10060158CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 7520 KIRWIN LN I CONSTRUCTION CO PFFRY ANI PERMIT NO: 10060158
OWNER'S NAME:
1 CUPERTINO, CA 95014 1 PHONE NO: (408) 605-8200 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 91, -1 %�
Contractor �h, �. ` �e-� �-6�Z� Date l$
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work, for which this
permit is issued. % ,� /
APPLICANT CERTIFICATION l////
I certify that 1 have read this application and state that the above info ation is
correct. 1 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 mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regillatio s per the Cupertino Municipal Code, Section
/%
9.18.
Date
❑ V OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following,three
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
1 certify that in the performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that 1 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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
With all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
:signature Date
711 r7_1
BUILDING PERMIT INFO: BLDG f � ELECT PLUMB
MECH IJ RESIDENTIAL r,—! COMMERCIAL r
JOB DESCRIPTION: REMODEL KITCHEN,DINING ROOM & FAMILYROOM
(723SQFT)
Sq. Ft Floor Area: I Valuation: $112000
APN Number: 35923003.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DYS FRO AST CALLED INSPECTION.
Issued by: �• ,/ O Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, l agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance Pith the Cupertino Municipal Code, Chapter 9.12 and the
Healt" Safety Codl, Sections 25505, 25533, and 25534.
Date: 4 i 10
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO,BUILDING PERMIT4 Q4
BUILDING ADDRESS: 7520 KIRWIN LN
TE
CONTRACTOR: WM H FRY DA
CONSTRUCTION COMPANY
OWNER'S NAME:
1035I SAN FERNANDO AVE DATE ISSUED: 09/07/2010
OWNER'S PHONE: 4082523594
CUPERTINO, CA 95014 PHONE NO: (408) 605-8200
❑ LICENSED CONTRACTOR'S DECLARATION
r7l r]
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # Ci`10'.,
MECH F RESIDENTIAL r� COMMERCIAL
Contractor L�,r-,;, F-fz.••k Cp�Date �p kzs::�
t
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REMODEL KITCHEN,DINING ROOM & FAMILYROOM
(commencing with Section 7000) of Division 3 of the Business & Professions
(723SQFT)
Code and that my license is in full force and effect.
10/18/2010 - REV#1 -ADD VAULTED CEILING IN FAMILY ROOM CHANGE
1 hereby affirm under penalty of perjury one of the following two declarations:
FROM FLAT CEILING
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for -by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for whig4his
Ft Floor Area:
Valuation: $112000
permit is issued.q.
APPLICANT CERTIFICATION
APN Number: 35923003.00
Occupancy Type:
I certify that I have read this application and state that the above information is
correct. 1 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 mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additional , the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-po' rce regulati s per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signatur Date o ZJ/
Issued byr, ��—Date: -� r
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health afety Cod Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
O Date: \tom12:7l (�
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 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
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
S ignature Date
Licensed Professional