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07050258 CITY OF CUPERTINO BUILDING DIVISION PERMIT TC)R IRM�'TI©N:`, PERMIT NO. BUILg 1f: f��sEsMT CREST PL TBD - TC BE DETERMINED 07050258 l 4 PERMIT ISSUE DATE OWNER'S NAME: 06/07/2007 GARY NEWMAN SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 Q C LICENSED CONTRACTOR'S DECLARATION Job Description vI hereby affirm that I am licensed under provisions of Chapter 9(commencing A 1 Z 8 with Section 7000)of Division 3 of the Business and professions Code,and my license is KITCHEN REMODEL-STRUCTURAL E/M/P try in full force and effect. DESIGNS PAID FOR B/L ON 5/25/07 ? License lass — Cog /6 p Datc Conuador - F w ARCHITECT'S DEC ATTON E; 1 understand my plans shall he used as public records )yU L..NLicensed Professional a OWNER-BUILDER DECLARATION a}, 1 hereby affirm that I am exempt from the Contractor's License Law for the p oa following reason.(Section 7031.5,Business and Professions Code:Any city or county ti which requves a permit to construct,alter,improve,demolish,or repair any structure Valuation "m prior ext its issuance,also requires the applicant for such permit to file a signed statement j Ft.Floor Area $25000 -Z a that he is licensed pursuant to the provisions o[the Contractor s License Law(Chapter 9 q e�H (commencing with Section 7000)of Division 3 0[the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 703L5 by any applicant for a permit subjects the applicant to a civil penalty of 35626009 .'V64 Number not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sale compensation, Required Inspections will do the work.and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees.provided that such improvements are not intended or offered for sok.If, however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contactors U- cense Law does not apply to an owner of property who builds or improves thereon,and who contacts for such projects with a contractor(s)licensed pursuant to the Cmntrxloes License Law. B&P C for this reason ❑I am exempt under Sec OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑]hsve and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Q u /iY.LtAdX4�PolicyNo.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(5100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compcasation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lendingagency for the performance of a. .7 the work for which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name C1. Lender's Address U C) I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating o rJ U building construction,and hereby authome representatives of this city to enter upon the above-mentioned property for inspection purposes. >'' a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and a nses which may in any way accrue against said City U 2 in consequence of the 'tin f is permit. Date APPLICANT D T D AND WI MPLY WITH ALL NON-P INT Issued by: SOURCE RE O 1 D6 : Re-roof; Signature Appl' t/Contractor Dao T of Roof HAZARDOUS MATERIALS DISCLOSURE Type ill the applicant or future building occupant store or handle hazardous material as defined by the Cupertino M unial Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All root s shall be inspected prior to any roofing material being installed. ❑Yes If a Too is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which craft hazardous air contaminants defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read the hazardo material quitcments u aptcr 6.95 of the Califor- nia Hcalth&Safety Code, d as 25 .25 3 and 25 understand that if the building does not curtenify h to nt th tt i y respo my to notify the ors of the Date rcqufrcmcntawhic st met o issuance CcrtificatcofOccupan Signature of Applicant All roof coverings to be Class"B"or better Owner or au zed age Dao CITY OF CUPERTINO BUILDING DIVISION PERMIT +Cd7L� To IRMAT��N� PERMIT NO. 07060233 BUILDjNG�I]j3RF�S$:RTLEWOOD DR TBD — 10 BE DETERMINED OWNER'S NAME: PERMIT ISSUE DATE ULICKI ROBERT L AND PATRICIA 06/26/2007 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i p a LICENSED CONTRACTOR'S DECLARATION Job Description W p I hereby affirm that I am licensed under provisions of Chapter 9(commencing ?Z w with Section 7000)of Dt inion 3 of the Business and Professions Code,and m is BATHROC M UPGRADE. LIGHT FIXTURES, SHOWER PAN, tad in full force and effect. ?� iz Li CI s L�.il TUB, VPLES, TILE, PAINT, TEXTURE, EXHAUST FAN O Date Coniracto ARCHITECTS DECLARATI N ,jQ f RE PLAC E MNT. i a< t understand my plans shall be used as public records >yU U.H Licensed Professional a OWNER-BUILDER DECLARATION r I hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county <.K which requires a permit to construct,alter,improve,dcmmlish,or repair any structure o Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area ris (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $13445 M that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type not more than five hundred dollars(5500). 3 6 917 0 C 1 � 0 1,as owner of the property,or my employees with wages as their sole compensadon, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insum for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wor Compensad nsurance carrier and Policy no be arc: Cartier; Policy No.: W CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z^ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of f1!> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name az Lender's Address U C) 1 certify that I have read this application and state that the above information is corm t.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way scenic against said City / U Z in consequence of the granting of this permit. APPLIC NT UNDERSTAN L COMPLY WITH LL ING -POINT Issued by: Date «CJJJJ SOUR EGULA Re-roofs Signa urc of Applican ontractor Dare Type of Roof MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cale,Section 25532(a)? �futurc All roofs shallbe inspected prior to any roofing material being installed. ❑Yes will the applicant olding occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as ncd by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code.Sections 2M5.25533 and 25534.1 understand that if the building does not currently h a it is y responsibility to notify the oc pant of the req uirpme sw t .1.1oraceryfic (Occu� Signatur( ofApplieant Date (/ �' All roof coverings to be Class"B"or better Owner or authorized agent Date