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02070056-FPCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORINT CUPEKrINO ® p c>S� D2 % APN # Date: Fee Group BAPPLOTHER Building Address: v'2 5 c.� Owner's Name: Phone #: BUELDING L+ ci � C ntractor: License #: BCONSTAXBQ Con. Tax for BQ Zone Povtact: Phone #: w e 0 9 9 S O A icant/C tractor: Fax #: -2— BELEC 1000 Bu lding ermit B1�lg^ El c ec i Job De ription: Resid ntial: �� Commercial: Sq.Ft. loor Area: $/Sq.Ft.: Architect/ r Valuation: Type of Construction: �r-- Vx Occupancy Gr up: 1 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUELDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 pIXZ moo_ �m Q U Z �QN FF -- Oz -O Fes= m d XOyU m30 m Kia m_v FZ< a3=� Alk CITY OF CUPERTINO CONTRACTOR INFO PION: BUILDING DIVISION PERMT BUILDING ADDRESS: 525 HEATHERWOOD DR ARTISTIC KITCHEN & BATH DES PERMIT NO. GN02070056 OWNER'S NAME: APPLI ��// I��002 C . COMAL 31 E EL CAMINO REAL PHONE: SANITARY NO. CONTROL NO - (650)390 -9615 ARCHITECr[ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t__:i u 1 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed untie`` provisions of Chapter 9 (comment ng withyec,'on7000)ofDivision3oFth,Busies.SandYrofessionsCode.andmylicense is in orce and✓✓Licelass •E7 Lic. #Contr KITCHEN REMODEL ITEcrT s DEC RATION I understand my plans shall be used as Public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following mason. (Section 703 1.5, Business and Professions Code: Any city or county, $40000 which requires a permit to construct, alter, improve, demolish, or repair any stnurure prior to its.issuaace.also requires the applicant for such permit to file a signed statement �rPfa, -,• •, , Valuation that be is Ucensq pwsSuahtrto theprovibigns of the Contractors License Law (Chapter 9 (commencing wo section 7000) of Division 3 of the Bysjness and Professions Code) ' , 3' 5 �"!t6'll• -100 . `,^ or that he is txempi therefrom and the basis for the alleged exempbiinl.Any violation ' • - of Section -7031.5 -by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ,�,.) 101 APP b UIV�I AT I ON , Occupancy Type ❑ I, as owner of the property, or my employees with wages as their role compensation, ' will do the work, and the structure isnot intended'or offered 1,salo'!Sec. 7044, Business and Professions Code: The Contractor's License Law does not annly • „n 103 - UFER Required Inspections owner of property Who builds or improves thereon. and who does such work tumself 10 4 - REBAR or through his own employees. provided that such improvements are not intended or -offered for sale'If, however, the building or improvement'is sold within one year of _ 105 — ANCHOR BOLTS -' completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.)' 106 — SEWER & WATER ❑ I, as ovner of the property, am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMB I NGconstruct the project (Sec. 7044, Business and Professions Code:) The Contractor's 203 — UNDERFLOOR MECHANICAL License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the 204 — UNDERFLOOR FRAME -• - Contractor's License Law. ❑ I am exempt under Sec.' , B & P C for this reason 205 - UNDERFLOOR INSULATION Owner i Date 301 — ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER I hereby affirm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's 304 - ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 305 - FRAME . ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 306 - HOLDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is INSULATION 307 - INSULATION issued. My Workers Compensation Insurance tamer and Policy number are: er.'. TU Z' icy nt �% V % I O -• • • - - 308 _— CERTIFICA ON OF E pppPP"'PPQQOfffiiO���11�� FROM WORKER6•; ,, x 3 0.9 • • - �- `EX•TERI OR � LATH .� COMPENSATION INSURANCE - 310 - INTERIOR LATH - (This section need not be completed if the permit is for one hundred dollars 311 - SCRATCH COAT ($100) or less.) I certify that in the performance of the work for which this permit is issued, I 313 — ROOF -NAIL shall not employ any person in any manner so as to become subject to the Workers' 501 - FINAL ELECTRICAL ENERGY Compensation Laws of California. Date Applicant 502. - FINAL PLUMBING ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should 503 — FINAL ME CHANI CAL ENERGY become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 504 — FINAL BUILDING ENERGY �. ' CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, civ. C.) -506 — GAS TEST Lender's Name - - Lender's Address - ING 507 — F I NAL PLUMBING 508 — FINAL MECHANICAL '1 I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating 509 - FINAL GRADE to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 510 — FINAL PLANNING (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgm costs and expenses which may in any way accrue against said 514 — FINAL UBL C WORKS , C in conseque ce f the granting of this permit PP s /rte CANT U: E STANDS AND WILL COMPLY WIT ALL NON -POINT OU CE REGU A ONS. I Issued b y: Date St tur o App ica o rDate Re -roofs H A D MATERIALS DISCLOSURE Will the applican or to a building occupant store or handle hazardous material Type of Roof ' at ode. Chapter 9.12, and the Health and Safety aid. f ped by the Cupenr MKUI,3� Code, Section 25532(x)? . • • ' ' - - - ❑Ye' o - ' All roofs shall be inspected prior to any roofing material being installed. Wdl the applicant or uwildingoccupant use equipment or devices which hazardous defined Aa. If a roof is installed without first obtaining an inspection, I agree to remove emit air contaminants as by the Bay Air Quality Management District? Cl Yes o all new materials for inspection. Applicant understands and will comply with all non -point source regulations. I have read th azardous materials requirements under Chapter 6,95 of the California Health & fe Code, Sections 25505, 25533 and 25534. 1 understand that idoes n t c eptly have a to ant. that it is my responsibility to notify the i wilofthe - occupa t rcqu" em is which must met prior to issuanc of a Certificateof ecu e Signature of Applicant Date _ All roof coverings to be Class `B" or better wn or authorized agent Date z VI096 V3 `ONLLHAJfj3 Q Ta aOOA4. 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