02030026 (3) CITY OF CUPERTINO ' . - '
BUILDLNG DIVISION PERMIT • CQI`TRACTOR IN'FORM.aTIC
BUILDWG ADDRESS: - PERMIT NO.
10395 BRET AVE. 02030026
OWNER'S NAME: APPLICATION SUB DATE
SAM WILLIAMS 03/07/2002
HONE: SANITARY NO. CONTROL NO.
C¢Z ARCHITECT/ENGINEER:
p±C O BUILDWG PERMIT INTO
&an F. BLDG ELECT PLUMB MECH
u`� U C=1 L.-J IJ
t <a
n i LICENSED CONTRACTOR'S DECLARATION
= I hereby X.that 1 um licensed under provisions of Chapter 9(comJob Description
P
mencing
;ytu9 wilhScnion7000)ofDivision3Dish,Business naPmfentries Code.and mylicense KITCHEN REMODEL.
t m is in full force/nQeff t.
mil u U License C' ( Lie S
!LL O G ARCHITECT'S DECLARATION LE
4 1 understand my plans shall be used as public records F8Nd
i�'u00 Licensed Professional gat q
LL tthat I am e,mmDER m the CoATION AUG 0 O 200E
1 hereby.(Seta that 1 1. exempt from the Gnntrns C s :Anse Law for the
t-Z O following mason.(Sutton]031.5 Business and improve,
de o demolish.
Coate:Any city or down,
acture
to xF o which rryuirts a permit to mnswn.altar,improve,demolish,or repair any swaum $15000
i3�ed
prior to its issuance.also m,luines the applicant for such pemnitto file a signed statement in nimr.
Nat he is Iinmed pursuant o The provisions of the Cmtmct&s License Law(Chapter 9 j p /�,lp Valuation
(commencing with Section 7000)of Division 3 of the Burliness W Professions Code) 3 1 V b V Ua.
or Nat he is exempt themfmm and the basis for the alleged demgion.Any violation -
of Section 70313 by any applicant for a permit-subjects are applicant ton civil Penally
of not more than five hundred doBara(SSW). 101dkPN t'UUNDATION Occupancy Type
❑1,as owner of Ny,e propanLir my employres with wages as their sole compensation,
will do tm wdrk:and the structure is not intended or offered for sale'(Sam.7010, -
Business aria Prefea.iom Coate:The contractor.License law dna:not apply to N
103 — UFER Required Inspections
• r or pmpcny wno nuuas or impmv<s mereon,aria wno aces:Lien work mmsdr
owne
or fl roegn ms own employee. Prodded that such improvements am not intended or .10 4 REBAR
-af(aed far side:If hawcver,the building or improvement is sold within one Year of
completion,Ne owner-builder will have the buNen of proving that he aid not build or 105 — ANCHOR BOLTS
improve for puryose of Mle.).
_. _
106 — SEWER & WATER
❑Lasa he .jo propcnY.amBasin...andnttxtingnsCocensedcCoacmrsto 202 — UNDERFLOOR PLUMBING _ i`: -
Lonswa the projm(Sat.]000,Business and Profcssians Code:7 The Commnor's '
icense Law dors not apply to an owner of progeny who builds or improves theme, 203 — UNDERFLOOR MECHANICAL':'
aM.wbe mar.cts.for such pro dc.with Is moussmal licemnd pursuant m.the
Commoner,License Law.• 204' = UNDERFLOOR FRAME
` ❑l am exempt under sec. B&P C for mason
205 — UNDERFLOORfINSULATION
ENS 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
I Wrlb firm uMer mt r' g 302 - TUB & OR SHOWER
y. pen Y a perjury Consent toollowla od for wor. 3 03 — ROUGH MECHANICAL
❑ 1 nage dna will maintain.cby Secti'of cote nt to L dad,for worker's 304 — ROUGH ELECTRICAL
Compcamando, as provided for by Section 3700 of the labor Cade, for she
perrorineore or Ne work rte worm Nis pem,it is iMued.
305 — FRAME
01 form and will maintain Worker's compensation Insurance,Its,sequined by Sadlim 3 0 6 — HOEDOWNS
issued.37W of do tabor Code,for Ne perfomwnce of the work for which this pemdt is
My Worker's Compensation Insurance carrier and Policy oamber art;: 307 - INSULATION
Currier 1 s• I SATIONP ION FANM - .
.. .. - . .
- coMPEN. 30;8.; ";S$EETROCK � ,
Policy
No
WORKER '
$�� 309 - EXTERIOR LATH '
IThisixamn'nicea out xcnm dated if .. .._.. ...,._. ._.
31'0.;-:';I,NTERIOR LATH___- :_,__
fs10D)wless.) p the is rte one nuMmd aouars — . ... .. .. ---
_
311 SCRATCH COAT
.'1'r<nify Nm in the peAorm.na'of the work fry wh'h this perms Is issued,) -' 3 T3 = ROOF'NAI Ii- ' ' "-" ' " ' " '"' -' '-- -
Coral Stat etioploy any pt,..in an m is Abe a Mbbn to Ne Workers' —
... .. ...
shal
pen. w , d° " mac 501 FINAL ELECTRICAL ENERGY
App ICE 502 — FINAL PLUMBING ENERGY-
66.
NOTICE yHodic nificate of Exemption,you should
z mesabjetnomewoeker.Com smionPmvisan,ofthe laW,Code,you must 503 — FINAL MECHANICAL ENERGY
Or comply with such provisions or this permit shall W deemed revoked.
504 -- FINAL BUILDING ENERGY''.-..
' CONSTRUCTION LENDINGkali,agency
Iherebywhichthanhertisscsued(Sc. Ienaingagencyforthperformande 505 — FINAL ELECTRICAL
0.--0., of Ne ',N forwhichthis peemit is issued(Sec.309],Civ. .J 506. — GAS TEST
'l1Mcr's Name-._.. - .. .:. .
lindef's Asmndsr _
U-0 507 - FINAL PLUMBING
V-� T. .I lenity that I have need this application.1 stem that the above infammion is 508 — FINAL MECHANICAL
,aa..;:
Or, cmim.1 agree to comply with all lily and county ordinances and sme laws relating
; to Wilding constructions and hereby authorize midesentratiles Ofthis city to enter upon 509 — FINAL GRADE
W she above-montiooeEproprty for inspection purposes.P 510 — FINAL PLANNING
? : f%)agree to save,indemnify and kap harmless the City of Cupeniim against
Igll liabilities,jadgmenm,costs and expenses which may in any way accrue egeinsr said 514 — FINAL P C WORKS
U.Z City in to sequcnc f Ne granting -
_ '" APP ICANT R TAN wTLL CO. ITH'ALCNON OILT y. I Date U Z�
so c Issued b
S' Nie of Applican D e
'
RA RDD ATERIALS DISCLOSURE Re-roofs
Will the applicant m funno building aapam store or handle Wiardous muerial Type of Roof .
m defines by Ne Cupertino Municipal,Code,Chapter 9.13,and cite Health and safety -
Code Solt on.25531(.) .. r .. .
❑res •s: p t�... .,.: ...-.
All roofs §hall be.ins ecte iior,to an
c P S3 P y.roofing_material being installed_ _
M'Ii Ne eppraami f tare„mated«That Bayed da Air oroe Management - If a roof is installed without first obtaining an inspection;I'agfee to remove
mit hazardous au contaminants ns defined by the Bey Area Air Qudliry Managcmem g
°is.""oYm No, all new materials for inspection. A licant,understands and wi11_com 1 with.
all non-point source regulations;
-pp., comply
1 have Dead he
Calif m•HeJth&15e'fay Code,Stttionslter 695 of the
15505,!mmenz under 35533 and VISM,Ipunderstand that
Deco Int or B start currently have a tenant.Nat it is my nsponsibilit to notify the
Ottupm dxs not tarns: Th must 4 me riot to issuance of Cenifica -
t N . .
P t
Signature of Applicant_ Date
np;or auNodxdi t' - -
" "• am. , All roof coverings to be Class"B" or better '
... - s r.'„.:•.a ..n..�,--.. ....._.. .- .. __. .. :..r^-'--:.: u.'g.._. _- OFFICE_ .. .. . ._...___._._ -
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SUBMITTALAPPROVED
�r tIN CORDANCE WITH THE CITY Ofi
,gdarJRTINO�ODES PV-41) ORDINANCES
IDATIF
SIGNED__
This set of lid spec xMions MUST
be kept on he j a I times and it is on
lawful to m kc any r,.. r s or alterations
On same with u, n pe.mission from
• the building 7ep ., C'. Cupertino. C
The stamping v. I'.° ' n ,Id specifications yam, n
SHALL NOI he ,e.: I t-- mit or to be an
£
approval of 11e v;,la..,n at any provisionsx
w=
of any Cir. � d n-,nre or ;tate Law.