03010040 CITY OF CUPEWrINO o- - x-''I
BUILDING DIVISION PERMIT CONTRACTOR INFCIRMATION:'"'..
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BUILDING ADDRESS: KRAMER CONSTRUCTION PFRMrr NO.
20648 SHELLY DR 03010040
OWNER'S NAME: 20667 CRAIG CT APPLICATION SUB DATE
JACKIE JACKSON 01/07/2003
ONE: (408) 255-6976 SANITARY NO, CONTROL NO,
ARCI IITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CII
Met,
LICENSED LICENSED CONTRACTOR'S DECLARATION
p 1 touch,antrm that I am licensed ander provisions of Chapter 9(commencing Job Description
od wan Section 710)oflyivishm 3 of the Business and Professions code,and my license is
ZOmm11fomeawRELOCATE FURNACE/WATER HEATER &n LicaseClass Lic.M
0MF, LIGHTS UPGRADE `I
pALED
Date-Contractor
ARCHITECTS DECLARATION
KO ee ee U 1 understand my plans shall M used as public records
to 3 w[- Licensed Professional FEB 1 12003
!' -a OWNER-BUILDER DECLARATION
S1 hereby affirm that 1 am exempt from the Contractor's License Law for the
dC0 following reason,(Section 7031.5.Business and Professions Code:Any city or county BUILDING
ieseqns
$� which uia permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to life a signed statement
I5C mrs
at he is licensedfuuanttotheprovisionsoftheConhactnr'sLiree
nLaw(Chapter9 Sq. Ft. Floor Area Valuation
WI- 1X1
$ (commencing with Section 90)of Division 3ofthe Business and ProfessionsCmle)or $2gOO
a. - that he is exempt Ihemfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500). 35915006 . 00
p y YP
❑I,as owner of me property,or my employees with wages as their sole compensation.
will do the work,and the swcwre is not intended or offered for sale(Sec.7W,Business
and Professions Code:The Contractor's License law does not apply to an owner of 101 - FOUNDAfgo4fed Inspections
property who builds or improves thereon,and who does such work himselfor through his
own employes.provided that such improvements are not intended or offered for sale.If, 102 - PIERS
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving drat he did not build or improve for purpose of 10 3 - UFER
ask) 104 - REBAR
❑1,as Owner of the property.am exclusively contracting with licensed contractors to 105 — ANCHOR BOLTS
construct the project(Sea Elate,Business and Professions Code:)The Contractor's Li
cease law does not apply to an owner of pmp,ny who builds or improves thereon.and 106 - SEWER & WATER
who non contracts for such projects with a contmnort0 licensed pursuant to fie Contractors' 202 — UNDERFLOOR PLUMBING
w.
I
am exempt under Sec. ,B&PCfon ;;mn 203 - UNDERFLOOR MECHANICAL
o er .��.� 0S 204 - UNDERFLOOR FRAME
W KER'SCOMPENSATIONDECI,ck'AnoN 205 - UNDERFLOOR INSULATION
I hereby alirm under penalty of perjury one of the following declarations: 301 - ROUGH PLUMBING
I have and will maintain a C,ninvide of Consent to for Workers Compcn- 3O2 - TUB & OR SHOWER
nation,as provided for by Section 370 of the Labor Code,for the performance of the
work for which this Permit is issued. 303 - ROUGH MECHANICAL
❑I have and will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
3711 of fee Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number a re: 305 - FRAME
Carver: Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
(Ibis section need not M completed if the permit is forma,hundred dollars(SIDE) 308 - SHEETROCK
.r leas) 309 - EXTERIOR LATH
1 certify that in the performance of m,work for which this proton is issued,10.11 nut 310 - INTERIOR LATH
employ any person in any manner ur as m Mcolnp�Ibikgtpmc Workers'Compensainn
Laws of Caltmrrka, Ie SII lT1 lL9 311 - SCRATCH COAT
Arm an'
NOTICE TOA a NT:If.after making this Cerificane of Exemption,you should 313 - ROOF NAIL
beenme sunjem m orker's Compensation provisions ofthe LiNUCode,you must 501 - FINAL ELECTRICAL ENERGY
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z0502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING
[-. 4Thereby alum mat mere is acomwninn lendiAGENCY ng agenty limhc performance of 503 - FINAL MECHANICAL ENERGY
Ix „> the work for which this permit isissued(Sce.3lri,Civ.C.) 504 - FINAL BUILDING ENERGY
W Ca Lend,r:Name
;D z Lender'sAdd.. 505 - FINAL ELECTRICAL
U o 1 certify mat 1 have ad this application end auto that the above informmiun is 506 - GAS TEST
lis t. correct.I agree to comply with all city and county oNinames and stem laws relating to
building construction.and hereby authnrim representatives of this city to enter Orionn the 5 FINAL PLUMBING
Wabove-mentioned property for inspection purposes.
G (We)agree to save,indemnify and keep harmless the City or Cupertino againu
Hy liabilities,judgments,emu andexpemes which mayin anyway poems,against said City 5 N
U rZ in consequence of me granting of this Permit. ISSUed by — NG Date
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT
SOURCE REG CATION o3
Re-roofs
Signal .fA i anUContranor
HAZARDOUSMATERIALS DISCLOSURE Type of Roof
Will me pplicanl orfalare builJing wcupam score nr handle ha'rudmus material
as defined by me Caliendo.Municipal Calc,Chapmr 9.12,and the Health and Safety
Code,Second DYcs 25512(a)? o All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuinre building occupant usecquipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hvardous air contaminants as defined by dye Bay Area Air Quality Management all new materials for inspection.
DiSlricl?
❑Yes Nu
HE read the haomint s materials requirements underChapter fi 95ofineCalifor-
nia Halm�Safciy COM.Secdom 25505.25533 pod]5534,1 undcrstaM muif me Wilding
does not currently have a wro nt.mm it is my mepomihiloy m notify the rcvmvpant of me
requirements,which mu Moret pOormissuance of a Ccnificam of apancyr. Signature of Applicant Date
7 03
Own ram 'red agent Dam All roof coverings to be Class nBa Or better