01080013 (2) CI BUILDF c DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10075 CRESCENT RD SHOWCASE KITCHENS 01080013
OWNER'S NAME: APPLICATION SUB DATE
STRACHMAN HOWARD L AND IRENE 3 12333 SARATOGA-SUNNYVALE RD08/03/2001
IN PHONE: (408) 253-0412 SANITARY NO. CONTROL NO.
w O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
m BLDG ELECT PLUMB MECH
Naw6 LJ i--I I-1 GI
z S N i LICENSED CONTRACT'OR'S DECLARATION lob Description
O 2_ I hereby affirm ma,1 am licensed under provisions,of Chapter 9(commencing
E.qs< License
sinessanJPre n,e.ae.at,amyronse KITCHEN REMODEL.
zml; is in full forte and efts
to—z Date Class Lic,p
O U Dam O ommetnr /
m u O G RCHITECT's DECLA N )
de }g and ffesum mY plans sM1ull be u¢J a,pubL re rd <�"CJ/
.'I p Licensed Profexsional jO
x OWNER. WILDERDECLARATION
I1r ='1 1 hereby allure that I am aempt turbine Commit.,',License Law mane
-z a following reason,(Section 7031.5.Business and Professions Cade:Any city.r countyar, $57991
Y O which requires a permm it comuuct.alar,improve,demolish,or repair any structure
to prior to its' a< requires the applt lot such nmot to File a signed.,mmemIld _._ .
(co he 'I with
no,n p '.vi l e t nrasinr Lavow 'ICI Code)
�({. glo 1�pOI" e8... Valuation
(commanding Set 7000)of Divi 3fen Basin d tlP.fAnyvi C.Je) f-r11>-� 3.20,U.'b Ub7 .'OUB - �) S,•
or that He is exempt thcmfrom'anJ ar basis for the alleged emmpu.m Any violation
of Section Than veanyapplicantfora pcnni,subje<u the applicant,on,civil perui,Y' �i,, -NI. Occupancy Type
..r not mare Than Bye hundred ealart asool. 101 APN P'C7�AT I ON
01,as owner of the p n,cay,or my employees with wages as their sole cen for satin,
- will do the work,and the structure is no,intended or offered for sale(sec:7043;
Buiiness and Pmfcssloo,Code:The Comr oar's License Law doe,not apply m an 103 - UFER Required Inspections"
owner of property Who builds or improves thereon,and who does such work himself
n,through hi ply :.pet J d Tom h imP c t. ,mended .._.-... _104_ _-REBAR ...._ .__ .-. .. ....
"off f 1 If,however,,M1 b ldin a ..
s p e t. la tdidno, or 105 - ANCHOR BOLTS
completion,on the owner Wilder will have me buNrn of proving that he did not Wild or -
imp rovefmpuryose.f,ole.). 106 - SEWER & WATER
OLmowner or Ne propcnv,nm enclusivcly commming with licensed convwmm,n 202 - UNDERFLOOR PLUMBING
construct the project(Sec.7(041.Business anti Pmfeaions Cade,)The Contractor's
License Law cases two apply,.as owns,of property who hood,or improver thereon, 203 - UNDERFLOOR MECHANICAL '
._ .and whocornmcss,for such mijeche with a contracmnsl licensed pumunt.,o,he
ContracmrsLicenseLaw, . . . . 2'04 " UNDERFLOOR- FRAME
❑Iameaemp,unaelsee. ,B&P.c r."m,rea<an 205 - UNDERFLOOR•' INSULATION
- _ ownerDale 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby afrte,under penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL
0 1 have and will mai;nain'a andi,me of Consent to ,elf-Insure for Worker, 3 04 - ROUGH ELECTRICAL
Compensation, re provided for by Section 37M of the Labor Code, for ,he
r. perf.mm.c of work for which do,permit is issued. 305 - FRAME
01 h d wili ;dandfin Worker's Compensation Insummoc,av required by Sect on 306 - HOLDOWNS
3700 of me Labor Code for,h 'fano c f tnc grrk fwhich'this permit a
issued.My tk is c peat nsumnce c o y(4y ysy othi 3 0 7 - INSULATION
( 7 308 , SHEETROCK
-. . ... _ —
Camer - Pul y No t
.CERTIFlCATIO FEYEhfPr10NFROAIXO_RKERS' - - 309 '- 'EXTERIOR-LATH r
'COMPENSATION INSURANCE ' ' __ ___
, INTERIOR- LATH -- - -- —
r erh, r"mesano,Wcdnple,dinnepermitisfotinehundreddollar, 31Ol SCRATCH COAT
(slml an«ad .
1re' m , , - 313 '- 'ROOF'NAIL'"'certify -
pc f Lan k for which,h pe t . ,su d 1. -
,nau t Nv rp 'vma, .tnn«pn njat,dmewa,eem' 501 - FINAL ELECTRICAL' ENERGY
o p ,ar.n Laws of Cal tom a.Date
-Applicant 502- - FINAL- PLUMBING- ENERGY----- ' -- -- --
Ncomesubject
uOAPotheWorkersC mpensmgnh,Ceri nso thlLabor ode.youhmld 503 - FINAL MECHANICAL ENERGY
Z
NOTICE
Wb APPLICANT.
Workers Compensation makatgthis coifisof the lrtwr Code. asmust ld
O p forth withcomply withsuch provisions or this is,rmitshall be eeemeahe rout. _ _ -504__-.-F.INAL...BUILDING-ENERGY_....._.. ..
CONSTRUC71ONLENDINGAGENCY 505 — FINAL ELECTRICAL
1 hereby affirm mm mea i,a cnnnuetion lending agcnry for the performince
�y , hiThe workr mcnm rc issued(See 3097 Civ.C) 506 - GAS_ TEST
L � 'Lender's-Name
U,o 1<ra neem. 507 - FINAL PLUMBING
1 nfY�h,lh Jth'. ppl' f d.wmthnh b f rar' , 508 - FINAL MECHANICAL
:OAF' mbuidl g 't cti vIa mall "t d ,y a' c. - d `, 1.11 erupon� 509 — FINAL GRADE
U i o inch ab 11 il,b representatives Rh ami crus'apo,
W theM df 510 - FINAL PLANNING
(X 1'g Id, -property 'fy andk php Ie.'smeGty ore yc,nnu inti
N limn l' I dg ,,. o,. d rte,which may in any noloi,against said 514 - FINAL PUBLIC WORKS
'U.Z Cny in ,mvv,acrccdfm g g fth perrmt. -
APPLICANT U f ERSTAUna A,')W L COMPLY WITH ALL VON-PONT''
""�
ONS.' Issued by: Date
.. tl onus rar - :. . _ . . .j Dam.. _rAZAR US MATERIALS DISCLOSURErfRe OOfSin,or f me building rracupba„tom or Type of Roof
da,defined bythe Cupmind Municipal Code.Chapter 9.12.and the Health and Safety --
'Code.Section2553'(a)', k ,t r • ,�- : • .
°Y . .--All roofs shall be inspected prior to any roofing mater al.being.installed. -
N
Will to applicant futurebuilding inpan,use equipment or devircs which If a roof is installed without first obtaining an inspectionr•I agree to.remove
em,1 d ore m,a1 doled by the Bay ArcoA Q Il Management
Di" 'oY
ON. ',�, ,, all.new materials.forinspection.,Applicantunderstandsand_will,comply,with
gemcn
-' - - all non-point source regulations.. -
1 h e'nmd the ha N l mriul reg em,end Chapter 6.95 of,the
-
Cal f Health&Safety Code,Sections 25505 25533 and 25531 1 understand that
iftne building dore
s not commonly have acnimrth.t it is my responsibility 1.notif,be-
.ocujmm of'he«quirem s nic ores,be met prior,.i.manec of a ceitific is of
Signature of Applicant.. Date
net .[V-u ag nt -- Date. All roof coverings to be Class B 'of•better
. OFFICE. .