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CITY OF CUPERTINO
INFORMATION s_
BUILDING DIVISION PERMIT
CONTRACTOR
BUILDING ADDRESS:
HARRELL REMODELING INC
P- "t"D 6070174
22268 BELLEVUE AV
OWNER'S NAME
PERMyr ISSUE DATE
PETER & GAIL YESSNE
1954 OLD MIDDLEF
09/01/2006
SNE:
SANITARY NO. CONTROL NO.
(650)230-2900
ARCHTIECr/ENOINEER:
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECN
t� I�
LICENSED CON ACTORS DECLARATION
Job Description
1 bmeby ".ma 1 w [i -e l mtler pmvi,ims of CkaPm 9 (commencing
%im Secdml7000) of Nirialoe 3 of the BWra W Ptafeavata Code.,rd my Brea E
mfwl rascal «,. n �4, 9 C�
KITCHEN REMODEL, ADDITION, NEW WINDOWS THROUGHO •
Lice Lk..
'.106'
Dore Camrxta
ARCHITECTS DECIA ATION
1 mdmmaW MY Id....s.n be Toed u pubfic mcath
Lkwed Profeabrd
DECLARATION
OWNER
-BUILDER
1 hereby
11. uampt from tEe Conm,cmis Lkmm law for me
won. . se m Ten Code: Any em a Countyi.
ew. and Pr
,trick(ollooring emian
comma, tivl. Improve, &ninll m reryn any
Hien rite im, pewit m e,
Permits acromo
pAa m is iawntt.,4o rtqurms me,pplium (much Permit m Tik a sitrcd auavrtcot
r
li� faw(CDapta 9
Sq. Fe Floor Area
Valu4QB500
" la, islicensed pnmant to the fmolvoluaf the, Coauacta'i
(commencing wim Senior 7000) of Division 3 of me Bvircsr W Profenimu Cade) «
ma ho u W the haws fa me alkgrd .....p vlahtim of
ppN N �e
Occupancy Type
t to a d
3 b myAper m a it aby x.PP �t la. a Penalty of
w3u y aodie
i a(S5WLfm
not man: man RK eetdred edun (ssrot
not.
3 5 7 01 ��4 .r0 0
❑ 1. u ovum of the Palmy, a my aaployme with vagea a mc4 nto mmpandm,
Required Inspections
.iBmbe, mijilee„«mm;,aIntended awieOlfor ak(S«.m.f.Bod.
W ProToo Codc Caau wA Limce Law do on, appy m awnm ,n a
preprey who bwids vii and wbndots sub wok bismele h4
dsoneseh impr edInman
awnav, tachimProre^.,a. art na upendedmoQaed roe NeI.
ft Wiwi.:. tJw
baiwer, me building a Improvwm nal are year or cam the..
rbw rnfee a
bull0m win bare the Wrdra of PalloL W t b< Ad m Nit or Improre fa PmWae w
_
ak.)
❑ 1. u avm N the K-P-ny, are mclusinly —maroons wlUr Bcmcd cmmana, to
conanca the p rjeet (Sec. 7044. Buainm Led Pnfealurn Cade:) The Cbti a s V -
c.... lav door nos L"Iy m an owner a, wren Y wbn bwtla a Improrea ilat.. toil
who moaner«subProles vial,eonuanmp)Be+exd Pneaat to we c«baee f'
IJccen law.
❑ I am uaopr miler See . B h P C for alistotm
Dat
WORKER'S COMPENSATION DECLARATION
1 hereby allkm ender Prn ty a Perjury one a the [00owiog dGaratioec
C] I Iu.e W will mainW a aCmirtae of Corucm m rJf-k4urt f« Warte(s Compem
adore m Prmidcd fa by Section 7'!00 M ala labs Code, fa the Psf«onuce a(de
work fm which oris pmnit k �mxd.
71 1 bare and will maintain Wer . CompemWon Imran, an Ieyulred by Senior
.
3700 of de Labor code. ra me Prtamutco of dt<wak f« wbkh oris Penoit u'....n
My WartelaImmala p�rp�cfq�W Poinuntbc ac:
_ canie'. 0 r Pa Na , S A 3y 8 GG
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rr�x reed ortbaeampkcd IfineienndIsfaone hueddoWu(3100)
a len.)
I anih mu m da Pmfarmana of me wok r« wbki this pcmit u iwetJ I Nall nil
.
emptyiqPeWn In my manner W a to become nblat m NC Worker'Compenatiat
Inc a California. Dae
NOTICE TOA r: B, aper maklnL Crnirrose tb Exemption• ym
NOTICE
i Tru
O V We labor Code Iw muss
bcc«nc nbjm m the Wahero Canpcwdan pmvidma
on 1W W
be
farmwitb comply wiJ such pro.iaiants a Nu pi 'Sall be d¢nmd mrntcl
Is.. LENDING AGENCY
1 horb afritmlP dart11•m aLexy far the iertannarrcw
"mere
ISM 3M.
the wart for which Jus pemtit b ivued lSa.3ern, Civ. G)
Lmdefs Name
'
� lodeYS Addw
1 caHfy Nat I have read Jus aPriiewan end wte tbv Ih aWn mromatim u
cornett I U. to comply vim JI city W county orifi. and ante laws relating in
Wilding crow tion. and bereby aurbMn mprucnudres of this tiny to enter upon the
for im,onaca
ahu.libia, recd proPny purch
(we) agree m are. indemnify W �p hamlea the City Of Capcnim Egli=
may
n liabilitia,}Wgmcnta.eaa Wexpwm which m,Ymary war wvaaLalmt Hid City
Z inconw-goenceND H ILL COMPLY WITH A NO POINT
Issued by: Date
UTATIONS
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Re -roofs —
ure CYPl ATERIALSDISCLOSURE tale
Type of Roof
Jn atplkart a f,.,,... C L oavpaaaae a balk n
eadib mmachl
a dennm by th CoRnma Mama P+1 Conk. Chaptu 9.12. W me FINm W saran
imil
Secrion 15332(')7All
❑Ya I—,k No
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Wdl de appli -am or forme balkGn[ oavpaot um eyulPnem a doNaa wNch
emir by ua air contaminants a lefurd by me Bay Acre Air Quality Man,LcnreM
all new materials for inspection.
Diurkt?
0Yea ewDfNo
the harm sCmalerulareg4hemcros aakr Chapu 6.93 of Ne Ulf..
1 here real v
,
w Holm h Saamy Code Set9«e 121%5.jS94W 23334.1 urndrmvtd that 9 m buildrq
y
Signature of Applicant Date
All roof coverings to be Class "B" or better
r « m«vm mta ..