02070074BUILDING DIVISION PERMIT
BUILDINGADDRESS:
10123 HILLCREST RD
OWNER'S NAME:
WOOLFOLK JOHN AND KAY
PHONE:
O FOF ARCHTTECTIENGINEER:
fan
rO �H LICENSED CONTRACTOR'S DECLARATION
E - 1 hereby affirm that i nm licensed under provisions of Chapter 9 (commencing
rc,_E with Seaion7 )of Division 3oflhe Businc nJ Processions Code. and my license
c, i 'n full fo fee ,-
as s ,�i a Licen Clan '- Lic.M L 'l 2 3
n O i L' Dat Convacmr
3 �'• rn ARCHITECT'S DELL ION s
t = O g 1 understand my plan shall be used as pu c mcoNs
c. T
OO Licensed Professional
OWNER"BUILDERDECLARATION
= 1 hereby . Sffieel that 1 am exempt from the Cocoon, Cod a An, c Law for the
t C following reason. (Section ]0]15. Business and Professions CMe: Any city or scurry
siiF� it O which requires a c. rds.m conswct, alcor, improve, demolish, or rtpmr any atoll re.
n 3 $ .,. prior m its issuance. nlso requires the applicant f.... ch penNno files Law Ch.pn
thattlq iq Ii¢afed pubwmtpaPMWgom of the Commcmts License law (CM1apmr 9 ECO
I
(cnmmencngwithSection(jtY10) ftl isionJof the ey avd Pmfpssions Cade) �'.4J Y
."hot he {'s eiemp( thcbefrom and the basis for the al f 9d e(tembtlob. Istry vi-fickm
of Section 9031.5 by any applicant for v permitsubjecta to, ... liront to a civil pcnalty-
oanot mom than five hundred dollars (5500).
U I, as owner of the property, army employees with wages ns their sole compensation.
-will do' the work:' and the snucmm is not Intended or'offered 'for saie'(Sec.-70a4,-
tBasineis'and Professions Cudc: The Conrmctims License Law does not apply hs an
owner of progeny Who builds or improves thereon, and who does such work himself
or through his own employees provided that such improvements are not intended or
coffered for sale. If. WI the bmlding or improvement a sold within one year of
'completion, the owner -budder will have the burden of proving that he did not build or
improve for purpose of safe .II
O T.-. Sowner of Nv ryopcny -am- esclusivelY comrecting with licenud canvaturs 1.
coaauvit the project (Sec. 7064. Business and Professions Code:) The Contractor's
License Law does not apply to an owner of properly who builds or improves thereon,
_end who contracts for, such. projecis.with, a commctoros).licemed.pursuant.so the.
C mranors License, Law
DI amexempt underS _�—s BIr A P C for renvon
Owner, at,
WORKER'S COMPENSATION DECLARATION__-_
-I hemhy aRrm under fpnnity of perjury one of the following declinations: -
9 t s
01 have and will' meinuio n'C6bificam of Cmiem in self-insum for Worker's
Compensation, as provided for by Section -37M of the labor -Code: for the
'performance of the work for which this permit is issued.l,,
❑ l Wiscriodvvillmainudo Workei s Co poor n l sum - required by S L i"n
c- l]W of the Labor Code for the porformarre of the rk for which this permit is
flai My W rkehCompensation Ins ce carrier and PI y ouniterarx. -'
S'11E4�R �t f t�nuey N °3Y .p z
'tst ,t CERTIFICATION OF E%EM✓NFROM WORKgµg.t"
_ f - '
COMPENSATION INSURANCE WOR"
L
:r11 r""'rl'his`sceiion need not tie cmplcted if the permit is for one hundred dollars
IS 1001 at lits.)
1 cert fyithet in the pe f m f the o k'f i" h this gems T i,i i ued 1
s'sh II t rept y any pe o y m nner s s m hecnme s be tto the Workers'
cmmrensar nn 1'nwe r,r r.d Tort, n neo- ,.
EMP
C F"
U
rw
F
torthwhh comply with such provisions or this permit shall be deemed revoked.
st I I
i, 1;,I! CONSTRUCTION LENDING AGENCY
�o' I hereby Rimh r ith r' ,a con w u n lending agency for the ighm nee
f the woul, for hich this pent is"ssi d (Sec J097. Civ C)
Lenore Nmns'
Lenders Address '
I eery that 1 have read th¢ applicroom and sumahm the'nbove raf.sm.pan is
correct. I agree r9 comply with all city and county ordinances and state laws relating
to Wildingconstruction; and h aby carbnate represemmives'of this city to are, upon
ih Iso mentioned progeny f nspec is p Arose
(W) gre'id save once 'minify and k p humlesi the City f Cupertino against
liab ht es) mors, costs on as u h ch may n any y eccme again. t said
Cly c ce of gr t n sh s/pen�n
APPLICA IINDEI ANi1'f�IFL�'WITHALLLO�Si �Oie
tt /a _ z . z
18ndMe orAPPOcant/Comoccuir: " f` (:'%`s t"F :, Da
+' HALARDOU ATERIALS DISCLOSURE`' '.':?
?s y K Il th
far
.ppl cat rm t hed co
a nt nnm
�•eD t mOYes r
Irrr
i I have rc d.the hazardc
California H ahh & Safety Cud
jl the hu ldm5 distribute rjrcfjftl
.. '.Peeoiicu V 1 N,P.e. cq'// . Ar
PERMIT NO.
02070074
APPLICATION SUB DATE
07/12/2002
BLDG ELECT PLUMB MECH
KITCHEN REMODEL Job DescOl" A L E
OCT 2 12002
BUILDING
$16000
101HrtI'MMMATION
Ton _ nTUnO '
103 - UFER Required Inspections-', 'llnr�
104 - REBAR
105 - ANCHOR BOLTS �'-� �"•' t> f- � t. .
106 - SEWER & WATER
- 2 02._- ' UNDERFLOOR__PLUMBING--
203 - UNDERFLOOR MECHANICAL'`". ^`'"
UNDERFLOOR -FRAME--
205 - UNDERFLOOA01INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
304 - ROUGH ELECTRICAL
305 - FRAME
306 - HOLDOWNS
307 - INSULATION
..}.np••__._-OVIIPTTAnsi.._._.._.............n...,W.«.e...,,-.......__....-._.�._.._...... __6666
?:d.. i
--------31.0-r- ZNTERI'OR--LATH_____....._.,______,._.__.
311 til ' SCRATCH COAT !
---:31-3, --ROBOFNAIL : '
501 - FINAL ELECTR'hCAli'rtENERGY
_-
503 - FINAL MECHANICAL 'ENERGY
504__-FINAL, _.BUILDING_. ENERGY
505 - FINAL ELECTRICAL
506 - GAS TEST `
_..CHBING -6666_.._ ._.. .__-._. _ ....._.. ...
508" --- FINAL MECHANIC
509 - FINAL GRADE
510 - FINAL PLANNING V /
514 - FINAL IDUBI47C WORKS
Issued by:
Re -roofs
Date /�// y� 5-V
is pal .Chatere).12. and the Health aM Safety..____pr_......__T_.,.'_.'.__......._»........,__....--...✓.._,
.. t y
1.
No I w Fi. c�i,lla ,' x ri i-� i -Ili 1'`�.," 1r_ Ai,tl ryp,. all P
_. All roofs shall be inspected prior to, any_roofing.matenal being installed.,
e buildingoccupant use equipment devices which, g , !s agree, t0 remove
d by theB y A Air Quality Management , t g P g
_ P PP will comply with..
N , I _ understands arid -
a Too Is nista a without first obtaining an ms ecnon I a
all new materials for inspection. Applicant anti
all non -point source ce ulanons ,
Signature of Applicant Date
.-- -... - -
6666. .. 6666
_
All roof coverings to be Class B or better I 1 - ' I
-OFFICE- 6666 .
.. 6_666._. _.. _.. ..........._... ........_.__.
CITY OF CUPERTINO "IN:
BUH,DING DIVISION PERMY CONTRACTOR INFORMATY
BUILDING ADDRESS; PERMIT NO.
10123 HILLCREST RD 02070074
OWNER'S NAME: APPLICATION SUB DATE
WOOLFOLK JOHN AND KAY 07/12/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITFCTIENGINEF.R:
'Z LICENSED CONTRACTOR'S DECLARATION
Z I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
4 t: U�l with Section7 )ofDivision 3oftheBusine dund Professions Code. and my license
is in full fo
0 Dat
25 n: 1X < Licem sF2. ec Lic. # Z 5 -5
Dat .7Z I A ContracContractorrt., /C6,A I
ar vs / ARCHITECT'S DECL TION
0 1 understand my plans shall he used as pu2111ecords
Lu a q p Licensed Professional
X
X o w OWNER -BUILDER DECLARATION
au I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure,
prior to its Issuance, also requires the applicant for such permit to file itaigued statement
a.
that girt is lictirsed pufsuabI ijthd Provisions of the Contractors License Law (Chapter 9
(cbm.meficiag�with Section, QW) of Division 3 of the Business and Professions Code)
or that he is exempt thenitmin and the basis for the alikical c$,Iripthdr- Any violation
-ofSection,70315by any applicant -fora permitsubjects the applicant to a civil penalty
of not more Than five hundred dollars ($500).
0 1 as owner of the ro rt or ra can toy ees with w I
BLDG ELECT PLUMB MECH
KITCHEN REMODEL Job Description
''will
y P ages as ersoecompensation ,
do the work., and the structure is nor intended or offered for saIe,(9cc.'7044;'
Business and Professions Code: The Contractor's License Law does not apply to an
I
103
- UFER Required Inspections
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
104
- REBAR
offered for sat6:1f,'hoWwvef, did banding or improvement is sold within ono year of...
'Completion, the owner -builder will have the burden of proving that be did not build or
105
ANCHbA BOLTS
improve for purpose of sale.).
106
SEWER CSe WATER
Cl L asowner of the property, am exclusively contracting with licensed contractors to
"2 0'2"
UNDERFLOOR PLUMBING
construct the project (See. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
203
UNDERFLOOR MECHANICAL
arid -who, contracts for. such . projects with. a contractor(s)-licensed pursuant to. the,
Contractor's License Law.
2,04-
UNDERFLOOR -FRAME-
0 1 am exempt under Sec. & PCIfor this reason
205
UNDERFLOOR':IN8ULATION
Owner Date
301
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302
TUB Sc OR SHOWER
I hereby affirm under penalty of perjury one of the following declarations:
303
- ROUGH MECHANICAL
0 1 have and will maintain a Certificate of Consent to self -insure for Worker's
304
- ROUGH ELECTRICAL
Compensation, as provided for by Section r3700 of the Labor Code, for the
performance of the work for which this Penult is issued.-
305
- FRAME
0 1 have aruf will maintain Worker's Compensation Insurance, as required by Section
306
- HOLDOWNS
3700 of the LaborCode, for the performance of the work for which this permit is
issued, My Worker's Compensation Insurance carrier and Policy number are:
307
- INSULATION
sLA.Ilcy N _7831 —0
3 0 8
SHRETROCK7--,
:CERTIFICATION OF EXE ION FROM WOR -URS'
3 G§11,
EX`12RIO LATH
COMPENSATION INSURANCE
-310-
-INTERIOR-.LATH
(Th ig section need not be completed if the permit is for one hundred dollars
($100)orless.)
311
SCRATCH COAT
Shir'I cedyitlrat in the performance of the work for whic-li'this -P emit is issued, 1
il not employ any person in any manner so as to become Subject to the Workers
313,
501
�ROOF NAIL-.-
FINAL ELECTR ICAL :ENERGY
Compensation Laws of California. Date
Applicant.,
502
FINAL PLUMBING ENERGY
Z
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
forthwith inch
503
FINAL MECHANICAL ENERGY
^1
ZZ
comply with provisions or this permit shall be deemed revoked,
504.,,-.,,
FINAL BUILDING. ENERGY,
CONSTRUCTION LENDING AGENCY
505
- FINAL ELECTRICAL
*0
I hereby aff .... that there is a construction lending agency for the performance
ofthe wr which this permit is issued (Sec. 3097. Civ. C.)
oNamrk foe ,
506
- GAS TEST
Lender
Lender's Address
I certify that I have read this application and state that the abovoinformation is
507
508
FINAL PLUMBING
FINAL MECHANICAL
P_Z
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter upon
the above-mentionedfor inspection purposes.
(We) agree to =cmnify and keep harmless the City of Cupertino against
liabilities, i is, costs and exp ses which
i." dii a i,,r.ny in an), way accrue..against said
City in cons trance of ar
UII�DE LYWITH'ALLNa 01\0
APFILICA��Iulmca
^igarnare.on Applienraluontractor
HAZARDOUS4eATRIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertmo.Municipaiode, Chapter 9,12. and the Health and Safety
Code, Section 25532(a)?
'(Q Yes No
Wilt , the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as it ed by the Bay Area Air Quality Management
District? e
0 Yes
No
I have read the hazardous materials requirements underChapter 1 6.95 of the
California Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that
if die;b- does -or cures dy hp- . tenant, that it is rry'responsibility to notify the
eet prior to issuance of a Certificate of
occuPa, re"ii..
Occupa Z)
509 - FINAL GRADE
510 - FINAL PLANNING
514 - FINAL PUBLIC WORKS
Issued by:
Re -roofs - / I I
Type of.Roof
"All roofs shall beinspecte pno,r.,to.any ,rQofing.mat(-,rial,b.p.itiginstalled, ..
If a roof is installed without first obtaining an inspection; I agree to remove
all new materials , for inspection. Applicant understands ,and will comply with
All non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class "B" of better
I OFFICE