07090209 CITY OF CUPERTINO "
BUILDING DIVISION PERMIT ����� ���Z����'����"
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BUILD PERMIT NO.
���.�I��AURETTA DR ANTIQUE TERMITE & PEST 07090209 .
OWNER'S NAME: P ���� DA �
PAYNE ZIE A AND DAVID H 1913 ST()NE AVE � 09/28/2007
NE: SANITARY NO. CONTROL NO.
(408) 99:i-6300
ARCHITECT/ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
� 0 0 0
� o o LICENSED CONTRACfOR'S DECLARA7'ION JOb DeSCrlptlOfl
� V� I hcrcby affirm �hat I am licensed undcr provisions o( Chaptcr 9(commencins
;z � wiihSection7000)ofDivision3ofihcBusincssandProCcuiansCodc.andmylicenscis REMODEL KITCHEN� MASTR BATH � HALL BATH � 1/ 2 BATH
� e 4 in full forec and eftec�
�� ? Licensc C s Lic. S � sc
.M� oa�c T pRC trec.-�rs oN BAR & F:CREPLACE RESURFACEE
i a Q I undcrstand my plans shall be uscd as public records
)yU
' a � Liccnud PmCcssional
� y � OWNHR-BUILDER DECLARATION
>' 1 hcrc6y alTirm �hat 1 am czcmp� trom thc Conuactar's Liccnsc Law Cor thc
� p O following rcuon. (Sccuon 703I.5, Busincss and Pro(cssions Codc: Any ciry or munty
�,°, � which requims a pc+mit to conswct, aUcr, improvc, dcmoli.ch, or repair any stmctu�c
? Z y prior ui its issuancc. alsu mquircs thc applicant for such permit to filc a signcd sutcmcnt ��, Ft. Floor Area Valuation
< ihat he is liccnscd pursuant to thc provisions of ihc Conuactor's Liccnsc Caw (Chapicr 9 `' $ 6 5 2 4 3
4�� (commencing wi�h Section 7000) of Division 3 ot ihe Business and Professions Code) or
,a, �� that he is ezempt themtrom and �he basis Cor ihe allcged exemption. Any violation o[
Section 7031.5 by a�ry applicant (or a permit subjecu ihe applicant to a civil penalry of 3 2 6 5 5 01 3!°'�� Number Oceupaney Type
not morc than fivc hundred dollars (5500).
❑ I, as owncr o( the propccty, or my uaployees wieh wages az the'v solc compentaGon,
will do thc work, and the suucture is not intended or oRered for sale (Sec. 7044, Businas Re u ired In s ections
and Professions Code: The Conuactar's License Iaw docs not apply to an ownu M 9 P
propeny who 6uilds or improves thercon, and who daes such work himselCar Uuougd his
own employccs, providcd that such improvemenls are not imm�ded or aRered fa sale. I[.
however, the building or improvement is sold within one year of complcdon. � owrcr-
builder will have the burden o[ proving that he did not btild ar improve tor purpiue of
salc.).
❑ I, as owner of the property, am exclusively convacting wiU� littnsed rnnuactas w
construct ttie project (Sec. 7044, Business and Professions Code:) The Conaacwr's Li-
ccau Law docs aot apply �o an owner of propeny who builds or improves Weceoa, md .
who conuacls for such pmjects wi�h a conlnnor(s) Iiceeued pursuant to the Cont�wfs
License Law.
❑ I am ezempt undu Sec. . B& P C for this rcawn
Ownor Date
WORKER'S COMPENSATION DECLARATION
16ercby afficm under penalry of pe�jury one ot Ihe fallowing declarotions
❑ I h:ve and will main�ain a Cenificate of Consent �o sel(-insure for Workels Compen-
sation, u provi d for by Section 3700 of �he Labor Code. [or �he performance ot the
waric f uh this permit is issucd.
havc and will maintain Worker's Compensatian Insurana, u tcquired by Scction
3700 oC Uic Labor Codc. Cor �hc pertormance ot the wrork for which this permit is istued.
My Worker's Compa�sation I urance a' an�olicy number are� w _ ,�
w wM fI/) .��
Cartier. Pol' No.VG(J•� ��V
CE TIFiCATE O E EMFf[ON FROM WORKERS'
COMPENSATION INSURANCE
(7]iis sectlan necd not be completcd if �he pecmit is for onc hundred dollars (St00)
or Icss.) �
I certiCy that in �he performancc of thc work Cor which lhis pertnit is issucd. I shall not
employ any person in any manncr so u to becomc subject io �he Workcrs' Compenvdon
Laws of Califomia. Date
Applican�
NOTICE TO APPLICAM: If, aftcr making �his CertiGcau of Ezemption, you sAou1J
bccome subject to lhc Warkcr s Compcnsation provisions of �hc Lalwr Code, yw must
� O forthwi�h comply with such provisions or this permi� shall bc dccmcd mmkcd.
z "" CONSTRUCfION LENDING AGENCY
H �-�. 1 hcrcby aRirm Uiat thcre is a consuucann lending agcncy Cor thc performancc uf
pC, � ihc work far which ihis permit is iuucd (Scc. 3097. Civ. C.)
a Q C.endcr's Namc '
� � Lender's Address
(� � I cenity �hat I havc rcad this application and zutc �hat thc a6ovc informalion is
�� corrcc� 1 agrce �o comply wiih all city and county onlinances and state laws rclaung to
0 U buildiag conswction, and hcrcby authome rc�rescntativcs of �his city to cn�cr upon thc
� W abovc-mcntioncd pmperiy (or inspccuon purposes.
a (We) agree to save, indcmnify and kecp harmless ihc Ciiy o[ Cupertino against
� r/� liabiliuu, judgmcn�s, cos�s and expenses which may in any way accruc agains� said City �
() z in consequcncc oC thc granting o( lhis permit. DaLe �r Z(/ — Q?
►�-� APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by:
SOUR LATIONS. E:I"/'^ ����
� ' ., Re-roofs
Signawm f ApQlicanUConuactor �� T of R�of
HAZARDOUS MATERIALS D[SCLOSURE }��
wll the appticant or futurc buil ' g occupantuore or handlc haiardous matcrial
az defincd by the Cupertina Munic' 1 Codc. Chap�cr 9.12. and the Heal�h anJ SaCetr
co� ,Scction25532(a)? All roofs :�hall be inspected prior to any roofing material being installed.
p Ycs o
Will thc applicant or fmure buildi occupant use eyuipmenl or dcvia�s w�hich If a roof i: installed without first obtaining an inspection, I agree to remove -
cmi� ha•r.ardous air coniaminan�s as cd by the Bay Area Air Quality Managcmcnt all new m�terials for inspec*ion.
Disvict?
❑ Ycs u
1 havc rcad the haiarC<ws materials rcquircmcn�c undcr Chap�cr 6.95 of the Califar-
nia Hcalth & Safcty Codc, Scctions 25505, 25533 arH125534.1 u�ufcrstand ihaiiC�hc building
docs not curtcntly ha`c a icnan4 �at i[ is my respnntibility m naify Ihc axupant af the
rcyuircmcnlswhic�e�ru�i�en�b[aCcrlific�_^fO�pan� Signature �fApplicant Date
�/
°�!r- Y� All roof coverings to be Class "B" or better
Own�uthori�cd agcni Datc