04020110 (4)(I`
CITY OF CUPERTINO,
CON GltACTOR INFORMATT(N
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
VANNI BROTHERS CONSTRUCTIO
SIM"O04020110
OWNER'S NAME:
PERMIT sxm DATH
E:
SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description '
1 that T am IIae under prevision of Chapter 9 (commencing
-
3Cf de BudrevaM Profestiona Code. and my license is
ion 7 ) of Bo
with Section
�'
and
in full forte and .Baca
■ ����D
KITCHEN REMODEL
uanm ass tae«
°amComK1er
ARCHITECT'S DECLARATION
MAR 2 B 2004
1 understand my plans shell W used as public records
Lkenmd Professional
DECLARATION
OWNER
BUILDING
u
-BUILDER
1 hereby .Into l .lamp(from LBW for the
NC Gorton
and Profdmmu Cade: Any city or aunty
on 1. an Coe e: Any c
following rcoan. (gado.
...arta. epic. improve, or repair my
t, .1m,s
which rcqulrci • permis construct,
ummum
re h permit t
pdoi m its issuance, eBo requires the Nevatmeenl for such permit m file aligned statemem
LianseLaw tCMpmr9
Sq. Ft. Floor Area
Valuation
Net Win licensed purmarl m We pmvisisionf these Business
(commencing Seeder] 000) of Division3 Incauslneyand Protestant;AnviCook) or
easwith
t
Nn W ta emmpt Nelefmm and de Casts for do allagc0 exemption. Any violation .f
3 6924181 CIO 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects on applicant to a civil penalty of
not more than five hundred dollen (M).
❑ 1, a ownerof Ne property, a my employees with wagesas their sok compensation,
Required Inspections
will do the work and the suumure is not intended oroffened forale (Sm. 7014, Business
and Profersiona Code: The Conuecter's License Lew does not apply to an owner of
property who Wild.orimpmveathercon,.ndwh.d.,..eh work himselforthmugh his
Own employees, provided Nat such Improvements ..at irmrldW "offered forest., If,
nrwnwo, the building or improvement Is sold within oro yea of completion, the ostro-
build., will have the burden of proving Net be did nut Wild Or improve far purpae of
ale.).
n
vely ntracting with liceued conuxl.m
Xo1, a owner of the p'oRrty, am exclusico
mwct the project (Sec. 7(114, Business and Prefeaiom Code:) TW Conuacter's Lb
came law does nal apply men owner of pmpeny who builds or Wine. thereon, and,
who contracts for such projects with a contnnartU licensed pursuant a Its, Contractors
Lianas law.
l am acmpt under SSce . B d P C far Ch
❑or
/
W RKER' OMP SATION DECLARATION/
1 hereby aRrm under penalty of perjury oa of the followi�g declmdkm :
1 have and will maintain a Cenifica sof Consent to self -insure forwarker'.crmpco-
atlas, pmvidfor by Section 3]00 Cf Ne labor Code. far Ne perfarmaime of Ne
work forr which this permit is loved.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
37M of the labor Code, fa the performance of Ne wok for which this permit is issued.
My Workers Compensation Imseraa aTa and Policy number not:
Cartier. Policy No,:
CERTIFICATE OF FX EM PTION FROM WORKERS'
.
COMPENSATION INSURANCE
(this section need not W completed film permit Is raroaehundme dollars ($1(0)
or lea..)
I certify that In the performance of the work for which this permit is issued, l $hall not
employ any roman in any manar an in to become subject to the Wrrkeri Compensation
Laws of California. DA¢
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become abject N the Workers Compeuetion previsions of the later Code, you mus
foMwith comply with such provisions or this Permit anal) W dictated revoked.
CONSTRUCTION LENmlNGAGENCY
1 1 herebyaffirmdu Nat Nem it a agency for Ne pcRormaa of
ad (S.. 0Icnding
Ne wok for wmm� tid. perms B issue. (sec. 3097. civ. ca
Undoes Name
Lemwe,naer.Addrca
j 1 cenlfy Na 1 have reed this application and sum Nil the show inforramu t is
' correct. l agree to comply with all city and county ordinances and state laws mleting to
building construction, and hereby autherim reprerentstivas of this city to enter upon the
ahove-mcnllCnee property for impaction purposes.
/
(We) agree to ave, indemnify ad keep harries, the City of Cupertino against
j liabilities, juegmcnts, Coals and a.,.$ which may in any way. arta. against a to City
in consequncc of the gaming Of permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:9 Date
SOUR GUL ONS.
Re -roofs
Type of Roof
nature of Applian tram, am
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or MMIC hanrdous nounhal
a defined by the Cupertino Municipal Code. Chapter 9.11. and the HO.IN and safety
CMc, Section 15531(.)7
❑Yeses
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or dcview which
alt hazardous air cantaminats as dcfmcd by the Bay Area Air Quality Management
all new materials for inspection.
District? ,,,�,,,,tttt
❑Yes 19No
I have read the mocumou materials requirements underCWp tO6.95 of the Califor.
nu Health @SafC yCodc. Samna 15505.15533 sod 15534.1 uMentmd thutifee Wilding
data not currently new a tenant. Nn it u my respenewity in Imdry the acupal of the
mqut(rtJ^�ntswmtnmasb m armiauame.f.C.rtlOcateofOec.
Signature of Applicant Date
\ X33/&*,
All roof coverings to be Class "B" or better
O er tar eushorimd ager
CITY OF CUPERTINO - •= "
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��rg. ,q, ''�,,��;;rr T " 0 ',r
CQL\nl
- .•.
But LDING' DIVISION' PERMIT
BUILDING ADDRESS:
PERMIT NU LI Z Z O i O O
7482 SHADOWHILL LIN
OWNER'S NAME:
PERMIT ISSUE DATE "
.RALPH QUALLS JR.
-
NE:
SANITARY NO. CONTROL NO.
ARCHITECT2NGINEER:
-
--BUILDING PERMIT INFO
ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
- "-- -
IOb DESCrlpt1OO
I thereby Apure that 1 am Beamed under previsions of Chapter 9 (commencing
. __
with S¢dun 7000) nfDiviaion 3 of dm Business and Professions Code, And my license is
,
in fun to= and affect.
BACKYARD" FENCE
'License Clew -
.
..
- -
Dam - Contractor
ARCHITECTS DECLARATION
CT'SD
- I Ilader6land my plans 'hit TIC uECd ea pYMIC mCardl
,
Licensed Pmfesaienel
OWNER-BUILDER DECLARATION
.1 hereby affirm Ojai I am exempt from the Contractors License Law for the
following moon. (Section 70315, Business and Profcesions Cade: Any city at county
-
which requires a permit to construe, alter, Improve, demolish, or repmr any structure
86000,-
pdormiuissuance. also requires inapplicant forsuch permitm file asignei ucruent
-_
"""Sq. Ft: Floor Area '-
" "' 'Valuation
mat he is licensed pursuant to the toonelons or the Canlruter's License Law (Chapter 9
-
(commencing with Section 701K) of Division 3 M the Business and Professions Code)or--•-
that he is exempt dmemf e. and the buts for lime Alleged exemption. Any violation of
-3 6jWRNNM;FeT 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the spplicut to a civil penalty of
not more that Eve hundred dollars (1500).
❑1, As Mara of the Impurity, lir my employees with wages As their sole compensation,
.. -.,,: . :, -
Required' IDSpeCIIODS
will do thework. and she awetum is not intended or offered for sale (Sec. 7044. Businessmay.
and Professions Coact: The Conitamrs License Law does not apply in an owner of
property who builds m improvu thereon, and who dos such weak himsel f or through his
ownemploycu, provided that such improvements are not intended whitened freesia. If.
however. the building or improvement is sold within one yeerafmmphniu. the owned
builder will have the burden of proving that W did not Wild or improve for purpose of
sal..).
-
f 1, as owner of the progeny, am exclusively convecting wish licensed contractors to
— .
c eruct the project (Sec. ]Oath. Business and Foramens Code:) The Contractor's Li.
"
cense Law does not apply to an owner of property who Wilds or improvu dlercon.lid
whocontsaisfir,uch pmjecu.fth..mMmu(s) IicenmpursuuttedeaCantnctars
License Law.
❑ I Am exempt under Sm. . B k P C for this much
nor Data
-
WORKER'S COMPENSATION DECLARATION -
1 hereby affirm under penalty of perjury coo of the following declarations:
Thaw and will meinWna Certlfinte of Continua self-insure farWarkcra Compcm
satian, u provided for by Section 37110 of the Labor Cede, for the peon..... of de
work for which this permit is umel
❑ I have and will maintain Workers Compensation Insuorm, az required by Section
3700 ofthe Labor Code, for the performance of the work for which this permit is issued.
- - -
MyWorkersCompensation Insurance carrier and Policy number am: `
Came, " Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
"
(Thissection need not w completed if tbe permit is Imone hundred dollars ($100)
or Ices.)'
1 cenifv that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner an As to become subject to
Law s Otc.l.forig.'DIP,♦'"
APPHe µal
-
NOTICE APP CA : ff. sMr making this CefflEmic of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed rooked.
"
CONSTRUCTION LENDING AGENCY
I hemhy affirm that dere is a construction lending agency or the Performance lir
the work for which this Permit is issued (Sec. 3097, Civ, C.)
'
Lender's Name
"
Lender's Address
1 comfy, that I have read this application and auk that the above information is
'
correct. I agree to comply with all city and county ordinances and sou laws relating I.
building construction. and hereby aushorice reprecentativea of this city to enter upon the
above-mentioned properly for Inipeelim pmpaYa
(We) agree to save, indemnify and keep harmless she City of L'upentne, against
liabilities, judgmanls. costs and expanses which may in My way seem. against sold City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued b Date
y.
SOURCE REGULATIONS.
Re-roofs
Type of Roof -
Signmurc of ApplicaData
HAZARDOUS MATERIALS DISCLOSURE
Will orfuture Wilding eaupmt or handle materiel
bytapplicant
az dcRned by the Cupenina Municipal Code, Chapter 9.11, end the Health antl Safety
rM Health A
ode, Semon 35531(.)+
❑Yes i41 No
All roofs shall be inspected prior to any roofing material being installed. - -
If a roof is installed without first obtaining an inspection„I agree to remove
Will the applicant or future building occupant use equipment or devices which
mit hevamow air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
[3 Yes VN.
I h&Safet mehuutlnusm 5505. 553i AndW under ernmed 6.95ofCalifor-
nice Health &e yawl he Code, wo btions2550als regJutl35534.1 rChater6.95 if the Wilding
/
(A
dura not currently haw A tenant, that it is my mspouibility, in notify the oex,e t of the
uimm n ichm m tpdo i eca�a C 'reAe fOccupancy.b
Signature of Applicant Date
C
All roof coven gs to be Class "B” or better - -
Owner or authodxed agent Dam