01110022 (2) CI OJON
PERTNO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10305 TULA LA CUPERTINO KITCHEN DESIGN3 01110022
Ii NAME APPLIC TION SyB DATE
VIPAPORA NICHAPANICH 10562 S DE ANZA BLV 11,05/ 2001 ,
ClPHONE: (408) 257-4900 SANITARY NO. CONTROL NO.
n C ZO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
u
- BLDG ELECT PLUMB MECH
FSG u u
LICENSED CONTRACTOR'S DECLARATION
1 herehy alarm that 1 am licensed under provisions of Chapter 9(commencing Job Description
iycto with Section7eromofoivismn IlheBoslncssand 'aresscascodc.awm fiansc REMODEL (KITCHEN & BATHRMS; NEW
o 'a infullfotcea < ELECALED
u tsimns<cmts��fp�@ V uc.a
13e u y Da//te ty�,Cl-pl Corer mr
:Lot-
10-5 ` �I ands J my p1ARCha17ECT`S DE:LAIC rccmdv'
; MAR 0 6 2002
i i p O Licemed Professional
OWNER-BUILDER DECLARATION
-�' 1 hereby allmn that 1 am exempt from the Contractor's License Law for the
EN"Z a follywinerson.(Seco.7031.5.Busness and ProteWim,Cady.Any ciy m County
BUILDING
FOoh urctiu construct. It p demolish.or rc.sl mune
y fdoto ' borequiresthe applicantf such points m file.
_
smmrrcm- - .. _ __. _ ___ _.-__.- ....2 5 0 0 0
3- that h0 is limosecipuisakeffit iot&jinsvioms ofth Commuctorx License Law(Chapmr9
(commarcn i�hsecuo 7000) fDrvis J fthcRusi,rcsaandProfcssomsCodq . fS Floors le o , Valuation
e C:CD\'"1 i.:-q`' 30 tk.5� ,�c.i1.�7'£ ti:
or thal he is exempt thcrcfrom and th<bazis for the allsge}I eiemptbn.Any violation
Iof N3CSanyemfarepermit subject me ppplicam toacivil penalty'
91 00
lorhot mmo,emanfveWndred dneddollars(ssao)," APN Number it, Occupancy Type
❑Lesownerofthepropcn,mirt,employtts wire wagauthdr sole compensation. 101 FOUNDATION
-willdo'the work:endthe'swctureis'not intended'or-oR<redfor'salefsecr7Bw.- 102 PIERS Required "')•-
f Rusmcxs and Professions Code:The Contractor's License Law does not apply to an "
owner of property Who Wilds or improves thereon•and who does such work himself 10 3 - UFER '
or thn ugh h'.own employees pro,ided that such mpmvent rat arc t,mended m
._ ._._ -._._._ _ _.._... _ ._. ..-___._ ------
completion,
-__.-
}ogq'dfo sthe.ger- thewill
gonmen of pinitse 'min not Wild
of - - .104- - REBAR --
improve ficuthummis, fmic.)�witl hasx me burden of prov,ng chat he did not Wild or 105 - .ANCHOR BOLTS
improve natvoseo '
.. __.. _
❑ii.;owntt erm<vropeny,am exew_siv.a_y..-c.on_mc _ licenced! 106_ -_ SEWER'-& WATER' • • . ,-_._.-_...-
h_ _
wit
_ nnswct the project(Sec.lou.Business and Profession Cade:)The Contramor s 202 - UNDERFLOOR -PLUMBING _I
u ' - Lid.,i Isw does na apply to an owner of limiacany who Wilds err improves thm.the
_ana.who.eommot mranrn.pro;«t.with a.eonnmrm(a)licensed pnrsaant.m.me _..._.........
20-3- — UNDERFLOOR---MECHANICAL ..._--
--- -
01amexemPt`une s«. ' '` R'&PC for thisneason 204 - UNDERFLOOR FRAMEt`It
net ' •' " ' Date" 205 - UNDERFLOOR INSULATION
` ;WORKEMSCOMPENSATION DECLARATION 301 - ROUGH PLUMBING
ss Ihereby affirm under penalty ofperjuryoneofthe following declarations: 302 -s TUB & OR SHOWER
Yf ❑ 1 have odd will maintain'a Ccnifcaie of Can..,m self-insure for worker's 303 _ ROUGH MECHANICAL
eooperardon, as provided for by Section 37W of the Labor code. for the
oerfom,bnce of me work for which this pets it is issued. 304
ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as remained by Sderion 305 - FRAME
37M of the LaWr Code,for the performance of the work for which this pcmth'is 306 HOLDOWNS
xsu d-MyW k 'sCmnpwsauoo.lmmvme carrier arW Policynalnbcrare�°. ---� --- ----"--•••---•--� "
- — 307 INSULATION'—
cai;,e _MSPolicyNo:�f� 0°'srr,308Y"'-. ,SHEBTROCMA_I;f`';:
E FI ATION OF EXEMP110N FROM WORKERS( a-
COMI'CNSATION INSURANCE[ - - .- .. _..
309 -----EXTERIOR-'-'LATH--'- --
missetonde<annthecomplet<dtfinep m tI,foronehundreddouars 310'1 INTERIOR LATH '.c°l; f},
1'c mfy thm'in the pef.ance n(the k(nr whicM1th pe lis iesued,l
shall not corprijr my person in any manner so as to become subject t the.WorkelY 313 - ROOF NAIL!
Com p oto a '_prclr Dte ..501. _FINAL ELECTRICAL ENERGY-_-_ _ . _.
-APP( t ...—._
NOTICEIOAPPLICANT,.ff,fte,hakionlimisCertificate otEx -pt y➢ should, 502 - FINAL PLUMBING ENERGY r'
z become s blem t th W .k C psnsat pow sof the W W Code you most
00 form m mply'di hp orth' vc t naBbedttmedr<okee. _ 5.03 -.-FINAL MECHANICAL ENERGY__
_ id'oCONiTRUCTIONLENDING AGENCY' 504 - FINAL BUILDING ENERGY
'F
I he¢b aIfnn Nat mere is a conswcuon lending agency for the iformence
x > r
0,Laiid pvotssuel(sec309rcv.C.) p 505 -. FINAL ELECTRICAL '
.a7�Z 'Wers Aad' which„ _y., ._ :. .. .__. _._ ...506- ._ GAS TEST._
”" 507 - FINAL PLUMBING "
�? O 1 ttndy mat l h.we R,a this
City
m anon any orate mat the aWve maws radon is
F 9rirms,Iagnee3o comply,witn all cEy arta enpntr omiwn<e�,and.rate lase.,elating ___- __508--- .-FINAL-MECHANICAL--
O'U to budding con.sutictiun;atidlherebysmho'tarepresenwtivesofthiscitytoenterupon 509 - FINAL GRADE
W I the above-mentioned propeny for inspegtion purposes.,, „_,
r_p„ (Q
nsave;indemnifyandkep hainhis roe City of Caperti,6,4rinst '- SIO - FINAL PLWING
Ills) fabanisu.coot and as nicn.may in any wayaccme against said
U:z ctyedrthegmnype_mnt. ._ : .'• . 514 N WORKS
'4.. A CIUER5TAND AND' LLCOMPLYWITHALL N N” OINe, -�URCvs. ',- "� "• I I S o Issued by: Date
sgn r. prcan✓c ., - 'o to".'. Re-roofs. . ..
NA2ARDOUS MATERIALS DISCLOSURE
W ll me ti p,1 am%f tune Wdd ng accupa t oro o,handle havmdou matenal Type.of Roof.
ss defined by the Cupen o Mun c pal Code.Chapter 9,12,and th Health and Safety _ ./ t
Cod S'cuon.25532(el s.:. 'I - }Y t7 .. . ,s L : -fl; Ti's i a`,l \I
❑Y<. f]No`I' 1;:'. 'r. All.roofs..shall be.inspected.priorto,any-roofing material.being.installed.. .
'w ill the applicant.1future building uccupma use equipment or devices which If a roof is insiilled without first obtaining an inspection; I•agree'to remove
Chair It LICus at,c6nommurnar as defined by the Bay Area A Quality Mgement
Dona""?
ona r __all new materials for inspection. _Applicant understands and will,comply_with _.
�,• oY :( ON ., o ,. all nofi-point source regulations,
'1 have ad me hawdous ma¢ridl re mremsnt ands,Chapter 695 of me
Calion eeh &safety Code.Sectlo ;25533 and 25536.1 understand that .
it d' ildine notemrentlyhav moan,, atitnorytaponibilitymnotify the -
poem o!t icquircmems wh' must et poor m issuance of o Cenif ate of
Cu n - Signature of Applicant Date _
f i ow m ri wag tii Data o All roof coverings to be Class"B"or better
r I ..•, y,, . .OFFICE. . .. _ .. . . . . .. .. ... . ...
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRFSS: PERMIT NO,
AM 11x 10305 TULA LA CUPERTINO KITCHEN DESIGN3
y 01110022
GVIPAPORA NICHAPANICH 10562 S DE ANZA BLV A1L1/05%2001 .
PHONE: SANITARY NO. CONTROL NO.
(408) 257-4900
e<Z ARCHITECr/ENGINEER: BUILDING PERMIT INFO
O 0 BLDG ELECT PLUMB MECH
D= LICENSED CONTRACTOR'S DECLARATION
s 0 1 hereby aRn,that l am licensed under provisions of Chapter 9(commencing Job Description�tYtq
Vol
„Cw with Section 70M)ofDivision 3ofsheBusiness and gPfessmosCode.and m license REMODEL (KITCHEN & B 1fvrAA1E�
;x i.mmllfortea a . ELECT PANEL)
C ve irense Clf te r Lie if
O U D¢ Con, nor
l LL o< � —I undo y Pm.:n�l�be usce z `"irk,aenrd, - MAR 0 6 200
phi'
i aO Licensed Professional
q� OWNER-BUILDER DECLARATION gulLDli'�+..
1 hereby aRnn that 1 am exempt from the Contmaor's License Law for the
Z" following reason.(Section 7031.S,Business and Professions Cade:Any city or county
IFC Which mr,iiniS a permit to construct,alter,imprave.demolish or repan any stncjure
mwid3c�
Prime to itss req also requires the applcamfor such permit to file a signed statement p - --- -- - - --
that his 1' rs
sed puu int to tha provisions of the Contractors License Law(Chapter 9 v .S ..Ft.Floor Asea , Valuation
(c a n<ng with Section 70001 of Division 3 of the Bush.and Prefeu,ons Code) C W-;, ! t. q : ° \ t.'s f- e
or that he A exempt therefrom and the basis for the alliged coma
uoa.Any violation
of Section 703 L5 by any applicant for o permit subjects the applicant o a civil penalty
:of at more than five hundred dollars($500)._ APN Number Occupancy Type
O L as owner of the propeny.a my employees with wages as their sole compensation, 101 - FOUNDATION
-will do the wosk:and Ina structure is not intended or Offered for$ala(Sea.7044, 10 2 PIERS .
Business and Professional Cade:The Contractor's License Law docs not apply to an Required Inspections
Owner of property Who builds or improves themon,and who does such work himself 103 - UFER
or through his own employeesprovided that such improvements arc not intended or ," . .,. .. _ ...".. _...._..
offered for sale.If,however,the Wilding- rent is sold within one your of - _..........'..... ... ....... .... ... .... .. .....
gar improse r 104 - RE13AR ,
completion,the owncoW ilder will have the hirden of proving that he did not build or
improve for Purpose of sale). 105 - .ANCHOR BOLTS
._... .... . . .. 106 _= SEWER ..&..WATER. .. - .. .... ..
❑Les owner of the ProMnY•am exclusively conuxting -- - -with licensed wnvacmrs to ....
conswct the project(See 7044,Business and Pmfeasions Code:)Tba Contractors 2 02 - UNDERFLOOR .PLUMBING ..
License Law dues not apply to an owm r of proper,who Wilds or improves thereon,
..and who,contracts for such projectswith a contmctoep licensed pursuant to uta ........ .. . 2 0.3 - - UNDERFLOOR--MECHANICAL- - -- - - --- ---
Commctors License Low.
❑I am exempt under Sec. B&P C for this reason 204 - UNDERFLOORS' FRAME- :-
".•owear Data 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I thereby atBrm under penalty of Perjury one ohne following declarations. 302 -, TUB & OR SHOWER
0 I have rote will maintain a Certificate of Cons°m to self-inert a for work«s 303 - ROUGH MECHANICAL
Compenamiom as provided tar by Section 3700 of the LaWr code, for the 304 - ROUGH ELECTRICAL
perf.mamoo of the work for which this permit is issued.
D l have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
3700 of the Labor Code,for the performance of the work for which this Permit is 306 _ - HOLDOWNS
:. issued My Worker's Comp<nmeon Insurance comer and Polley number are: ...... .. _
.. ....
camp aOu=yNo '4(o1 —o f
307 — INSULATION
FROM WORKERS',^ 308+ ISHEETROCKI' ' -
.,:. COMPENSATION INSURANCE' .[' ... . . . ..._. _..__._.3.0.9----. .EXTERIOR"'LATH..".....-
''(this section need trot W completed if the permit is for one hundred dollars
310 INTERIOR LATH
(glgl)Or less.) .. "
311- —SCRATCH -COAT.
1 campy thm y n the performance ofnor s work for which th subject
to Permit e.issued,I
Chaff oro employ any feint in any manner sat as m become mbjen to the Woheri 313 - ROOF NAIL
Compensation I:e's of Calif rota DataApplicant . ..501 - FINAL ELECTRICAL .ENERGY
NOTICETOAPPLICANTIfn mak ,,Cretin.,, fE -pd..Y.,hOmd. 502 - FINAL PLUMBING ENERGY
z become subject tthe Worketes Compensation p o ons of the Labor Code,you must
O O forthwith comply with hp ions thispermit shall beretained revoked503 - FINAL MECHANICAL ENERGY
4 '' CONSTRUCTION IENDINGAGENCY 504 - FINAL BUILDING ENERGY
.1 hereby affirm that there is a construction lending agency for performance
a'> Ofthewokrorghichihis ea(See3M.7.C,,,C,) 505 - FINAL ELECTRICAL
am is;esu
a.q LenaeriName..,. .,.... . ......._.. "...,�. ._ . ... . .:�. .. . . ._....506 '- GAS TEST
] Z Lparsnddress - 507 '- FINAL PLUMBING
V'O 1 certify that I have read Nis application and state that the above intonation is
ebnco'.lass to comply with all city and county ordinances Dna state laws ralatmg . . . ..508 ...FINAL MECHANICAL
- O U to Wilding construction,and hooray national represcouttives of this city to enter upon 509 - FINAL GRADE
.ythe aWve-mentioned property for inspection purposes.
ora) ono save.indemnity Dna keep h ml<si he city oredp lona against SIO FINAL PLANNING
h liabilitic as, not,costs and exp s hich may in any way aceta against squid
URCE RE ULATI CS. 514,r N WORKS -
City q
e of the grunt of t pemut
A fICA1T \UERSTAND AYD LL COMPLY KITH AIL\ \yolt.-r Issued by: Dale
a11 Is. �s I I
Signat Pl rmuccinsgyyr na=cre D tmatm
Re•roofs v
HAZARDOUS MATERIALS DISCLOSURE -
Will die applicants an future Wilding occupant amort m handl el .Type of Roof.
- as defined by the Cupertino Municipal Code.Chapter 9.12.and Ne Health and Safety
Code Section 25537(a)
All roofs shat
0Yet ONOIl be inspected.prior to.any roofing ma[erial.being.installed.. ., .....
Will the applicant orfrture buil ding occupant use equipment or devices which If a roof is installed without first obtaining an inspection; I agree to remove
emit baganeraa air conuminams no defined by the Bay Art Air Quality Management
®District? all new materials for inspection. Applicant understands_and will comply with
°Yes ONO . - all non-point source regulations.
.. Vlh.v�id the nawdous mmeniAa rc uirtmcnts under Chapter 6.95 of the
&Safety Code.Sectio .25533 and 25534:1 understand shat
s not currtnuy Cavi terunt, as it is mY responsibility m notify die
quirements whi muss ct prior to issuance of•Cenif am of
Signature of Applicant Date .
a v
ow mOaaed agent Data All roof coverings to be Class "B"or better
:. =.
' � � � OFFICE