02060163 CIBUDINC DOry
PERNO
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10453 SCENIC CT BRAND KITCHENS & DESIGN 02060163
OWNER'S NAME: APPLICATION SUB DATE
�HIROSE RONALD AND GAIL T 13715 QUITO RD 06/25/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 871-8190
C coo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u C BLDG ELECT PLUMB MECH
n<od
Z�y Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z g2O I hereby ar0rm that I am licemed under provisions of Chapter 9(commencing p
rf_s-m who Section of Division a on he Bmi:eZjsna Pose,sion..Cod.and my been, KITCHEN REMODEL
sxl� .ccluullf and R �Ca FON ,q LRE
�I< Li n QN �elIS3 URR44lY�N
a G Doc — Commoner
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< 1 untlertmnd mY Plan shat I be uuze�gpTiblRArecmds
a re p C Licensed Professional SEP 2 5 2002
OWNER-BUILDER DECLARATION 'p {��
I hereby affirm that 1 am exempt from the Contractor's License Law for the BU I LIJI ICf/�
68
f—? following reason.(Section 7031.5.Business and Professions Code:Any city or county Y 0 0 0
I F G
which quirt a perm i s consumer.alrcr p demolish, pi y structure. -T
do 3 .-prior to its issuance.also requires;thef such Permit file signed statementa. _ ..
that 1, nc nedh Sc4lpursuant todc 000) i:vis of the C incl L (ChapterCase) _p11��
O ea.y a 'S Valuation
fed giNsccy ]DiolrDbic don Business and iProfession,eme) ti's) k 'a3!57S8" b'i3 :.� i 4,3.r?.i'iC7, j
.'in..ne is 31.5 bythcrcfmm and she bans for the alleged esempnoo Any l violation
of Section]011.5 by any aPPlicam for a permit w;bjevas the applicant to u civil penalty
of not more than five hundred dolare P55on). 101 AP�ATI ON Occupancy Type
01.ox owner nr the prnperrY,or or employees with wages as their sole cnmpenwtion.
for _ .. .. .__
will ne mail Prof and the s0ucmroC not intendedice a Law doll sale(Sec: to 103 - UFER Required Inspections,,.no,
ss end Pid,Wio build,CWe:The Coo,thencs Lianu od dces not apply to alf
owner of progeny Who leeor improves ore such,and who docs such work need or 1
or Nmagn ma own employee.. ended ma; improvements mans are not intended or 104 REBAR
_.offered for sale If however,-to budding oimprovement- is -IJ' Sh n'onc'Ycm of _._. ._ .. -. .. .. .. ...... .. _..._._... ._..___.. .._... .._-. _._ ._._..
impletion me owncobsulder will have the burden o(proving that be dm not or 105 - ANCHOR BOLTS
impm'`for pmPowe of"ale'. 106 - SEWER & WATER
-oi r.u, c party i ly na<t g inl«.eec vara rs to 202 - UNDERFLOORS PLUMBING - - --- - - --
Lon.t t thep 1 t(S 7DU Business. d Pmf :Cal )Th Contractor s
iv Law does nol applyit)anowner ofproperty who build rimproves thereon, 203 - UNDERFLOOR MECHANICAL
.and who connects(or.such projects with.a estimations)IicenYd
p 1 pursuant m Ne
- =
Contractor's License Law. ,. 204 '= UNDERFLOOR FRAME
❑lame.=mptyne=r,sec: BmPcfar miare,ann 205 - UNDERFLOOR INSULL TION
_ DWppr " Dale 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
Ihereb trumunder b of one of thendlowin declaration,: 302 - TUB & OR SHOWER
gnat Yo perjury g 303 - ROUGH MECHANICAL
❑ I have and will"mainwin h Cetnrcate of Consent to soft insure for Worker 304 - ROUGH ELECTRICAL
Compensation, as provided for bs Section 3700 of the Labor Code, for the
_- - performance of Ne work ter which this p�ndit i.is..nea: 3 0 5 - FRAME
❑1 have and will rommu m.Worker's Cumpcnsmion Insurance,as regLircd by Section 306 - HOLDOWNS
3700 of the G bor Code,for me perlovoance of the work for which this Permit is
voided,Mr Workers c p . r I ..tone,=artier and Policy robe are: 307 INSULATION
.. . __..... ...._... .. ........ _...,,
c' « rai<YNo - 308, ,: . S{-IEETROCK
\- •CER o xen,Prl PROMw RK ftS ^- f,/ ' V6 9'- -° EXTERIOR"LATH''
COMPENSATIO SURANCE `
_31-0 - INTERIOR--LATH---''_......_._`______-........_ ...
181 WIcsx,�<non'ne<J ria be romplcmJif the permit is Tor one hundred Jollms 311 - SCRATCH COAT 1
I<edny Nat in he poH'orm ice or me work Tor which Nis permn is jawed.l 313 ROOF- NAIL-
"
AIL . '•. .;,m ..".._.. ..
'aha11 not enmlo,y any pervon in any manner sat,a,to become•abject to the workers 501 - FINAL ELECTR I CAL--ENERGY
Compensation Laws or Cal bola.Dole'
Applicant. 502 - FINAL- PLUMBING- ENERGY -. ... ..... .... ......_
NGFICE 9'0 APPLICANT:If,after making this Cert fiemo of Esemnaiors.you should
Z neemoat.unJi<ttnnnewnrke.cmm�ensaronprnvdsian. nheLannrenae.yonn,aa 503 - FINAL MECHANICAL ENERGY
OO firs hwiNcomply with suchpmvision,orhis Form ish0bedeemetluvoked, ._.,504 FINAL .BUILDING_ENERGY._ . _.__...._
Z ta _ ..
CONSTRUCTION LENDING AGEPC)
505 '- FINAL ELECTRICAL
1 h by f which
th tcsued(S ding age cy for the perfoiinance 'I
k? p Lenderx Name permit aura(s lath uv e) 506 - GAS TEST
.. of Nc work for hich N
Z.Z Lender',Address 507 - FINAL PLUMBING
U o 508 - FINAL MECHANICAL
1 ccnive Nat I have ream his application and state thot the above i Ic.,rnion rt
w. dbrreN.1 agree m winner won hullereby
am and enemy aminanes and tate law.erupog 509 - FINAL GRADE
C;V tto heimingmnasrud prandnercbyamctionlepresemmivesorthiociymemerupon
W meabovee)c,cn eq pmprtymrifyoilkishrrnmle 510 - FINAL PLANNING
C; ps" IN'c):,grmtos:ry<,tonne on" keep M1nrmleei rhe City of Cupertino uguina
Vi "abilimies,judgmenSs,costs mJ a p=oses which telly;n any way accme against said 514 - FINAL UB C WORKS
U Z� City in dcmoq", cd,of thegmm ,gofteh!,womit.' /-s (y./
NDS IND WILL COMPLY WITHALL�I-POINT ' Issued by: Dale
SUURCE RIP a\'illNi y
4-215
Sig,umre ufdp mUCn teratvte Re-roofs /
HA'ARI'OL MATERIAL}DISCLOSURE
Will dre plicv t tottourre Wilding c.,nt more or hoodle hat does material .Type.of ROOF__ .-__. _.__ _ _... _ , ._..... .. ........
.aJ(nal by the Cupertino MiummPil CW Chpt 91',adthHealth andgfty
Coe ❑Y< 25532(yl t( - .. s i• - e .s7a o ti., S Tb I'( prior . ,any r :
' .-Al roofs shall be inspected-error to.any roofing material being Installed._ .. .
Will the applicant ortuture Wilding p r useequilinuent ordidicos which If a roof is installed without first obtaining an inspection;I agree.tolremove
emth> d con;a n ¢as Jet nem by rh Buy Ar`eaj\rQ IUP Manag mem
-- -- all non oint source re laticns. understands and
Dist t❑Y all new materials for inspection. Applicant will comply with
_
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1 have read the ha Code, mmenals5052533requirements under 4.1 un 6.95 of the
1,mCalifornia
mil Health, Safety Cade,5 tions 25505,t it'% and 15534. un==hand that
it Nc bdildmme pri r currently sea ,thin it is my responsibf,Cin ificau the
oicupanr of Ne yuiremenrt wh h m si be nn prior to issuance of,a CeniOcolc of
' Occupancy.
Signature of Applicant Date
it Ownernromon agent All roof coverings to be Class "B" or better
,.
OFFICE .._... . . _.. -..