06030037 CITY OF CUPERTINO enap,
BUILDING DIVISION PERMIT 'CANBTR4.C�`�U''' RINTU MA'�'Ybl�
"'o xis, u RM :d�
BUILDING ADDRESS: CLEAR CHOICE ELECTRIC PERMIT No.06030037
12R T,FRANON DR
R'S NAME: PERMITLSUEDATE
ELLIOTT ,CAROLA V 12333 SARATOGA- 03/08/2006
E: - SANITARY NO. CONTROL NO.
(800) 779-4956
ARCHITECOENGINEER: BUILDING PERMITINFO
BO O PLUMB� O
Sop LICENSED CONTRACTOR'S DECLARATION
F 1 hereby affirm that I am licensed under pmvisimu of Chapter 9(commencing Job Description
Zj with Section7(M)of Division 3 of the Beat.and Profesam.Code,and my license la
n>>; in full fame andeR n Li I �3��3 MOVING WASHER/DRYER .TO ORIGINAL LOCATION IN THE
Datense ClyCon[reckr
CC til GARAGE. ADDING (N) CABINETS FOR BUTLERS PANTRY
ARCHITELTSD ATION WITH SINK & V/C REFER. LIGHTING TO REMAIN
1 understand my plana shall E used as is rtcords
btep� Licensed Professional
^ OWNER-BUILDER DECLARATION
gm 1 hereby affirm that I am exempt from the Comantofa License Law for the
M0 fallowing mason.(Section 7031.5.Business and Professions Code:My city or county
1$1 which requires•Permit to enwmcL ohne improve.demolish.Or repair any someone
�t prior te its issuance,also requires the applicant for such permit to fik a signed statement -
[hat he is licensed pursuant to the pmvisans of the Contractor's Uccnw LAW(Chapter 9 Sq. Ft. Floor Area /f�7 g �[ Valuation
�$ Rommencing with Section 7")of Division 3 of Ne Business and Professions Code)or gg�M (){L B *4'100
..
that he k exempt[bemfmm and Ne basis for the alleged exemption.Any viohuon of /f FFF777 NNN A'Ig %
Section 703 1.5 by any applicant for a permit subjects the applicant k a civil penalty of `H.
not more Nan fife hundred dollus($%syt APN Number cupancy Type
❑I,as owner of the Property,or my employees with wages u their sole compensation, d /'
whldmlhewodtandthe sWelumhnotinkndcdoraffemdkrsak(Sa.70s4.BuM=s Re uiTed Ins eG6O s
and Pmfecdons Cade:The Consomme,Lianae IAw does nal apply m an away ofPropq P _
Ownertplaym,ldmded that
sch Imprandwha dasamhende aroffeedthrsaleangh his
awnemPloyens,ping or iNala avant is said it taemyeaededmpleti n,fm ask.if. ({tpGljlflYbg/77 ,fI`apa�ya /,�. `-v`
bull&' ill ban um Inc impmvemenl k said hei i in of year of i m road..the owe of
builder MB have tiro burden of proving that he did not build ea Improve for purpose of
❑h a owner of the property.am exclusively contracting with IlRlaed contsarnm he
construct the pmkca(Sec.70",Basimcd and Professions Cade:)71e Cm.mones U.
cents Law does not apply m an owner of poperty.who builds or improves daemon.and,
who contracts for such injects with a contactor([)licensed pumans to the Conumemes
License Law.
lam Mconplumbe Sec, .B&PCfmthls..
It Date
WORKER'S COMPENST10N DECLARATION
1 hereby affirm under penalty of perjury arc of the following dmlantimts:
❑I low and will maintain a Certificate of Conaenuo self-Imum fm Worker's Compete
astian,as provided far by Section 3700 of the IAbm Code.fm the pea loon a of the
weak for which this permit k issued.
❑1 have and will maintain Worker's Compemadoo Insurance,as mquimd by Section
3700 of the IAbor Code.fm the performance of Ne weak far which this permit is[ssued.
My Worker's C. ens tion Inrvnntt artier and Policy number sm:
Grtier. Policy No.:J�
CE FICATEOFEKEMPTiONFROM RWO KERS'
COMPENSATION INSURANCE
(This recd.reed not In Completed lithe .It ts far.hundred 011.(SIM)
or less)
1 ar ify that in the performance of the work for which this Permit or issued.I Nall not
employ any person in any manner an as to became subject to use Workers'Compensation
Law,of California.Date a
Applicant
NOTICE TO APPLICANT:If.after making this Ceniftes c of Exemption,you should
become subject m the Warker's Compensation provisions of the Labor Code,you must
.J Q forthwith comply with such provisions or this permit shall be clamed revalued.
CONSTRUCTION LENDING AGENCY
F Ihemby.1irm Nal them is a consactinn lending agency for the perfmmaoce of
a.moi the work for which Nb Permit is issued(Sm.3157.Civ,C.)
W QLendces Name ,
O z Lender's Address
U O I certify that 1 haw mad this application and sate thou she show information is
U. COMM I gree to comply with all city and county ordinance,and state laws relating to
O building Conswetion.and hereby authadte representatives of this city mercer upon the
LU alwn-mentioned property for inspersion purposes
gL (We)agree In save,indemnify and keep harmless the City of Cupertino against
WA llabllidaijudgmena.costs and expenses which may In any way acerae against said City
in
of the readiof
U s rmit.
APP CANT eUNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date -3- cr_U6
SOU REGUL IONS. _
3 b Re-roofs
gra ra afAppli<HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future building occupant score or handle haws mus material
Road by the Cupertino Municipal Code.Chapter 9.13,and the Haallh and Safety
Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑yrs �iqb
Will the applicant or future building occupant use cyulpment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
H hvAfdnus tar conuminsnu as dcftmd by the Bay Ama Air Quality Management all new materials for inspection.
DiaMCC7 Argo
Yes °
I have real the harardousmaterials mquimments under Chapter6,95 ofthe Califor.
nia Health&Safety Code,Secti.a25l05,25533 ad 25534.1 undersand thetifte,building
does not tonally haw a moan,that II ts my responsibility w.dfy the occupant of the
co=ich mustp met prior toissuanccof.Certificate ofOctt Signature of Applicant Date
w r or eutharixed agent p06 All roof coverings to be Class"B"or better
,ty i - •rte. m
t m +ty r�µur . . ? Sl3Z� q S A ar^f rRF i i s� r x i? s. T FYi54 �
4 'ki G M I x
°;RESIDEMY.t, PROJEC�;,COVER;SHEE,T" 7" srr
CUPEEZFINO {� ` ' N ae
. ..+.ut�`r -. .,,1R._.r ti^4S„'..,.- <S.`a-9 - vs+.:_
Assessor's Parcel Number: `S Le -2-
Name
Name of owner. dZ_7_
Project address. 1042- 2
��✓a� ��
Contact person. Phone. 410?' Z�3 1�4Y3
Fax. 4eMT
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor: iti �f
Garage:
TOTAL:
• Are thereat least two 10 foot by 20 foot clear spaces inside the garage? C% N
Is privacy protection planting required for the project?
On what floor(s) is work being done?
Brief description of work. { dow�S,
Code editions:2001 CBC (Y - N)2001 CFC (Y -N)2001 CMC (Y-N)
2001 CPC (Y - N)2001 NEC (Y -N)
Effective 11/1/02
Hill
0 0 2006
OFFICE copy � .�.
Plan Review Process Work Book Page-8-Revised 4/28/04
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All dimensions size designations given are '" r' This is an original design and mus[not be Designed:3/8/2006
subject to verification an job site and i^/[`xuo o'i!"t j;a ie"s�,A released or copied unless applicable fee has Printed:3/N/2006
adjustment to fitjob conditions. been paid orjob order placed.
elliott III If /�/�y �� aV LCA U" All Drawing d: l S nle: I I'