02080108 (2) CIBUILDING DIIVIISIONNO
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21628 FLINTSHIRE ST THE REMODELING PROJECT 02080108
APPLICATION SUB DATE
°LK AYNICZ JOSEPH B AND ELEAN 724 BERRY AVE 08/20/2002
PHONE: SANITARY NO. CONTROL NO.
+, (650) 969-2555
p`mi O O ARCHITECT/ENGINEER: g BUILDING PERMIT INFO
m q BLDG ELECT PLUMB MECH
a z m
6
LICENSED CONTRACTOR'S DECLARATION
z 5 H- I,mreb Kq.f that i am licensed B ander oro ofcha r .and(commencing Job Description
oz—ne r provisions p" g .RFVTCTCIN--IN HOUSE USE ONLY
p ad I j with Sectio=and afect. on J of the Business and Professions Cade,and my license
�mY< minox CIaveand effect. (ORIGINAL $#02060019) NO NEW PERMIT ISSUED
z�a License Clazx Lic.p
w 3 a U Date SContractor
DECLARATION ARCHITECT'S DECLARATION
t=0 ej 1 understand my plans shall be used az public rernrds
x O O Licensed Professional s
z
OWNER-BUILDER DECLARATION l
m1 Hanby.faro the,I am exempt from the Contractor's License Law for the
t=Z a following massa(Section 7n,Canonici. repairsw
L5.Business and Professions Code:Any city county
R m rn
as c, which requires a permit n .alter,improve.Demolish.or
repair any ewrc
to pr, tots'castrance.abso req.res theappi cant far such .it to Bleasrgncd statement - - _ _that he r ied.parsman,l Chep nsisnsofmaComaaonLcenuLawlCM1apmr9 r ,Sq. Ft.FloorArea ,,� q Valuation
(commencing with Section 7000) f Division J of the Business and Professions Coast { { I,t c .t a. YJ'•. :1 i j s 1St r ,�';) 7I
or Nat he is ewmpt therefrom and the basis for the allegel exemption.Any violation '"
of Section 9031-.5 by any applicant fora permit subjects me applicant m a civil penalty
or or mare than fire hundred Wllmxs(S5W). APN Number 'C,• . .. Occupancy Type
El T.as owner of me property,or any emplsyces with wageam their sole compensation, 101 FOUNDATI N
will do the work,ane the structum is not intended or offered for sale(See.70ar, 102 — PIERS Required Inspections'
Buiiness and Professions Code:The Contractor's License Law does not apply m an
mer of property Who builds or improves thereon.and who does such work himulf 103 — UFER
or through his own employees.provided mpa,such imnveroenm are oat intended or _
oder,,ibr sate If.however the building -improvement-. 1n,within one y.of - 10 4 REBAR
compleion.,he owner builder will have te burden of proving that he did not build or -
improve for purpose ufsale.). 105 — ANCHOR BOLTS
ownerorth poprtr. m exclusively contracting ''a�aioRio ----106 — SEWER &—WATER
❑I:ax
contract the project(see 7DMe,Business and Pmfeaxions Code:)The Contactor 2 02 — UNDERFLOOR PLUMBING
License Law does not apply m an owner of property who builds or improves thereon. - -
and.who_ditinatx.far Such pojects.wnh.a.comrunodx).licensed puramanttothe
Contractors License Law. 2.03 _ UNDERFLOOR'—MECHANICAL -- _.__._.... _....__._._._......__..
-
❑I am exempt umler Sec. ' ' ,B&P C for this reason 204 — UNDERFLOOR FRAME.' !:'
owmee Daae 205 — UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby alrmt under penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER
❑ 1 have and will maintain a cemrca,e of Consent to reit-marc for workers 303 — ROUGH MECHANICAL
Compensation, as provided for by section 37W of the Labor Code, for the
mt
perfoanceoftheworkforwhichtmxpermitisissued. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compenmion Insurance.as regioned by Secdnn 3 05 — FRAME
37W of the labs;Coda,far the perforaanc<or me work for which his firm,,is 3 0 6 — HOEDOWNS
issued,My Worker's C pen i Insurance tamer and Policy number arc
307 — ' INSULATION
.NOFEX M No' Y '" Iss 3:OS"_=)S HEETROC K'T`t
f .'.1 CERTIFICATION OF EXEMPTION FROM WORKERS' s
COMPENSATION INSURANCE' " _..... - 30'9 --EXTERIOR--.LATH." _.. _ .. -._ ._. . . .........__
' (This vccridn need m,i x enm l and T me 310 — INTERIOR LATH
(SIW)or 1<as.) p permit is for one hundred dollars
ori fr frim in the performance f m k f wbohm pe issmea i' - 311....— SCRATCH•"COAT
shall not plor'anY person in any matter so as in become.,abject to the worker, 313 — ROOF NA I li'"' :1
Compensation Laws of C 0ih moa.Dam "
Applicant. 501 FINAL_ELECTRICAL ENERGY _...._.. ...__. _.. .
NOTICE TOAPPLhe ANTWorker
s Coupensffor atiohisovisios m of Exemption,you should 502 — FINAL PLUMBING ENERGY' "
h..
z become subject to the worker's Comprnsation provisions of
a.gehn.ecyLabor h.C_e opde.er._.f
oyro-mu.mus,
forthwimolywithsuch .isioorispei,shaetacavoked
. ..FINAL._MECHANICAL
_
E_N._E..R..G._Y
CONSTRUCTION LENDING
AGENCY SO4 FINAL BUILDING ENERGY'
W 505 FINAL ELECTRICAL
-Lender's Name
LemderxAaercsx _506 '_— GAS TEST__ _
_
- VO e 507 FINAL PLUMBING- '�' l�
s 1 certify that 1 have read this applicator,and shim that the above information is
correct.1 agree,o comply with ail city and comity onrnancea dad stare laws mlmlvg 50 — NAL MECHANI CAL
f,_i m building construction.and hereby authorize representatives of this city to enter upon
y:W he abovcmenumncd p openy for no"'t on purynses. S 9 — ONALDE
- `.a, Iwe)agmemsavgindcreno!yaMkeepharmlc£s,heCiryofCupenimiugainst 51 —btics,jadgmam,costs and expenses which may in any way accrue against said City in consequence of thegramingalibispermit5514 RKSAPPLICANT UNDERSTAN'DSAND WILL COMPLY WITH ALL NON-POINTSOURCE REGULATIONS. Issued byi Dale
7. Signature of Applmam/Camaam Date Re-roofs
HAZARDOUS MATERIALS DISCLOSUREl r.. , Will m pplic r f, building c p r.mm or handle Wasol us m m l T e of Roof
autsex nernedh me Bay Area y g If a roof is installed"Without first obtaining an ns ection; I - -
as defined by th Cupertino Municipal Coe Chap, 9 13,and the Health and Safety
.
Cod S.lrW 255J21a) n, 1 44 (,
fEiN t t E
F rAll roofs shall be ms ected. nor.to.an roofing material being installed
1
Will the ireapplicant fit Wildingoccupant iequipment d amil mm e
em r oar moms air ebnr r r Amar, Marta<mem, g P � agree to remove
District, new materials for in, IT Applicantunderstands and will comply with.
t
o Yex - ❑No. all non-point source regulations .
1 have read,he h yardu-mamials requirements under Chapter 6.95 of the
re
'Cal foa Health Si&Safety,y C le Sections 25505 '2533 and 5534.1 understand that
if the building does not currently have a tenant.that i,is my responsibility to notify the - - " ' - - -- ... ....
occuparn of me mquimmen,s which must be met prior in issuance of a Cenibcam of
,occapancy.
Signature of Applicant. . _ _ Date
`owner nr aam�r.ed ag�n,, Date All roof coverings to be Class "B"or better
._...._
' OFFICE