02070193 OF
CI BUILD NG DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
1104 NOVEMBER DR KITCHENS BY MEYER 02070193
OWNER'S NAME: APPLICATION SUB DATE
LARRY H AND DIANNE WAU 278 CASTRO ST 07/30/2002
I.
PHONE: (415) 968-8318 SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w- BLDG ELECT PLUMB MECH
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Z S y Z LICENSED CONTRACTOR'S DECLARATION Job Description
e _o hereby a).f that Iam.3liana ll under provisions si Chaper 9(commencing KITCHEN REMODE
Fu;l_-w withSmion]000)of Dbision hof me Business Professions Code,ro mylicenx *1
nit, is in fullf cans rf :A r
z s z License Li
c.x
Out
con�naJ(dt
3 I understand my plan..shall to uused a MATIOSTV /7'accords
FEB 2 8 2003
u°i rc p p Licensed Professional
n s OWNER-exempt R m the Contractor's
BUILDINt
u� 1 hereby affirm that 1 oro exempt from the CRmmO.r's License law for the
C Z a following reason.smairm 7031.5,Business and Professions Ce dc:Any city or county 0 0 0 0
F c which mantras Permit t c omet,Marc,improve demolish. pv any swcmrt - -
n.3°-�O
prima.ts ss ami al martini the ap,]I,.fm such puma fl gnulntaxmcnt ._.. ....
'hat facts l cent d puts Pat to the pro riocas ofthe Contractors License Law(Chapter 9 , Or ea,.. ^y Valuation
ci m clg ithS I ](100)ofDivision 3ofthe Business ndProfessions Codu •.;} „3;6'L-fb9�?,P 0` f,,,,14,t',{tI ,
Or that tic Is ese[np(therefrom and the basis for the alleged emmpHon.Any violation
-of Section 103L5 by any applicant for n pcnnit subjttta the applicant m a civil Pcn+lty '
l.rn;,m.re mMn fivehunaree d;uas(ssW). 101 APN ATION �'-R>"" Occupancy Type
0T.,msncr of Pie property..,my employees with wages as their sole compensation, 102 -
-wilt'tlo the work:and xxions odesmuTh Contractor nor intea d or seems oe sae( ply - -
B neer ofpro erty Who case:Thr rthers ,and w law earn not apply m.n 103 - UFER Required Inspections', L
Owner ofpropertyhis ow Who Wilds or improves at such,and who does such work intended
a, 10 4 - REBAR _
or through his own employees,provided that such improvements mcno are not intended or R' ' 13'
.,_-_
;bR--d("ala.IChowevrr:who buddinImprovement- ` IJ �thnone ear of """ '_ .. _.._ _. _..___ ._—..... .._...._ ._. .____. ... ...._-_-_
completion,the ownerhalder will have Ne matin of prvamg that he did not bold or 105 - ANCHOR BOLTS '.w,l„ rf• i.- ti,
improverorpurpoxornale.). 106 - SEWER & WATER
- - -- contracting----- _ with -se -are_ _ -PLUMB ----- --- -.... ---
pti=saeannep(Set.744,Bala.issandessionsCMe:) heonweactra 202'---UNDERFLOORING-_ 1."t
ronaw<t me proirat(Set.]ou,Business and Professions code:)me c;mmcmra 2 03 - UNDERFLOOR MECHANICAL =r'I 1 ,;r. x
Llcenae Law does not apply to an owner of property who builds or improves whereon,
....and who.contracts for such prejcts with...commi,tor(s)licensed.pursuant wo me .._,.-.---- -204--- --UNDERFLOOR--FRAME--_.___—_.____.___.__
- S Carramemes Lice.law. 1��, . .,,y ,�in .YI
p 1 am exempt under See: " .'B�&PCfm this reason
205 - UNDERFLOOR,° INSUliAT30N
; : . ,.
_ Co.net.,r., . , 'r Data' 301 - ROUGH PLUMBING
_ O
E
WORKR'S COMPENSATION DECLARATION
_ - 302 - TUB & OR SHOWER
Ihrxhyafrm,nnicrprwtyprarjJyoMartneronawingserlaratian.:- 303 - ROUGH MECHANICAL
01 have and will"xeimaiho Certifieme of Comem to velf.insum for worker: 304 - ROUGH ELECTRICAL
Compensation,-as provided-for by Section 37W of the labor Cade, for the
- -_- Performance of the work for which this pcm,it is issued. 305 - FRAME
01 have and will m min Wo kern Co a sat Imam ee eq orad by Section 306 - HOLDOWNS
37M of the Lahr Cod far*the performance of the work f which this perms is 307 - INSULATION
Is
d My Wo ker's C ,e 1 Insurance'came d Policy umbo ere: " x
�L r _308-,,,_,-SHEETROCK-_
`;
+�/1f .e TtlYl df',�P bay N. 3�'�J Dl - '•:aa�:w,:oH
Mmcr ,. N.f.. r•J .. .,., 5
CERTIFICACOMPENETION IN NFROMRANC WORKERS*:, `309EXTERIOR LATH ,
COMPENSATION INSURANCE ---•_-• 3IN,aERIOR- LATH 1 -- - - s-_ —• •.•�..�„.•••-�.
mr;inionneed nn[be completed Trm
the pet is for one hundred dollars
TUM) ,lea,.) 311 SCRATCH COAT
313 --'=ROOF NAIL -- -- _
1 e
"ploy
to
N penin e f m work'(; h ch'th perm t I,natural,I ),,, ,I -
':nan;.w employ any ler... a any ma per tni as to;besare soars 1;the W.,kers 501 - F INAL ELECTR'I CAL ENERGY
Compo fon lows f C 11 ia:Dale - '
Applicant ' ` - " 502----._.FINAL-.PLUMBING-.ENERGY_.-_-__._ _.
NOTICE TO APPLICANT.If.after milling this Certificate of EmanaLon.you should 503 - FINAL MECHANICAL' ENERGY
bcc the subject m the Worker'.C m ,imeo p n.of the Labe Code y - ust
OQ fonh '0icion y m chpro'ians thispermit nllbea d vuked _5.04 ..FINAL BUILDING....ENERGY-.._-_.._,
z ., ._.
'y °f ``' 'IICONSTRUCUOILENDING AGENCY I 505 - FINAL ELECTRICAL
I Ilicmby:off,[nl,fiat thea iso construction lending igency(or the p rfomxad.
' . -
f ate wmIc for
h axis Permit is
ared
W.., LindIedm,,1 er have and tars a5eu a[ioo anawa1mm mdaWve tar;� 506 GAS TEST
a,rZ Londe Name )
D-Z L d Addm,, `.� .. - - ._ ...5.07.. .- .FINAL-PLUMING P
U'O 508 - FINAL MECHANICAL
moan is
Ito.:F mean.I agrte tq eomply_with all chy and roomy pNinanccs and nam laws totaling 509 - FINAL GRADE
O..p fob le' g o .wr, nanrthyaum rep<.pmnve nn. hyror[nqupoo 510 - FINAL PLANNING
the bo e t :node pie ty fa taxed t Prim,.
'CL lW I g ee to sa a mdemn fy and k<ph Iasi lh Cry of Cupertino gains,
y I b 1 t rydgma c sc and expenx h ch may m any y cc toga nn said 514 - FINAL UB C WORKS
T U z C,y scq - the 8 pL[ t perm t
\T v g./
APPII UEI T\ .D\ ILL COMPLYW ITH ALL\ON-P 1 ! `
-n
issued by: Dale
igmwrc of Appfcan✓Cnmrnaor'.� -" " 1.v Date ,;," Re-roofs
` T HAZARDOUS ATERIALR DISCLOSURE
wu me appl ram or fm W le cup t mrc or nnml na>arat m _-Type
Type of Roof .._ ....._. ... .T_. - .. r. ........ ..e ,-
def dby m<Cuped n.Mumw od Ch Flier Al2 dwh H hh ad Safety
Cade Sect orI255321a1
1 , )\ -' .,1st I. si,. M1 I's+ .s�.. r s a fi
or N. 1,R , _All roofs shall be inspected prior to any-roofing material being installed,....__...__ .
Will he ap,ta,md,a�r Wtl p t ;a equipment or devices h' h If a roof is installed without first obtaining an inspection I'agrce to`
remove
eart a e it,corittant an,, ca by th Bay Arc Air Quatifin,Man gement
D tact - all new materials for inspection.-Applicant understands and will comply with.
❑Yet,.:: oNd all t source regulations;.( , _, i❑
1 havii read the haembous smaterials mq is ace s3 d Chapt n6.95,af the
Call lim He &Safe,,Codr.Seiricasr 25505 25531 and 25534 I understand that .
-III, Wild s tc Yhaveamwn[,toot it is my responsibility[.amifythe
cc e,ieq :in..W t p form timed bf n Condi to o
eS Oce icy'
f (elle U Si ature of Applicant _ -Date
o ror authors: - Da< All roof coverings to be Class "B" or better
OFFICE'