod by Sectron 3 0 7 - INSULATION 6s �37W of the Labor Code,for the perio mance of the works for whmh his permit is .. . issued.MrWorker's eaml><nsatmnmsuraneecamieranaPabrynamberam: 308 .--. . SHEETROCK.. carie;: 6.''' ""s Policy No.: 3'09 -`; EXTERIOR _LATH CERTIFICATION OF EXEMPTION FROM WORKERS'. ' _',_COMPENSATION INSURANCE._. ts '(T,iswrkti nred act becompleted ifNepetmhi.for one Wroleddollars 311' - 'SCRATCH COAT. loo)aness.) 313.. ---ROOF..NAIL . _. ., i enliy'mai in'hu.per ane0 of the work far wit eh to p h'k o md,'' 316 - INT SHEAR " t .., .r.','' 'shall not employ any person is any manner so as m become subject to he Worker' Compen:atsonLawsofCalifornia. Date 501 - FINALELECTRICAL ENERGY 'Apprcaat - .. __. .. ..- _ ...... .. Nor ICE TOAPPLICANru,after making this CeniBcateofExunptlan.you should 502 - FINAL PLUMBING ENERGY Z become witiect to the Worloo's Compensation provisions of the Labor Code.you mm" 503 - FINAL MECHANICAL ENERGY C O fonhwitheomply with such provisions or this Permit shall b,deemed revoked. Z . " 504 = FINAL -BUILDING ENERGY.� - .Nn ' CONSTRUCTION LENDINGAGENCY .a 7 ''I hereby affirm that there is a comwction lending agency for me performmicc 505 - FINAL ELECTRICAL ` G matbsoedlser.ag97.cm.c.) - 506- GAS TEST r,,, of In.work far whlcM1 oris pc . . _ ... . . gt� ..1<nee.a Name• - .. ._ .. .. _. .. .. Z 'Lenaennaa as 507 - FINAL PLUMBING ' U O I rectify that 1 nave mad this appliearnn and stair mat the above mformatmn is 508 — FINAL MECHANICAL correct.I agree to comply with all city,and county ordinances and state laws relining O U to Wilding comtmction.and hereby radianu represemztives of this city to enter upon 509 - FINAL GRADE y Ir] he:move-memioned pmpeny rm inepecimn pmpa,i,, I rF. p„ (We)egrectosave:indarmifyand keep narmlescrhe CityofC.,cPmo — agmnst 510 FINAL PLANNING lin liabilities,judgment,.rots sad expense,winch may m.ay way aerrre.gains,said 514 - IN WORKS Ciry in consequence of me granting of this Permit. -API'LICAN'i'UNDERSTANI)SAND WILL COMPLYWITHALLNON-POINT Issued b�: Date 'SOURCE REGULATIONS. " ' Signature pf ApppcanvCommcmr , Date Re-roofs HAZARDOUS MATERIALS DISCLOSURE' WilhNdate.,pii..or fugue Wilding oceupant store or handle hzurdend marenal Type of.Roof ;a,defined by the Cupertino Municipal Cade.Chapter 9.12,and the Healm end Safety 'Code.Section 255321x)^. 1.5;'x, :, - •. . ❑Yc, 'oNo. :. AEI roofs shall be inspected prior-to-any-roofing-material being installed. _. ..-. will the applicant orfinum building occupant use equipment mcksioOs.mrn If a roof is installed without first obtaining an inspection, I agree to remove Pit fie s aircontaminants as d fined by(be Bay Area Air Quality Magement di all new materials for inspection. Applicant understands and will comply with wee ON all non-point source regulations., 1 have read me h rardous materials requirements under Chapter 6.95 of me Cobfi mid Health&Safety Code:Sections 25505.25533 and 25534.1 undersmnd lhm _ if the building dues nm runcntly have t renam,that n i.my Poppnsibillq m notify the occupant of the requirements which must W met prior to ismance of a Cenificam of ' o c"Pan°` _ Signature of Applicant Date Ow.net or authorized agent " Data All roof coverings to be Class "B" or better "' - OFFICE CITY OF CUPERTINO PERMIT NO, BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: 009304094 BUILDING ADDRESS: 1 /9766 rzksha g/a�C pY zYIU SANITARY NO APPLICATION .SUnBMI TAL DAT OWNER'S NAME: V TA / 7•L / ) ` 1 C. Q /� v �'E�'R�,' \ NIC CONTROLX P / 1 C ❑ A�IT��/NUINEE BULDING PERMI"1'INPU 00 UEm N n LICENSED CONTRACTOR'S DECLARATION O_zo„= 1ion7 dimsdust Iem damBuunder nd Preldnaof Chapter Neese 1. Job Description 2:❑j iwith Station TB08)ocDivision3ofthe Business and Profeuions Cade.and my license is he < in full force and affect. he he fVe.•..Clan L:e.N ��CL w 3 w Date Coneecror. F-u.O S ARCHoRiCTS DECLARATION fy IundmWe mypWsthdl be uudu public rccards zas uxenred Pmr..iand OWNER-BUILDER DECLAMTLON H z a 1 hereby a(Seco on ram exempt froman the Contractohs License law for Nc `z❑ following reason.(Section 1031.5.Business and Pmfesaimv Cade:MY city or county 3 m which rtquiees s Pamirs to cotuwn,dw,improve,dennliN,or rtpe'a any avucrosc Sq. Ft. Floor Area Valuation primmits isxuena,Jm rtquim the appbcam for such pertnitmDk uigned ataerrent ^0 --c”' Nn he:a licensed pursuant to N)provisions of de a Buss tor,Littnu law(CWpter9 of that he exemptnsactina T0o0)os,beenioor th Neaaai�exe tawon.Aninn.enx)tar APN Numbe Occu ane T e Wt he is rump thaRrom and do been;far the dkged exemption.to a civil violation of /T Ply.Y� 'YP section 7031.5 by any dont fm.permit subjects the yrylirant m a civil paW7 of V D wit moth than Eveec'm hundred dolor....pi. I,aanwncrortWpropeny,mmycmployee.withwagcau Heir sole comp Bear.. Required Inspections will dofework,utathehe Com is iwt:.ravens Law forole(Sec.90 an owner uW Profession,Cade:The Contractor's,License w law docs txw apply e lf owner of his property who build,or video such i,and who edea such work ted or or through his own owave ft provided thu such mentis old w..rpt inended m offend for rale.If.however,ted wildinguren of roving issoldwithinoreywafmprve for tM r-W ilea will lave do Wrden or proving Net he oleo not WiW m improve for Pur- Cl st in owrw of the Ses.property an Buttress ad connecting Cod licensed condor.to construct the project(sec..an Baine.and Profeai bur Code)Tha Conation.and who law does nm apply to ts owner o(properry who buil,,or..at Netto.,and who contracts fm such proiau with a conhador(q Ikensed parsaam m the,Cdntractore U.N.law. lam caemPtuMcr Ser. .B&PClue Ni rtnan Owwr Dna /3 WORKER'S NATION DECLARATION 1 hereby.form under eery f perjury ore of Ne following dtteuetiom: I havcand will msimaina a¢ofConunuaulGinmrtfmWorkehCompen- snion,in provided for by Section 3700 of the Labor Cede.for Ne petfomuma of the smk fee which this permit is issued. I have and will maintain Wortces compensation Insurance,as required by Section 3700th'the Labor Code,for the performance of she wort for which this permit is ora d. My Worker's Compensation Insurance carrier and Policy number are: - 1_ Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' //��\ COMPENSATION INSURANCE E ](Ibis sedummarra Weompkred BNe Permit i,for.hundred"Bear 5100)m lea,.)Loyany Pars on the anymanner o as toworkbec for whichtio me Worn imiCo Hill R 142000 .employ any person sany manner,oastobecomewbjecuoNeWoM1eriCompxn- ation laws ofCeliromia.Dale A,IkahmtNOTICE TO APPLICANT:If,after nuking Nis Cenifreste of Exemption,you should bacer.,ubject to Na Worker,Compansuion provisions of the labor code,you must forthwith comply wit such provisions or this permit shall be deemed revoked, �"'�•�- CONSTRUCTION LENDING AGENCY 0 O (hereby affirm Nat Nem is a construction lending agency tonne performance rzi Ne wmconstruction for which this permit is issued(Sec.3097,Civ.C.) Landers Name (� > larders Adores, WFz 1 certify door 1 have read Our application end awe out ted above mice.en is 91. correct.I agree to comply with ell city and county calui cez and sate laws misting to r7 z building construction,and hereby authodu cepreunwiva of this city to enter upon the V 0 above-mentioned property for inspection purposes. W P (W.)agree m save,indemnify and keep haradess the City of Cupertino against C U liabilities,judgments,cozra and expenses which may in any wry name against said City } W in rohuqumce of the granting of this permit. [� P• APPLICANT UNDERSTANDS AND WI LL COMPLY WII H ALL NON-m1NT SOU RCP.RVOU IATIONS. �)/�/ r / r7. 3 � U Z �egM / A7r/A/Vn-/ l l/!n I / . 3 Si ufA,IicandCmm.Ior Data rJ s:�d V G• - H R ATERIALS DISCLOSURE Hill do applicant tar cot ilding accupanumthmhaMkha.Nous mawid Re-roofs o dcfired by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Type of Roof Code,0Yes25532(gP m4e_ YP l Will the applicant or future Wilding occgpant use equipment or devices which All roofs shall be inspected prior to any roofing material being emit Noneadous air contamhunta as expand by Ne Be,Arte An Quality Manegarem installed. If a roof is installed without first obtaining an inspection Ask DistderP eke I agree to remove all new materials for inspection. Applicant 0 Yea Ifa.reed the hvwdou,medals,m9uiramena muter Chapter 6.95 of din cob un er$tand$ and will comply with all non point source regulations. 7b.0ding Health&safetyCode,Sections 25505,25533 and 25530.I understand that if Ne .Nm this.nm currently have it is my responsibility notify the occupant s n inch muse 1,4ret'a.a into...of. if, OccuParn 7 / Signature of Applicant Date or mittemnsindiistun a All roof coverings to be Class"B"or better OFFICE