06010075COPY OF CUPERTINO
'
BUILDING DIVISION PERMIT
`CONTRACTOR INFpORMATION .
v
BUILDING ADDRESS:
GK CONSTRUCTION & DEVELOP
"°06010075
NAME:
PERiffTLSSUE DATEEHIMGUNDT
DEL
2 6
fR'S
E
SANITARY NO. CONTROL NO.
408)874-0323
ARCHm:CT GIKMI
BUILDING PERMIT INFO
BLDO ELECT PLUMB MEt}i
LICFNSM CONTRACTOR'S DECLARATION
Job Description
1 huoby afErm that 1 am Ileo under pm iWu or Chapter 9 (cmmmcl ing
with Section 7000) of Division 3 a be tl dodos and Proreuiou Code. old my Icuca4
in Poo roma and offer
REMODEL BATHROOMS (3)/MINOR STRUCTURAL
Licelr¢ Clw tel]- cri s �`�3
Dale l 11Y I$ L Camnnm GN J "
ARCHTfE(.TS DECLARATION
1 wldacaml my Plans shall be ucd u puh6c rtcaNa
liccvcd Pmfcuional
OWNER-BUILDER DECLARATION
I booby affirm Nat I am comp, form tk Contractors Lcuc law for bo
rolwwing r o, (Section 70313, Bwirca and Porfelsiou Cadc: My City or county
witch ic,l a Pumil to conu,ocl, aha. lmp , 4moE4h, or ¢lair My urvcnuc
$7500
Pda on iu iausnc, also tryttirm the applcam for such per,nit to fik a aipnd rwemco,
Ft. Floor Area
Valuation
Prot he 4lccnedpt.t to the pmvioou of the Coeuacwri liana Law(Clitpnr 9
Sq.
(eommcueing wd r Section 7000) of Division 3 of the Burnouts and Prafalm n Cool or
than M 4 eemp Ihcmfrm and Oe bu4 for the alleged eaanptlm. My . oatim of
-3 Avg
Occupancy Type
Snalon M21M by any applcam for a porch subjects bo ap tient to a civil Pmahy of
oat.OrtolhsbunEmdamla IMP.r
Luwxrof the yartyorwwwo w4hwagu uJmvmle
-
Required Inspections
Ivldcd cortemd B
widdoIowanCo e: 0",Buo.
dooti
ply
he Co . tms s not Ed ad of
sod cane: Cmuactets Lierte Vw doe ort appty w eco awns a(
nnyw1WProf.
rip
pmpn,y win Mtilds aimproae Nemm.snrt whodousuci wok hima3ru thoruyb h4
ownempbyas. ProWrtN Nasuch improsemesaue van wo-medaoRmW faralev,
.wfy/iafaq¢
howner, the LLdldirtg ar impovemm 4 WId rithm me yea of rnnplWon, tie oma-
Flip
wilm WB Woe tit bPrdut M gvWng Out he did van dtiW ar Imporae fa puryoa of
LE®
alk.).
Y 11
❑ 1. u owns of tie no,xn" w cachoivcly commalnt wIN be u d ctnrn w
conurvct the pmjm(See 7014. 111 r1 s sod Profcatiwu Cole:) ric C®vapors U
. law dots no, apply n eco aw r of propcnWilda y who lda or lm. pro tad a W
J1.�1 L
wlp CIPmKY IR YCb Pmjaw with a Com acw.) liallid pm Wart on NC GomKWra
Lac,. law.
❑lam wmin andu Src ,Bit PC fa lWis,oam
Dae
IpJ��fyH p6®��ss5'�ra
UIL" IN
WORKERS COMPENSATION DECLARATION
1 hueby Mrm ,order penalty, or perjury arc of the fmwwiog dclvsdau:
ood ab will maintain aCwfo,e of Couml to ulf-Ina nd for Worter's Cmpe
, u povWcd for by Section 3700 of pe Labor Code, for thc pedmnana of lie
13�1
for which Ws prmtiluoos
wi0 mutmin VJakers Comr e i m InvRanc, u required by Sectimof
W labor Cade, for Ne pufamaa ofthe wk fa w bieh Chia pump 4 booed.orkers
Cann'a.. ,,,, InWrsa¢ eaiu and Policy oumbm.m:
7
C.rtic S%aJz �^^'a" Polity No:
CERnFICATE OF IXEMMON PROM W KERS
COMPENSATION INSURANCE
-
(thlsxctimxcd.a4cmoplcndifthc crud 4 for ale tonthN 40aR(SIM)
ar leu)
I ccfdfy than, in the perform. of the ooh for which this perorlt 4lvintl. 1 shag no,
cm,doy any pecan In any manrCr W a b hocomo W bloc, w the WOftLfa' ComMatad®
1 of California. Dac
NOTICE AM: If, afar making this ChdOee un Eacmptio
E TO you should
d
cr W the W the lade Code.. Horn
wenm Wojcm tw Wekcra Cmopcovhort
erovlilmu
forthwith Comply with such pmvidma a Nis Permit shall be bsrocd math
y
CONSTRUCTION LENDING AGENCY
1 hcorby affirm that Nero 4. co a roctinn aMing agcrcY for de perfomuna a
the work for which Ih4 pennil4 iatW (S¢ 3119'1. Civ. C.)
LCodcra Name
,
� Isndets Addmu
I comfy thu 1 has rad TMs .pplicuion arL sun than tic awos of.dan 4
correct. l agms to compty MN all city and county mdinacsa and sun 4wa m4tiM to
wilding cnuNWction. and hemby amharl mpr rwM or thio city to cmcr upw lit
awocmcndmd Pmpc ty for borrow. purywas.
(W.) -'ns to ave, indrnmify and kap harnka Iw City a Cuperdw.gaiet
j lubilide,jndgmrnu,costs old capwo Miei may in.ny w.y umnagalutaM City
.q 0f tht gMti Ibp Ifmtit.
L UNDER N AND WILL COMPLY WITH ALL NON-POEM
Issued by: Date
G d S
Re-roofs
Type of Roof
uur H muse TFRIAfS DISCLOSURE D.k
Will applicant a I. Wilding occapam sac a handle haaudam nom4l
;it
(1x4 by the CupeNoe Mumcipal Code, Clupw 9.13. and the lialth sort Safny
.Sc don 2553$4)7
All roofs shall be inspected prior to any roofing material being installed.
__0 Y. ❑NO
If a roof is installed without first obtaining an inspection, I agree to remove
will the appli n or fatma wilding occupant ve egeipmem m devkss wbicn
hvacdtw air conamiuna u 411x4 by Ne Bay Arta Air Quality Mawgemea
all new materials for inspection.
°Irvin?
Dy. ❑Nu
1 bac rtnd the hai mnedabi rtyulmncnu under CTaper 6.95 of the Calif a-
n a Itoalth 6 Safny Coo, Sctr.255W, 15733 and 25534.1 mlduaund that Rthe Wilding
doe xtc ha.c that It 4 my nop lJhy an tnify the aetpant of do
mquimdc: rh Mo' of.Catif.oranPdcy.
—Signature of Applicant Date
All roof coverings to be Class "B" or better
owteror WthmllLda It Dan