05080229 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTnR INF�O$MATION.°.
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BUILDING ADDRESS: BATHROOMS BY REMODELING PERMIT NO.05080229
OWNER'S NAME: PERMIT ISSUE DATE
HOWARD & SUE TR DRAiT
E: SANITARY NO. CONTROL NO,
(408) 378-6700
ARCHITECT/ENGINEER: BUILDING PERM IT INFO
BLDG ELECT PLUMB MUCH
:O p LICENSED CONTRACTOR'S DECLARATION C.. "`a.t
C hereby affirm Net I am ftha Ra under provisions of Chapter 9(commencing Job Desarip[ioDnS M^ c
^mi with Section an Cr&Division Sof NC Business and Professium Code.and my license is
< In full forte and cf LCA
�lgz Lieenacelau Lie.a REMODEL (2) BATHROOMS
�—c Dam Cngra""
ARCHITECTS OECLARA'p I' �C1 ?005
Iundengand my plate shall lac used u public mentos vT
0 n Licensed Professional
OWNER-BUILDER DECLARATION
0 f I nasoereby affirm that 11. exempt s an the Cssiona o eLicense Ae Law for dx T
0 0 following moron.(Schon Icon LA Business and improve.
derium Code:Any tiny or county t\ .
K m which requires a pertnin m cnmwd elxr.improve,dcmolLN.at repair any structure •�� 4 C 133697
Fit prior an its issuance.also requires the applicant for such penmiuo File a signed statement
<
thal he is licensed pursuant to flic provisions of dic Contractors Umnac Law(Chapter 9 Sq.Ft. Floor Area Valuation
,ts-O (commencing wide SectionT1100)of Division 3 of the Business and Professions Cedc)a
Nat he,is coampt Ncrefmm and Ne baso for the alleged ammeter.Any violation of
Section 7031.5 by any applicant fora permit subjects Ne applicant to a civil penalty of
reOccupancy T n a m Nan fisc hundred dollars(S500). P Y YPe
❑I,uownerof Ne property,or my wployee wide wages as Heir xlc mmpcmauon.
will do Ne sort,and the he Com a noes Limed aro w do Torula(Sec. Owner
and arty who
Code:op Contractors Liana law doe,not apply lf an owner is Required Inspections
mancoplo Willsmrimpmvmch improvements
doessuchwork himxlrer through his
ownemployers,pmvitlW prsuchimproamott art not ear of
moeued for main.
however,the building ha improvement is said within one Stu of completion,the main.
Milder will have the burden of proving that k did not Wil in improv for purpose of
salt.).
❑I,m Owner of the property.am exclusively contracting with licensed contractors to
construct Nt project(Sec.7044,Business and Pmfcxsioro Code:)The Coneracmr's U
came law docs not apply to an owns of property who Wilds or improve thereon,and
who contracts for such projects wide a contactor(s)liarued pmsuann in tk Coneracmrs
Liana law.
12m exempt under Sec ,B k P C for this recon
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirmr penally of perjury aro of Ik owi
follng decontiom:
k.e unde
and will maintain a Certificateof comem m xlf-insure far Winters Corn am-
sation,as pmvided for by Section 37M of the labor Code,for Ne performance of the
work for which this permit is issued.
have and will maintain Workers Compemnlon Imuran¢,ss acquired by Section
Of the labor code,for dx perfarmma of the work fm which this permit is issued.
My Workers eo penution 1. p ria licy F" o��
Cartier. ryNo.: �fJ
CERTIFICA OFEXEMPOON FROMWORKERS'
COMPENSATION INSURANCE
(Thuxcum need notkcarepkxd if Ne permit is fun one hundred dollars(SIM)
or las)
1 anify Nat in Nc perfxonsom of Ne work fm which Nis pante is issued.I shall nae
employ any perm in MY manner an e In become subject in the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Carnes,of Exemption,you should
become subject m one Worker's Compemsuon provisions of the Labor Code.You mug
.7 z foMwiN comply wide such provuimm or Nis Permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[--� I hereby all that Nero is a crmwction lending agency for an,Performance or
G' Nt work for which this permit is issued(Sec.3(y91,Civ,C.)
6W.Q lenders Name
5 z Lenders Addicss ,
V Q 1 anify that I have rod this application and sale that the above information is
D, V COMM 1 agree to comply with all city and county ordinances and some laws relating to
C) building construction,and hereby autharia mpmxntativ¢s of this city no enter upon Ne
shout-mcnuoned property for inspection purposea
H 4 (We)agree in save,indemnify and keep harmless the City of Cupertino against
lZ)z incoitio,juim of ts,the granting
nind uyemnsmit. may in any way aceta ageing said City
U Z inconsequence of the costs
Of exNis permit.
APPLICANT UNDERSTANDS NO WILL COMPLY WITH ALL NON-POINT Issued by: Date -�•�,�
SOURCE REGULATIONS.
Sig....of Appl perm Re-roofs
HAZARDOUS
S MATERIALS DISCLOSURE Type of Roof
Will theapplicant mrm future ni Whinge.Chaptgoreof handle Health
material
az defined by We Cupertino Municipal Code.Chapter 9.13,and the HcaIN uJ Safety
Code,Section 25533(x)? All roofs shall be inspected prior to an roofing material being
❑Ye �Nn P P Y g g installed.
Will the applicant or future building occupent use equipment or device;which If a roof is installed without first obtaining an inspection,I agree to remove
hacardous air contaminants a defined by dx Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
I have mad the knndousmalerials requirements under Chapterti.95 cruse Califor.
nit Health&Safety Code,Sec..35X15.35533 and 25534.1undeotand thatifthe Wilding
does a.,<urtenI It moan".Nat it is my respomihility m nmtilythe..'ant of On
requimmcnm wh' sl be net prior missuana oft Ccnifcaxo apancy. Signature of Applicant Date
Ownesur ndhmircdagcnn /lO spate All roof coverings to be Class "B"or better