03010109 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR�JNFORMATI
BUILDING ADDRESS: PERMIT NO.
8147 HYANNISPORT DR
WNER'S NAME: APPLICATION SUB DATE
TONY & DORIS HARRY 01/21/2.003
ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION
9.C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
<z 'th Sectio 10011)of Division J of Ne usiromi d Profa;iou Code.mtdm license is
r rccanJcffcct. Zp�(�y KITCHEN REMODEL
�Z Lic Class Lic.N
zZ�p Da Cunlrazlur tn.�1-'�,1✓.�
F=t-� AR ITECT$Sl f1RATION /
T Prole mimy Plans shal>�uuJupuhlie rtenrda
OyU ��1 •/
rLLo� Licensed P f I Y
OatNE.BUILDER DECLARATION Q
pp u�<E 1 Wrcso affirm that 1 1. eaempl Pram @e Convenor'sLicenseCode: c Law Airline
u�i 6 p o following reason.Permian]03L5.Business and ve nm demolish.oAny city os coumy
$ which squires a pemtit re mires n.alcor,impmw,hrrhittor repair any swnure
iy
poor oiniensedpabant in the tbe applicant for eahpatmiuo cense Law(Chapter
<
that he islicensedwit pursuant 7")provisions of the hominess nittnulaw(Cnaplar9 Sq. Ft. Floor Area $51 (�(IOn
y—� (commC&exempt
pth Section7")and she
Diem;f r the
exempt PrOfeon.Any
of
d;$ the;be u eaempl therefrom and dm buts for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicam to a civil penalty of
not more them five hundred dollan(53011), e
Occupancy Type
I,as owner of tbe property or my employees with wages as their side compcwtion,
will d,the work,.M Bre wruto.is not imeMed or offered for We(Sa.]OOa,Business —
md Prorenions Cade:The Conuscror's License Law does not apply to an owner of 102 — PIERS equired Inspections
property whobuilds or improves thereon.end whodoessuch work himself or thmugh his
ownemployea,provided that such improvements see not intended oroRemd for We.If. 103 — UFER
however.Ne building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving Nat he did not Wild or improve for purpose of 104 - REBAR
"1c) 105 - ANCHOR BOLTS
❑1.as owner of the property,am exclusively contracting with liceved contramn to 106 - SEWER & WATER
construct the project(Sec.7(N61,Business and Professions Cade:)The Conuwtots Li.
eeue Law does not apply to an owner of property who Wilda or improve;thereon.and, 202 — UNDERFLOOR PLUMBING
whomLicenentrawts for wchpm' tswith a contractor(s)licensed purwanuo the Canvactoh 203 - UNDERFLOOR MECHANICAL
❑lame;e «. _,B&PCf Nista en 204 - UNDERFLOOR FRAME
Dat 205 - UNDERFLOOR INSULATION
KCR>COMPENSATIONDEC 301 - ROUGH PLUMBING
I hereby alarm under penalty of perjury one of the following d lantions:
I haus and will maintain a Certificate of Consent to self-inmm for Workers Compen- 302 — TUB & OR SHOWER
union,as provided for by Section 37M of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL
work for which thispermitisissued. 304 - ROUGH ELECTRICAL
1 have and will maintain Worker's CompeuVion Inauraae,as required by Section 3 05 - FRAME
3700 of the labor Code.for the performance of the work for which this permit is issued.
Myw ker';Compensation Insurance carrier and Policy number art: 306 — HOLDOWNS
Policy No.: - 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
((Lis section nail not tecomplemd if the permit is(Orono hundred dollars T$100) 309 - EXTERIOR LATH
or less') 310 - INTERIOR LATH
1 certify Nat in Q01" armanco of the work for which this permit is issued,I shall not 311 - SCRATCH COAT
cmployanypersonmany m){t j ug, oma subjectto the Workers Compenntion
La sofCaliiffgtn/p /aIIfIL�I�/ ,TI 313 - ROOF NAIL
Nar— _0A II IL rmaking this Certificate of Exemption,you shouW 501 - FINAL ELECTRICAL ENERGY
become subject to the workers Compcnution previsions of the labor Code.you must 502 - FINAL PLUMBING ENERGY
Off; forthwith comply with such previsions or this permit shall W deemed revoked.
z0 503 - FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I herehy alllrm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY
S Unders Name work for
W 505 - FINAL ELECTRICAL
W O Lende
�Z Lenders Address 506 - GAS TEST
UO Tram(ythat Ihave r,ad this application and mom that the aWveinfotmatiunis 507 - FINAL PLUMBING
(L correct.l agree m comply with all city and county ordinances and state laws relating to
O Wilding convection.and bemby authonm mpresenudva of this City to corer uin,n the FINAL MECHANICAL 114
Wabove mentioned profs rty for impaction purposes. 0 9 FIN
(We)agree to sew,indemnify and tarp harodem the City of Cupertino against
y liabilities,judgmcnes,cosuandeepcnsesw�c ay in any wayscenic against mid City 5 G
U z in consequence of she grm", f Nis De
'—' APPLICANT E AN SAN LL COMPLY WIT NON-POINf Issued by-51 WORKS Date
OURC Ul, e
Re-roofs
Signature CIA plicani(CoMmebar Dam _
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Co e.Chapter
orhandleEn hazardous material
az defined by the Cupertino Mun' 'Pal Code.ChaDmr 9.13,and the Health and Safety
ode.Section25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yos
Will the applicant 'boom Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hanMnu;ear soma inane as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dims'?
El Yes
I have mad the har nus mamrialsrcquimmcnrs umkr Cltapmr6.95ofthoCalifor-
nieHcalth&Safety G9Jc. Gore 55" and
anJ 255)6.1 unJcrstmJ NVR Willing
tine;no,currently haw a sena Nat it is my reposer ' ty m nod( W ecu set of the
ne n wnm R m a aCenlOamara a Signature of Applicant Date
OwnaaraamoHas ascot o J All roof coverings to be Class "B"or better
CITY OF CUPERTINO p 3 a I
CITY OF
CUPEI�TkT INO PERMIT APPLICATION FORM
AP # Date:
Building Addr s:
Owner's Name:I Phone #:
Contractor: License #:
Zcl C0 i QLD
Contact: Phone#:
196b qe 586L)
Applicant/Contractor: Fax #:
Bui d' g Permit Info:
Bl Elect Plumb ech —
ob Desc ion, IZe+ti GJ-C,(zV% — -T-P r
esidential �x1� eS — Ze �GCe If Commercial:
Sq-Ft.b .Floor Area: $/Sq.Ft.:
s
*ArcntiltecV,hn ineer: aluati
ype of Co [ruction: Occup p:
IZP t l
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/OfflCOmm/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP I New Comm Plumb PLUMBING
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