03020042 (2) CITY OF CUPEWrINO '•° r '- v sr,5
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION `'.
Vii„ °
BUILDING ADDRESS: VANNI BROTHERS CONSTRUCTION PERMIT NO.
880 HYDE AV
WNER;S NAME: 914 HYDE AVE APPLICATION SUB DATE
CHARLOTTE M LUDEMANN 02/12/2003
TONE: (408) 253-7028 SANITARY NO. CONTROL NO.
ARCLIF EC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
w00 LICENSED CONTRACTOR'S DECLARATION
<�GI hereby affirm thatI am licensed under provisions of Chapter 9(commencing Job Description
zri<a w,In Section 7000)of Division Sof the Business and Pro&sslonseode.and my license is
t_ow infellIn.andeflcel. KITCHEN REMODEL
Z0F'OLicense Clara Lich
4 Dam Contractor
FON
ALED
ARCHITECTS DECLARATION�
of I understand my plans shall IN used as public records
wju� Licenced Professional MAR 0 5 2003
Fu.Ow OWNER-BUILDER DECLARATION
sI 1 hereby aftirm that 1 am exempt from the Contractor's License law for the p
to
e. 00 following mason,(SttGon 7071.5.Business and Professions Code:Any city or county BUILDING
I
$ which requires a permit to construct,alter, m
er,improve,demolish,(it repair any structure
._i• prior its issuance,also requires the applicant forach permit file a signed statement
iRomalheislicensedpursuanuomeprovisionsoftheContrannrsLlanselaw(Chapter9 Sq. Ft. Floor Area $24Vig0tion
(commencing with Section 7100)(it Division J of IN Business and Professions Curve)or
Wthan he is exempt mcrefrom and the basis for IN alleged exception.Any violation of
Section 903 L5 by any applicant for a permit subjects me applicand to a civil penalty of
not more than five hundred dollars($50f). Occupancy Type
C] I,as owner of the property,or my employers with wages as their sole compensation,
will do the work,and the suuaum is not intended or offered for sale(Sec.9044.Business
and Professions Code:lie Conuaztors License Law does ma apply m an owner,of 102 - P I ERS egmred Inspections
I mperty who builds or improves thereon,and who does such work himself orthrough his
own employees,provided that such improvements arc not intended oreffered for We.If. 103 — UFER
however,me building or improvement is sold within one year of completion,the owner
Wilder will have IN burden of proving wt w did ton wild or improve for purpose of 10 4 - REBAR
sale.), 105 - ANCHOR BOLTS
L as owner of the property,am exclusively contracting with licensed contractors to 106 - SEWER & WATER
conswn me project(Sec.7044,Business and Professions Cak:)The Contractors Li
renselawdoesnmapplymanownerofpropertywhowildsorimproverhomes,and. 202 - UNDERFLOOR PLUMBING
Who contracts for such projects with a comeacmr(s)licensed pursuant to the Commerce's 203 - UNDERFLOOR MECHANICAL
License Law.
I]I am exempt under Sec. ,B&P C for this reason 204 - UNDERFLOOR FRAME
� ' fn °ad� Smote �`-� 205 - UNDERFLOOR INSULATION
WORKER'S CO. NSATION DEC oN 301 — ROUGH PLUMBING
1 hereby affirm under penally of perjuryonto of the following declaralions:
❑I have and vrdl maintain a Certifier..1 Consent to self-insum for worker's Course- 302 — TUB & OR SHOWER
construct
as provided for by Section 3100 of me laver code,for the performance of the, 303 - ROUGH MECHANICAL
work for which mix Permit is issued. 304 - ROUGH ELECTRICAL
1 have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
3701 of the labor Cole,for the brommance of the work for which this permit is is umd.
My Worker's Compensation lnsumee career and Policy number are: 306 — HOLDOWNS
Carrier: PIisRO
CERTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
less.)
(This seetiun need not W eme,lamd if to permit is fee be hundred dollars IS 101) 309 — EXTERIOR LATH
nr 310 - INTERIOR LATH
1 ttnilY that in cert performance,f the work for which shin permit is issued,Lahall inot on
Laws of
Citpersoninanymanncrsn satobecome subjccths the Wnrkcci Compensation 311 - SCRATCH COAT
AAawscant umia.°'m 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If,after making this Cerifica¢of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
become subjcet to the Worker's Compensation provision,of he Labor Code,you must
0 z forthwith ecend,with suer Pro kimimmispermitshallbedeemedrevoked. 502 - FINAL PLUMBING ENERGY
z O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY s
aIherehysffir.thmthere isaconswaionlending agency I heperformanccof 504 - FINAL BUILDING ENERGY
> Lrrkmm
rwhmisprmltisissued(seedFn c¢
. C.) 505 - FINAL ELECTRICAL
a p Lendeders Name
= z <ndersAddreas 506 - GAS TEST
U p 1 cenify that 1 have read this application and sue that the above information is 507 - FINAL PLUMBING
14 F corer.I agree to comply with all city and county ordinances and slate laws relating m
pU building construction,and heichyaumodzerepresentatives ofthis city menter open'he5 FINAL MECHANICAL
;v. 1above-mentioned property for inspmcnen purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino.,at., 0 9 F IN
y in
es.qunce of ts,the comes and expenses which may in any wayaccrue against mid City 5 N I G
U ,z A APPLICANT
of UNDERSTANDS
of this D WILL
Issued by51 — WORKS Dal
.-t APPLICANT UNDERSTANDS AND WILE.COMPLY WITH ALL NON-POINT
SOUR REGULATIONS.
''`�""" R�z'o3 Re-roofs
gnamrt of wpprcanVContranor Dme
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant er future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.Section 355121x)'/
❑res FN„ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future occupantbuilding usee equipment If a roof is installed without first obtaining an inspection, I agree to remove
mit hanNous air contaminanss as defined h ths Arca Air en g p
r r Quality Management all new materials for inspection.
Disrricl7
❑Yes �Nu
1 have read the lea'raNnus materials requirements under Chapter 6,95 of the Carter-
holding
arter-
wilding
docs tar Carmody hast a tenant that it is my responsibility to money the,occupant of the
m
yuimmenu which aid M mel prior to iss rsom of a Ceni ficate of lkcupanor
Z= x�tag eta7ro Signature of Applicant Date
2—rz—0 3
,02p,or .,cut I ,;� All roof coverings to be Class "B" or better