03080117 (5) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ` a4C`0 TRACT0_RJNk'OX2MATI`�z
BUILDINGADDRESs UTLEY NELSON V AND BARBARA PPARMIr"D03080117
OWNER'S NAME: PERMIT ISSUE DATE
HONE: P_LC;nN nor AND RART:iARA
SANITARY NO. li�2 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!00 LICENSED CONTRACTOR'SDECLARATION Job Description
w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
�<� with Scction]P10)Of Division3 of dm Busincsn antl Pmfcssions Codc.end myliccnu is
o� imfull force,and effect. KITCHEN REMODEL FiIVAI..�®
License Class M
Lic.
o Data Commetch
: �
ARCHITECTS DECLARATION DEC 1 7
! < 1 understand my plans shall W used as public records 2003
)dU
�Oy Licensed Professional
< OWNER-BUILDER DECLARATION� 1 hereby alrirm that 1 nm exempt exempt from she Comranor's License Low for the BUILDING
o O following rcasnn.(Section 7031.5,Business and Profession.Code:Any city or county
5 m which requires a permit in construct.shot,improve.demolish,or repair any moot e
prior to Its issuance,also requires the applicant for such permit to file a signed statement
2�¢ that he is licensed purauanun the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area . Valuation
rF0 (commencing wi th Section 7000)of Division 3 of the B usiness and Professions Code)or
O R$ that be is exempt themfmm and on,bas's for the alleged exemption.Any vitiation of 32635029 ,
Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of APN Number Occupancy Type
not mom than Eve hundred dollars($500).
❑1,u owner of the property,Or my employees with wages ss their sal.compensation, '
will do the work.and the shuctum is not intended or offered for sale(Sec.?W,Biomass -LU17 — DAWLTR dInspections
and Professions Code:The Conuaztorh License Law does not apply to an owner of 10 2 - PIERS —`t y
property who builds or improve.thereon,and who does such work ormelror through his
min employccs,provided that such imparwromns sre not intended or offered for into.if. 103 — UFER
howev,r.the building or improvement is said wimin one year of completion.Ne owner,
builder will have Ne burden of proving that W did not Wild or improve for purpose of 104 - REBAR
Zram' 105 - ANCHOR BOLTS
as owner Of One property.am Oxeluaively contracting wife licensed convectors to
ons�roct the Project(Sec.7044,Business and Professions Code:)no Contractor Li 106 — SEWER & WATER
cenee as,does not apply in an owner of propusay who Wilds or improves themon,and. 202 - UNDERFLOOR PLUMBING
Who contracts for such projects with a contractor(s)licensed pursuant to the Commclor's
License Law. 203 - UNDERFLOOR MECHANICAL
01.ase tp er Se B&P C f phis casts(
ownerDate PIP
d i 204 - UNDERFLOOR FRAME
R R'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby affnm under penally of perjury one of the following declarations: 301 — ROUGH PLUMBING
l have and will maintain a Cenincas of Common ulf.insaro for WorkersCompen. 302 — TUB & OR SHOWER
..rico.m provided for by Section 3]00 of the labor Code,for Ne Performance of the 303 - ROUGH MECHANICAL
work far which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,ss required by Section 304 — ROUGH ELECTRICAL
37W of the Labor Code,for Ne performance of the work for which this permit is issued. 305 — FRAME
My Worker's Compensation Insurance carticr and Policy number are: 306 — HOLDOWNS
Carrier. PoliNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.)
(This section re cd notal completed lfthe fcruit is forone hundred do[(.pUNff 309 - EXTERIOR LATH
'
I cenily Inas in the perrormancc of the work for which this permit is issued,I shall net 3 10 — INTERIOR LATH
employ any person many manner an as in b.comc subject,.the Workers Campcnaatiim 311 — SCRATCH COAT
Laws of California.Data
Applicant 313 - - ROOF NAIL
Laws
NOTICE TO APPLICANT If. Futr making this Ccmincase of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Workers Compensation provisions of Ne Labor Code,you most
J Z forthwith comply with such provisions or this Permit shall the deemed revidad. 502 - FINAL PLUMBING ENERGY
z 0
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
~ -
Hicrichytiffirrindolther isa construction lending agency ortharnifformanco of 504 - FINAL BUILDING ENERGY
!Yi
are work for which this permit is issued(See.3097,Civ,C.)
W Ca Lender's Name 505 - FINAL ELECTRICAL
z Lende,aaddress 506 - GAS TEST
U O 1 certify that I have read this application and state that the above infmmuiun is507 - FINAL PLUMBING
correct.I agree he comply with all city and county ordinances and state laws relating m
p V building construction.and hereby authorise representatives of this city to Onto,upon the FIN MECHAN CAL
�" U above-mentioned property for inspection pueposs.
(We)agree to save,indemnify and keep harmless the City or Cupertino against 0 9 FIN
Ii abilities,judgments,costs and expenses which may in any way seems against said City 5 A NG
U 7 in consequence of the granting of this permit.
R APPLICANC _ 6RSTAND AND WILL WITH ALL NON-POINT Issued by:5 WORKS Dale 3 3
APPLI A A'FIONA / f
a pr D O
617216 3 Re-roofs
pbcxH HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(Uinta building occupant store Or handle hithromis mulan.]
as dcrined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
egde, Yzss25532(a)?C] s /u All roofs shall be inspected prior to any roofing material being installed.
❑Ye ❑N
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants sa Jcfned by the Bay Arca Air Quality Management all new materials for inspection.
C]Yes l_Iwm
1 have mad the hmallousmamrinls requirements under Chapter 6.95 of the Ca1ifm.
'aHcalN&S, of.ttc_Sccdon.25505,25533 and25534.1undcsmnd thatirtic Wilding
does -csf'Iay�.a.tenant, at it is my resp natality a redly Ne use pant of the
ra�ent mcrmnat�bam dorm amecamnracap y J Signature of Applicant Date
or ora mrri,cd ag.nl o All roof coverings to be Class "B" or better
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Dimensions are provided by the client.Any extra charges
p( y �; f incurred due to incorrect dimensions are not EXPO's res AUG 2 2 2oW
[.)V, ponsibility.
Client Date '�R,v;,�--��
wg no.
62508801 Scale:maximum Design: 06/25/03
All dimensions&size designations THE This is an original design and must Date : 07/30/03
given are subject to verification on EXPO not be released or copied unless
job site and adjustment to fit job applicable fee has been paid or yob
nditions. order p� Designer
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AUG 2 2 2003
All dimensions&size designations This is an odginal design and must Scale:1/2"=1' Dwg no.
given are subject to verification on EXPO not be released or copied unless '
• job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed. Wall/C Line# 8
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.ECEIVED
AUG 2 2 2003
All dimensions&size designationsThis is an original design and must Scale: 1/2"=1' g no.
given are subject to verification on EXPO not be released or-copied unless
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job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed. Wall/C Line# 3
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All dimensions&size designations This is an original design and must Scale:3/8"=1' Dwg no.
given are subject to verification on EXPO not be released or copied unless
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed. Wall/C Line# 4 —-
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Note:This drawing is an artistic
interpretation of the general TME
appearance of the floor plan.It is EXPO
not meant to be an exact rendition.
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Note:This drawing is an artistic g no.
interpretation of the general ree
appearance of the floor plan.It is EXPO
not meant to be an exact rendition.