03080085 (3) CITY OF cumwrINO
BUILDING DIVISION PERMPI COI\=TRACTt�R INFORMATION
BUILDING ADDRESS: SHOWCASE KITCHENS INC PERMIT N003080085
7
.R'S NAME: 12333 SARATOGA-SUNNYVALE R PEff Hy"suEDATE
MARSHALL WILLIAM J AND FLIZABE08/18/2003
PHONE: (408) 253-0412 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
100 LICENSED CONTRACTOR'S DECLARATION Ib Description
�U¢ I hereby affirm the,1 am licensmOCSCTIped under provisions of Chapter 9(com
encing
< withSection 7")o(Division3ofNCRosine and Professions Code,and my license is w°/�
jeZ LiccnuCl`anderre` Lie.*_ -g BATHROOM REMODEL (2). FINALE0
Dow Contractor
< ARCHECrS DE p ATION
Iunderstandmyp.ramheuredas ramods OCT2 2 2003
eon Licensed Pmfcssinnal
OWNER-BUILDER DECLARATION w..
<I 1 hereby affirm Not 1 am exempt from the Cohlractoh License Law for the BUILDING�'�1�
❑yO following reason.(Section 71131.5,Business and Pmfcssions Code:Any city nr county ��www\\U LD ,Y
f 2 LL which mor ims a pemdt to construct.BIMr,Impmve,demolish,or repair any arm ctum $14918
Ztprior to its issuancc,also requires the applicant for such permit to rile a signed statement
jjC that heisRelated pursuant todue Provisions ofthe Contractor's LicensLaw(Chapter 9 Sq. Ft. Floor Area Valuation
Fps (commencing wi or Section 71100)of Division 3 of the Business and Prurusinns Cmle)ur
L 3 9 that be is exempt therefrom and the bub for Ne alleged exemption.Any=of 35619019 . 00
Section 703 L5 by any applicant for a pamtil subjects Ne applicant to a civil penalty or APN Number Occupancy Type
not more than love hundred dollars(5500). - -
❑1,u owner orlon property,or my employees with wages as their sole compensation,
will do Ne work,end Ne stomona is nal intended or offered for sale(Sec.7044,Business - d Ins Inspections
and Preffami as Code:The Contractor's License Law does not apply a an owner of 10 2 — PIERS p
property who builds orimprowa themen,end who does suchwofk himself or through his
own employers,provided that such improvements sae not intended or offered for ale.If, 103 - UFER
however,Ne building or improvement is sold within one year of completion.the owner.
builder will have Ne burden of proving that he did not build or improve for purpose of 104 - REBAR
sal`')' 105- - ANCHOR BOLTS
El 1,as owner of the pmpeny,am exclusively contracting will licensed contractors to 106 - SEWER & WATER
consumer the project(Sec.7614,Business and Profauimts Code:)The Contracurs Li
cense raw ones not appy to an owner of property who builds or lmmavu thereon.and 202 — UNDERFLOOR PLUMBING
whaces for such project,with o ronwcmr(q licensed!pursuant m
puualhe Contractor',
ence Lew.
203 - UNDERFLOOR MECHANICAL
whonse
L
0 l me exempt under sec. .B h P C for this reason 204 - UNDERFLOOR FRAME
rDare 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DLCLARATION
I hereby affirm under penally of perjury ow of the following declarations: 301 - ROUGH PLUMBING
❑Ihaw and will mainuina Certirieauuf CorrtinuoxlGinumfor WorkeM1Compen, 302 - TUB & OR SHOWER
station,as provided for,by Section 3700 of the labor Code,for she performance of save, 303 - ROUGH MECHANICAL
work for whim this permit is issued. 304 - ROUGH ELECTRICAL
have and will maintain Worker'Compensation Insonate,u required by Section
of Ne labor Code,for NC Performance of the wart for which this permit is issued. 305 - FRAME
My Worker's Compensation lnrumnce carrier and Policy number art: 306' - HOLDOWNS
CaniA:.�✓ d/� - Policy No.: 00 O 307 - INSULATION
f CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
or (fnlr section need nor becomplemdiilial rermh is form=hundreddollars(SIM) 309 - EXTERIOR LATH
I cenif) 310 - INTERIOR LATH
employ certify mat e r the performance of the work Tor which this permit is iw Com shall nut
Law,
Person in any manner mazmbecome subjecnothe Workeri Compensation 311 - SCRATCH COAT
Laws or California.Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making this Certificate or Exemption,you should 501 - FINAL ELECTRICAL ENERGY
Wooten Subject m the Worker's Compensation provisions of the Labor Code,you must
�z forthwith comply with such pnsvisioo,Or this permit mall be deemed revoked. 502 - FINAL PLUMBING ENERGY
ZO CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that there is a contrunion lending agency for the Performance of 504 - FINAL BUILDING ENERGY
x > Nework'sNamewhich his p mlGsissd(sea3097,civ.c.) 505 - FINAL ELECTRICAL
]] Q Under's Name
�z <nderbAdd� 506 - GAS TEST
J 0 I certify Nat 1 have read this application and lute that the above infmmatiun is 507 - FINAL PLUMBING
correct.I agree to comply with all city and county ordinances and rule laws relating to
Vbuilding convection,and hereby anthodre mprescmadvxs or this city m chloroform the - FIN MEC ICAL
N U above-mentioned pitifully for inspchlion purposes. 09 FI
(We)-,me to saw,indemnify and keep hatmless the City of Cufar ino against
'PYA Iiabilitics.judgmenu,costs and expcues which may in any way accrue against aid City NG .
Jz APP CAST ueraceoNDERSTShigrunting othis
NDWILL COMPLY WITH ALLN "POINT Issued by:5 C WORKS Dale
SOU EGULA^IONS
✓ Re-roofs
turc of ApplieanUContractor Dim
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haramous material
finetl by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Section All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
:mit humorous air contaminants u domed by the Bay Arca Air Quality Management all new materials for Inspection. -
D'suicl7
p Yes
I have mad the haanlnus materials requirements under Chapter 6.95 or[he Califnr.
.is Health X Solely Code,SCNuns 25505,15533 and 25534.1 understood mot if dte hoilding
does not cumemly have a tenant that it is my ma poneihility to notify the occupant of me
rcqu' cnuuwtuchmost her roar toissu oeCcrd11, Oct Signature Of Applicant Date
ser anthorizcd age. All roof coverings to be Class "B" or better
ole