00090188�r6011E nl`1SION1V PERMIT I CONTRACTOR INFORMATION:
BUILDING ADDRESS:I PERM I'1No.
OWNER'S NAME:
PHONE:
LICENSED CONTRACI OR'S DECLARATION
1 hereby affirm that I am Iicemed under provisions of Chapmr.9 (cnmmcncing
with Scotian 711(0) of Division 3 of the Business and Pmfessions Cole, and my license
LIa full Iota and elect.
iceoc Clac. I.a,. k
Date _ _ Conhamm
as public mctmN
OWNER -BUILDER DECLARATION
I homby aflirin don I am c—apt loan We Comnmmr's License Law for the
following mato (Section 70315,Busiaessend Prdmsxivas Codc Any ehy of county
which momma a permit oh am. too. alms improve, demolish. of repair any slommm
Kier o its issuance, alar maniasthe applicant to .on permit n file a signed dement
that he is licensed pusuan' to the provisions of the Commctors License law (Chapter 9
(commencing with Section May of Division 3 of the Business and Professions Code)
or that he In ncmpt thercfmn and the basis for the alleged nmraptiod Any Onlaiion
of Satin 7011.5 by nay xplifcunt 161 it Pcnnit Ithlacts the eppl'eant to a civil penalty
of not snore then five hundred dollar (851x1).
01. us owner of the property. or any employees with cages as their ale connpenwran.
will do the work, and the structure is not intended or offered for sale (Sat. 7044,
Business and Profession> Chde: The Comrvdor's License Law does an, apply m m
Or mr f pmpeny Who builds ser improves demon, and who docs such work himself
omagh h6 own crrployces provided It mel, irnpmvcmeat, are not intended ser
uncred far sale. if, blhwovcm the building ser impmvcmcm is sold within arc year of
mnmpleion, the own omilder will have the burden of proving that Ie did not build ser
prove for propose of sale.).
❑ L as owner of the pmpeny, an exclusively contracting with licensed eunlrai to
instruct the prn]at (Sec. 7044. Business ,.,it Prol'epvion. Code ) The Conmactor's
L'mense I.uw does not apply to and owner of pmpeny who builds ar improves thereon.
and who contract far such projects with a umtmcmrfs) licensed pursmun ., the
Cnnowlor Liceopn�s1e L�mp'.
❑lame rip B & P C for this mason
Dw a / Dam X79
K171Z S COMPENSATION LECLARAnON
1 hereby affirm under penalty of perjury ane of the lldluwing declaration..
0 1 have and will maintain a Ccnificate of Comm n selfirrum for Worker's
Compensation, as provided for by Section 3700 of the Labor Code. 1'or the
lued'emmnce of the work Ibr which this permit h isued.
❑ I have and will maintain Worker'. Compensation Insurance, as required by section
37M of'hy LeMsr Code. for the pen�d//conduce of the work far which his permit is
namd.%IJNmilk ConnuCtsdam Mwmneecame,and Policynumberare:
f/Zy/-v COMPENSSHON INSURANCE
('This section need not be completed if the permit is for one hundad dollars
1S 1000 Or less.)
I ecday that in the pertormance of the work for %Inch this permit is issued. I
nuI employ anv,pe'ann in any nnmuco,,O agp,i...ouno nuhjee , da Workcrd
&conte.object m the worker's Compensation provisions of the Lobar eoue. you mac
forthwith comply with such pmvieioo, or this permit shall be deemed revoked.
CONS 'I'RUC']ON LENDING ACB?NC.Y'
I hereby allina that there is a construction lending agency for perlbnnunce
of the work for which this permit is issued (sec. 3097. Civ, C.)
Lender's Name
Lender's Addasr
I aril, that I have mad ads appreueah and sem that the above Inrnnnaaon Is
correct I agree to cnmply wino all city and coum, onho: ccs and ome la— relating
m bonding omsmoelon, and hereby mahoo,c moco,aii, cs of this city It, Inlet upnh
the aMrvomemioned property for inspection purposes.
(We) agree to save, indemnify and keep hannlesrthe City of Cupertino against
liabilities, judgments, ensu and cxpcmes which may in any way came against said
City aquence f}}h, gatingg t'Iis p. hit.
.am, ularaTnicrou 'ToisTiq NMl,lf I�OMPIY WITH ALL NONI'OINI
HA7ARDOUS MATERIALS DISCLOSURE
WHI the applicam or furore building I.Werit done ,, handle horandnus m:nedal
s calmed by the Cuperino Mi nieipul Cndc, Chapter 9.12, and the [Icahn and Safety
Cole, Seeinn 2553200'!
O Ycs t»fRl"
Will the applicant or future Wilding occupant use equipment or devices which
emit hazardous air contaminants as Jcftued by the Buy Area Air Quality Management
DOvict
i
:1 Y" El N"
I have read the leodmous materials requiremenn under Chapter 695 of the
California Health & Safety Code. Sections 25505, 25533 and 25534. 1 undo mad that
none building does amigo ntly have . tenant, that it is my responsibility in notify the
eupant of tx requiren�.s which t $y be mot prior to isomwe of aYCcrlrwam of
BLDG
Job Description
KITCHEN REMODEL
Required
34250002. 00
sun DA'ni
00090188
CONRol, NO.
09/29/2000
BUILDING PERMIT INFO
LECI' _ PLUMB _
1,
Valuation .+1 h
Occupancy Type
101 —
FOUNDATION
102 -
PIERS.
1.03—
LIFER
104 —
REBAR
105
— ANCHOR BOLTS
106 —
SEWER 8 WATER
202
— UNDERFLOOR PLUMBING
203 —
UNDERFLOOR MECHANICAL_
204
- UNDERFLOOR FRAME
205
— UNDERFLOOR INSULATION
301
— ROUGH PLUMBING
302
— TUB & OR SHOWER
303
— ROUGH MECHANICAL
304
— ROUGH ELECTRICAL
305
— FRAME
306
- HOLDOWNS
307
— INSULATION
308
— SHEETROCK
309
— EXTERIOR LATH
310
— INTERIOR LATH
311
— SCRATCH COAT ,
313
— ROOF NAIL
501
— FINAL ELECTRICAL_ ENERGY
502
— FINAL_ PLUMBING ENERGY
— FINAL MECHAN ENERGY
�, y503
1�-a4
- FTNAL BUTI—DATM ENERGY
Issued
Re -roofs 506 — GAS TEST
Type of Roof - 507 —FINAL PLUMBING
508 — FINAL MECHANICAL'
All roofs shall beSWcted gnl(WgI_al16R1qfiU material being installed.
If a roof is instal y�1i[houlFf'ilytlCli�iption. I agree to remove
all new materials r nspecfaciINAE?$11�1Itt�ff lijdf w� will comply with
all non -point sou L'r gu at
Signature of Applicant Date
All roof coverings to be Class "B" or better