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CITY OF CUPERTINO
CONTRACTOR INFORNIATI N:
BUILDING DIVISION P ERMTT
BUILDING ADDRESS:
PERMIT NO.
7505 HEATHERWOOD DR
CUPERTINO KITCHEN DESIGNS
01100050
OWNER'S NAME:
LI ERIC H AND APRIL C
10562 S DE ANZA BLV
APPLICATION SUB DATE
10/09/2001
PHONE:
(408)257 -4900
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Job Description
with Section 7000) of Division 3 of the Business and Professions Code. an m tense
REMODEL & ADD 4 6 S Q . .
isinfull force (
(ADD
TO DINING & KITCHEN & REMOVE
sandeffeEt!
License Class N
Date - ��..�; -7��- Li,. Contractor
WALL
IN BEDRM & UPGRADE ELECT SERVICE)
ARCHITECT'S DECLA A
I understand my plans shall be used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the,
following reason. (Section 7031.5, Business and Professions Code: Any city or county
I which requires a permit to construct, alter, improve, demolish, or repair any structure
- - - - - •- - -- - -
i prior toils issuance, also requires the applicant for such permit to file a signed statement -
i eS.q: ;F,t- -Floor Area ': , ' - -
c. s_ r r ( t '• t
. $ 1 1 0 O nation
' that he R- licensed puisulnhi-to the provisions of the Contractor's License Law (Chapter 9
Division 3 Business Professions Code)
(commencing with Section 7000) of of the and
or that he is exempt therefrom and the basis for the alleged- e:iemption. Any violation
It r / :, n` - :
< , ,t
: ^ -
of Section 7031:5 by any applicanE for a permit subjects the applicant to acvil penalty
of not more than five hundred dollars ($500).
p�� },,,
3 5 AR g_nitI;10
Occupancy Type
O 1, as owner of the property, or my employees with wages as their sole compensation,
will do'the "work, and'the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractor's License Law does not apply to an
101 -
- - -- -- "
FOUNDAT 3;0*ired Inspections'
owner of property Who builds or improves thereon, and who does such work himself
10 2 -
or through his own employees. provided that such improvements are not intended or
_ _
_PIERS
offered for sale. If, however, the building or improvement is sold within one year of
103 —
UFER
completion, the owner - builder will have the burden of proving that he did not build or
improve for purpose of sale.).
104 —
RE BAR
O!, as owner.of the property, am exclusively contracting with licensed contractors to
105 —
ANCHOR BOLTS
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
10 6 -
SEWER & WATER '
License Law does not apply to an owner of property who builds or improves thereon,
and who contracts For such projects with a contracior(s) licensed pursuant to the
.. - - 202 - --
UNDERFLOOR PLUMBING -
Contractors License Law,
❑ I am exempt under Sec. , B & P C for this reason
203 -
UNDERFLOOR MECHANICAL
Owner Date
204 -
UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
205 -
UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of the following declarations:
301 —
ROUGH PLUMBING
❑ I have and will maintain a Certificate of Consent to self - insure for Worker's
302 -
TUB & OR SHOWER
Compensation, as-pmvided for by Section 3700 of the Labor Code, for the
perf° k for which ou permit is issued.
303 -
ROUGH MECHANICAL
O 1 htain orke Compensation Insurance, as required by Se ction
3 0 4 -
ROUGH E LE CTR I CAL
3700 de, fo th' rformance of the work for which this permit is
'ec
3 0 5
Vthe
issueampensa n nsu once. an Polic .number are:.
O oo'
- • •..
3 0 6 =
-HOLDOWNS
CarriPolicy No.:
'TION
' II
_
OF EXEMPTION FR M WORKERS',
= 3 0 7
•'INSULATION
COMPENSATION WSURAIyCE
_ _ 3 0.8 -,�-
SHEE TROCK
Mis section need not be completed if the permit is for one hundred dollars
3 0 9
EXTERIOR LATH -
($100) or less.)
310 - - —`
I NTER I'OR LATH - • - - - • '- - '
I certify'ihat in the performance of the work for which this perrim is issued, I
shall not employ any person in any manner'so as to become subject to the Workers'
311 -
SCRATCH COAT
Compensation Laws of California. Date
Applicant - - -
313 -
501 -
ROOF NAIL .-
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
foithwith comply with such provisions or this permit Shag be deemed revoked.
502 -
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503 -
FINAL MECHANICAL ENERGY
1 hereby affirm that there is a construction lending agency for the performance
t of the'work for which this permit is issued (Sec. 3097, Civ. C.)
504
FINAL BUILDING ENERGY
Lender's Name
_-
505 -
FINAL ELECTRICAL
Lender's Address
i
506 -
GAS, TEST
t I certify that I have read this application and state that the above information is
t correct- I agree to comply with all city and county ordinances and state laws relating
� 5 0 7 —
FINAL PLUMBING
I to building construction. and hereby authorize representatives of this city to enter upon
the above - mentioned property for inspection purposes.
508 -
FINAL MECHANICAL
(We) agree to save, indemnify and keep harmless the City of Cupertino against
'
509 -
FINAL GRA
1 1' ities, judgments, c expenses which may in any way accrue against said
Ci ' consequence of rig of this permit.
t
510 r
NA NG
0 CE IN TONS S AND %�nF CONIPLY lNTTH ALL NON -POL \T
Issued � _
Date
Signal u o Applicant/Contractor Dam
'
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE '
WiI the applicant or future building occupant store or handle haiardous material
Type of Roof
-
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
.
Code, Section 25532(a)? - - . -
.
. ,
El Yes ° No
All roofs shall be inspected prior to any roofing. material. being installed, .
Will the applicant or future building occupant use equipment or devices which
If a roof is installed
without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
all new m terials
for ins ction. Applicant understands and will comply with
❑Yes ° No
all non -po t source re
' I have read the hazardous maierials requirements under Chapter 6.95 of the
C ifomia Health & Code, Sections 25505, 25533 and 25534. 1 understand that
if building does n cu Vy have a tenant, that it is my responsibility to notify the
7�L '
'u an[ of the require wh' mmi met prior to issuance of a Certificate of
Signature o ppli6
nt Date
All roof coverings to be Class tB" or better
- own or authorized agent - Date
OFFICE
CI
HUILDOI G DIVISSIIONVO PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
7505 HEATHERWOOD DR
CUPERTINO KITCHEN DESIGNS
01100050
OWNER'S NAME:
LI ERIC H AND APRIL C
10562 S DE ANZA BLV
APPLICATION SUB DATE
10/09/2001
HONE:
(408)257 -4900
SANITARY NO. CONTROL NO.
I
ARCHITECTlENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i
u o u u
' LICENSED CONTRACTOR'S DECLARATION
1 hereby affmt that 1 am licensed under provisions of Chapter 9 (commencing
'cense
lob Description
i wim Section 7000) of Division 3of,he Business and fessions Code. an my
REMODEL & ADD 4 6 SQ . FT .
i is in full forceand ef(
License Class I.ic.M
(ADD TO DINING & KITCHEN & REMOVE
' Date 11!(" -1. Commamr _
WALL IN BEDRM & UPGRADE ELECT SERVICE)
ARCHITECT'S DECLA A t
I understand my plans shall he used as public records
i Licensed Professional
j OWNER- rxim,o.RDE DECLARATION
1 hereby a0imt on 1 nm exempt from Inc Convns License Law for the
FINALED
following rtasaa(Section ](131.5, Co
and Professions Code: Any city or county
1 which requires a permit s. alter,
maamc0 alter, improve, demolish, any
re fi..goods aterie
$ -prwrtoiu iswat.e. alw rrquiru the applicam for CaM1nical
T �rI i3
$1100 ° .[ion
Licer. aw(Chtatncm• (commencing ng wis pSectiot tdjhc pmxaons of me Contactors License fTs (Chapter )
(c throne ills Semion17000)ofhe builtohe allgad a lard Prpfganycli Code)
y
or too he i703
Ihc'rcfmm send the .Psis for the slllged e4em..t us
- L5 by st l pennon
o(Senion ]031:5 by oby opplicam for o permit subjttu the applimnt m a civil penalty -
iafnotmomthvnOvehuntlrtddollars (530(,). -_
.Occupancy Type
❑1, as ownerork; progeny,rumyemployees withwagesastheirsolele
smadon.
-wilreo'me work; rsims Coda: The C nofimende t... Lrw does, Out (Sec: 7UW;
and
' His and Prof m an
Code: The Convector's License Lew does not ork
101 - FOUNDAT Ired Ins ections �0 " .1 D
d P -
r Who b
(if nude, nr improve. and won sacs work himself
wdor rf pr
'd
102 - PIERS_
Me mch.
M, e. mx
d tom ach tmprnvemems ore not omen - d
or erect fo his own a ply ; p nded o
.-consplemralelr:hoee me bussed p' wimp one we
_ _ - -
•- =103- -- --LIFER
of poll is
me owncr na mar will nave me wme or pmwine mat he did oat Wild ar
`amplaunn
mpmva ran parpone of sole.).
104 - REBAR
- Ol;mownen cenTh
mofessins
10'5 - ANCHOR BOLTS
armwclthe project (See. Convors.
rojeep.penyam Business and Co
apply'a a easiness and Professions
License Law does not apply m an owner of property who builds or improves thereon,
who bilode:)Theves thereon,
106 --.SEWER &.- rLl.�'1 a..is
- � � - '
_and who contracts for.such.pecill with commelods ).licensed- puraaant.m.mo-
._ . ______2'02-- -- UNDER' FLOOR — PLUMBING-----= -- --- --- - ---
ulaw.. .,.:. -.
❑nnvaaors Umndpr sec, .s ' " ",B'APCfonhis reason
1 em exempt un....: ..,. ... .. ......-
203 - UNDERFLOOR'= MECHANICAL
o "� ".• °:,sa.l.,pa�a
204 - UNDERFLOOR FRAME
'___WORKEWS COMPENSATION DECLARATION
205 - UNDERFLOOR INSULATION
I hereby affirm anderpetaltyoI PM.yane of ill -:,a following laationa:
301 - ROUGH PLUMBING
I 7 1 have and will maintain a &ertIRWle or CORert In RIGIaN. far Worker's
302 - TUB & OR SHOWER
Cash motion, as- provided for by Section 3700 of the labor Code, for the
perfo ' nceo( iheworkfnrwhicluhispe `mitisissueJ..
303 - ROUGH MECHANICAL
01h. in Of will ma ml n ke C'ompc sat In umnc< .i eq d by Sector
304 ROUGH ELECTRICAL
3700'o La.pr coda r< K ... - r me pr for wn h'th p a l s
issued
305 FRAME
o et Co pe n c e- Pal -M. berarc
^ 'O t/ OOOO'
., _ a -_.
" HOEDOWNS
Cam C! fall o
' I RTfPI T)ONOFHXEMPTION FROM WORK
}3'06
�' �3:0'7 `' gl`1 NSULATION
-, COMPENSATIONINSURANCE-
- --- - --
^n"
1 „• ' Cl3aaasema uaaeeaanthecrmple .e- amepermaiamronenunarcaaun.rs
".1' "� >T,a.
309µr EXTERIOR LATH'
(SlW)orlees) t
4 w J I
I rest that in the pe f an of she k m l i n this
hall any In
_310 -- ....,INTERIOR- -LATH
'COAT '
not employ per on any manner so as td beemi yggct to the Workers
_APpl ant. nEdws pr cal neon Dap., _ .:_:. _; ._... �_
311 - SCRATCH
„ -._ -. - 313..-- ROOF_NAI L.
W6.hQG)'O APPLICANT.I Ccommakillim his mCbima. of Labor iod.youmad
become sbbjeci temp Worker's Compensation proviaiom of the IsMr Code, you muv
501 - FINAL ELECTRICAL ENERGY
fans thamplywith uchp ions or this permit shall b deemed m invoked
502 PLUMBING
1'CONSTRUCTIONLENDBWAGENCY'
.. "ENERGY I -____
503 - FINAL MECHANICAL ENERGY( "'
` I hereby aRrm that mcm is a cbdsvumton lending aieney (or me perroim.nce'
oftnewmkmrwltien this perairn issued Emc .J097, Cis. C.) _ "
,.�....
_
504 FINAL BUILDING ENERGY.
.. Lenders Name -,... -- ....,.,..._.0 ,..
Ltnemanaere:n' r ,.. '-,. ,. ,.•.
... _
505 - -FINAL ELECTRICAli—
n,
'.heabo, is
,r::,. .;5 I,❑
506 - GAS-TEST
ramify that
verify that 1 have rcae this application and stare that the shove information is
r.,,, information
aI
IIl ill city and county sae lawserlating
_._... -. -rj O7___- __g_I -NAL— PLUMBING
so building g contrcom:brid sepgorJimncesand
th, elvare- mentionadda :pertyfctiyaumodu.p.sentntives of ihii city to corer upon
the ebo(We)aglonud, pmppnyfminspection
508 - FINAL MECHANICAL
kephahmb,. ,,,, -n."
hamyin the Oty (Cnce ass
tntlersexpens
(W) gnorls
- -
5 O 9 --` F INAIL' 'GRA
I
B i s 3, dg ems, c n expenses ,which may any ay cme.gamv neap
s,whi against
Ci q eh «an g gortm peat "
AP CANT WELL WITH "''
S 1 O„ N NG
U.NDERSTA AND COMPLY ALL YON POINT
8bu Gf11iATI0NS
.. _ ,.
Issued Date
Sign. of APpliwnJCantracmr ,'•..'r "p' /..:•.,: 1: -Y ? ". Ua. -; is°
__.._..
-Re =roofs
HAZARDOUS MATERIALS DISCLOSURE
-:' W II the t a f b I Co Kcupeni t handle h Halt n m led
_
-'gyps Of ROOF, -
a Cupp
m l Si i. to 320.D o Municipal Cone Ch pt 9 II and the Halt and Safety
CadeSCtnn255]3 ±e) q .. _
-
-'-
�P�lyd 55JLA ((..N v Y;1fcYsLe�i Troy , :.'is..:. .,
Phi t4 -..
.a ❑YS 1 ON tl ,.
1� \ar 1 „'
I�
1 _ ,t. i�4 .'C.
_.- All.roofs.shall be inspected pnor.to: any material. being,mstalled.
; , Will she applicant o f . buildin g scup tuuegmpril do � il` Pam
-
hmad it iy
,roofing, _ _ _
If a roof is insialledwithout first obtaining n ins ection,-Pa ree,to Fe'move
g P B
tat s contaminants defined b the B Area Air Qual Management
Iyiat m] , y r 1 '� -
all new m terlals for insp chon. Applicant understands and will comply with,,,,,
^, t PYe" „ , ONO .
a, nT �
_ .. . .
all non -po F— source re Lons:
have read the hazardous maiedals requ rermnts under Chapter 695 of the
'
C If ch ash"& Code Sudons 25505 25513 end 25534 I demand mat
'if bold ng docsn c 0y ha eem o t moots my, esponstbthty to modify the
" - 'tad
"-
'
u em of th req it t w met pour to isauam of 6 Cemfiwc of
Signature o ppli nt._ Date
.
All roof coverings to be Class. "B" or'bettere'
g '
Own or amhorizad .gent ; lr Date
. r
,w. I t t, 1 ,
.OFFICE --.