04090224 CITY OF CUPERTINO " '+ •�•-" ' ` ` '' z
BUILDING DIVISION PERMITC-ONTRACTORINFO'i2MATIQN '
BUILDING ADDRESS: BATHROOMS BY HANS PERMITNOO 4 0 9 0 2 2 4
ER'S NAME: PERMIT ISSUE DATE
LARRY &
NE:
SANITARY NO. C OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
0 0 0 0
_00
LICENSED CONTRACIOR'SDECLARATION Job Description
y U C I hereby affirm that I am licensed under provision of Chapter 9(commencing
isection 7W))Of Division 3ofthe Busincea and profcssiun Code. dmy license is
pNaxt ¢¢rearm«r S'��83g ADD 85 SQ. FT. /KITCHEN REMODEL
ja? Lm Clna L
Cuntractor M Y v-)
ARCHITECTS DECLARATION
?w U I uMcrsmnd my plans shall he tired n IlBtmf�nrds
MoLicensed Professional
S OWNER-BUILDER DECLARATION
a� 1 hereby affirm Thal l am exempt from the Cmntmmor's License Law for IM
?p o
following reason.(Section 7031.5.Business and Pref sunoo Code:Any city or county
y$e which myuires a permit In COmemet.alter,improve.Jcmmlish,or repair any swcture
Fiy poor to its issuance.also require the applicant for such permit to file a signed statement
< that he is licensed pursuant otheprovisions nfthe Contractor's LircneLaw(Chapter 9 Sq.Ft. Floor Area Valuation
�'a (commencing with Section TBW)ofDivision 3 of IM Business and Prmfesioe CMB)or
y that he is exempt therefrom and fire basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32AUTM1IftrO0 eupancy Type
not more Nan five hundred dollars($5 ). /
1,as owner of the property,of my employees with wage as their tele compensation,
will do fire work and to structure is not intended or offered for sale(Sec.7W,Business
and Professions Coec:The Contractor's License Law does not apply m an owner of Required Inspectio
propenywht buildsmrimprovethereon,and whodoesauch work himselfor through his D
own employee,provided that such impro emems art not invnded coffered for We.IL .[�
however,the building or improvement is sold within one year of completion,Ne owner V
builder will have Ne Wrden of moving Out he did not Mild or improve for ptupuse of
sale.).
O 1,as owner of the property,am exclusively contracting with Hemmed comoseors to
construct the project(Sec.7014.Business and professions Cade)The Comracor's Li-
came,taw dors not apply to an owner of property who Wilds or improve thereon.and
who contracts for such projects,with a eomereons)licerved pursuant to the Contractor's
Liam"Law.
[3I am exempt under Sec. ,B h P C for Nis mason
Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following dealarstioe:
O[haw and will maintain aCc ribleam of Consent to self-insure for WorkehCompen-
cation,u provided for by Section 37W of the labor Code.for the performance of the
work for which this permit is issued.
❑1 have and will maintain worker's Compensation Insurance,as required by Section
37W of the labor Code,for the pcdormenee of the work for which this permit is issued.
My Werke Comperuatio/t�2uw==Priu and Policy number l �✓�lr iry N .:12,24 — I�-O IO
CERTIFICATE OFEXEfvBTO ORKERS'
COMPENSATION INS(IRA CE
(Thisseelmo need mol eecompleted if the permit is fmranc hunered dollars(51 W)
or less.)
I Mmry Out in the performance of the work for which this permit is issued.I shall not
employ any person in any Contact an as o become subject o do Woft a Compensation
6awa of Califomin.Dao
Applicant
NOTICE TO APPLICANT.IL after making this Ccnificam of Eacmplion,you should
become subject m the Worker's Compensation provisions of the IaMr Code,you must
.JQ fmMwith crumplywim such pmvsmon or this prrho shall he deemed mwked.
Z N CONSTRUCTION LENDING AGENCY
[-+ Ihereby aMrm thal ft.I..eomlocdnn kndingagemy forth pe,far..of
Z' the work,for which Nis permit is issued(Sec.309r,Ci,C.)
U]Q Lender's Name ^ �
=z Lcndcr's Addos
aV
U O 1 o ndy Nat I have read this application and sum WI the shove information is
Fcorona.1 agree to comply with all city and county orcirunas and state lawa reining to
�fJ building construction,and hereby authonm repmeenelives of this city in enter upon the
ahove-mendoned property for Inspection purposts.
G (We)agree o save.indemnify and keep humble N City of Cupertino against
Ffq liabilitiexjudgaro a,c which may' an ay¢erne again?said City
VZ APPLCucrmcUNth ti of Nis emit.
L O WITH ALL ON- OINT Issued by:%12�( Date
REGUL
Re-roofs
Vndo,�cdon
wantlContrector ate '
HAZARDOUS MATERIA ISCLOSURE Type of Roof
applicant or fuum building«cu IStore at handle losomi sea.time)
Cupertino Municipal Code, &plat 9.12,and the Health and Safety
532(a)? All roofs shall be inspected prior to any roofing material being installed.
pplicant or fwuo Wilding ottuWm sex equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit har mlous air commonn¢ 1,JCfTcd by the Bay Area Air Quality Management all new materials for inspection.
District? r\pj/y'\
Ycs
I have rerJJbahaes nusm rials mVuiremc rChepmr695 of the Glifor
nia H«INffi SafnyCM 2 5.25533.y, SJn undcrsuM thmif Nc Wilding
docs tIY t, tit's my r tai 'IY o nosily IW m an mf Nc
tri LSW mel n0 Ydll o erllfltile of e.
-J - Signature of Applicant Date
nF ter am ivcd agent /,th, All roof coverings to be Class "B"or better
CITY OF CUPERTINO " '+ •�•-" ' ` ` '' z
BUILDING DIVISION PERMITC-ONTRACTORINFO'i2MATIQN '
BUILDING ADDRESS: BATHROOMS BY HANS PERMITNOO 4 0 9 0 2 2 4
ER'S NAME: PERMIT ISSUE DATE
LARRY &
NE:
SANITARY NO. C OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
0 0 0 0
_00
LICENSED CONTRACIOR'SDECLARATION Job Description
y U C I hereby affirm that I am licensed under provision of Chapter 9(commencing
isection 7W))Of Division 3ofthe Busincea and profcssiun Code. dmy license is
pNaxt ¢¢rearm«r S'��83g ADD 85 SQ. FT. /KITCHEN REMODEL
ja? Lm Clna L
Cuntractor M Y v-)
ARCHITECTS DECLARATION
?w U I uMcrsmnd my plans shall he tired n IlBtmf�nrds
MoLicensed Professional
S OWNER-BUILDER DECLARATION
a� 1 hereby affirm Thal l am exempt from the Cmntmmor's License Law for IM
?p o
following reason.(Section 7031.5.Business and Pref sunoo Code:Any city or county
y$e which myuires a permit In COmemet.alter,improve.Jcmmlish,or repair any swcture
Fiy poor to its issuance.also require the applicant for such permit to file a signed statement
< that he is licensed pursuant otheprovisions nfthe Contractor's LircneLaw(Chapter 9 Sq.Ft. Floor Area Valuation
�'a (commencing with Section TBW)ofDivision 3 of IM Business and Prmfesioe CMB)or
y that he is exempt therefrom and fire basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32AUTM1IftrO0 eupancy Type
not more Nan five hundred dollars($5 ). /
1,as owner of the property,of my employees with wage as their tele compensation,
will do fire work and to structure is not intended or offered for sale(Sec.7W,Business
and Professions Coec:The Contractor's License Law does not apply m an owner of Required Inspectio
propenywht buildsmrimprovethereon,and whodoesauch work himselfor through his D
own employee,provided that such impro emems art not invnded coffered for We.IL .[�
however,the building or improvement is sold within one year of completion,Ne owner V
builder will have Ne Wrden of moving Out he did not Mild or improve for ptupuse of
sale.).
O 1,as owner of the property,am exclusively contracting with Hemmed comoseors to
construct the project(Sec.7014.Business and professions Cade)The Comracor's Li-
came,taw dors not apply to an owner of property who Wilds or improve thereon.and
who contracts for such projects,with a eomereons)licerved pursuant to the Contractor's
Liam"Law.
[3I am exempt under Sec. ,B h P C for Nis mason
Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following dealarstioe:
O[haw and will maintain aCc ribleam of Consent to self-insure for WorkehCompen-
cation,u provided for by Section 37W of the labor Code.for the performance of the
work for which this permit is issued.
❑1 have and will maintain worker's Compensation Insurance,as required by Section
37W of the labor Code,for the pcdormenee of the work for which this permit is issued.
My Werke Comperuatio/t�2uw==Priu and Policy number l �✓�lr iry N .:12,24 — I�-O IO
CERTIFICATE OFEXEfvBTO ORKERS'
COMPENSATION INS(IRA CE
(Thisseelmo need mol eecompleted if the permit is fmranc hunered dollars(51 W)
or less.)
I Mmry Out in the performance of the work for which this permit is issued.I shall not
employ any person in any Contact an as o become subject o do Woft a Compensation
6awa of Califomin.Dao
Applicant
NOTICE TO APPLICANT.IL after making this Ccnificam of Eacmplion,you should
become subject m the Worker's Compensation provisions of the IaMr Code,you must
.JQ fmMwith crumplywim such pmvsmon or this prrho shall he deemed mwked.
Z N CONSTRUCTION LENDING AGENCY
[-+ Ihereby aMrm thal ft.I..eomlocdnn kndingagemy forth pe,far..of
Z' the work,for which Nis permit is issued(Sec.309r,Ci,C.)
U]Q Lender's Name ^ �
=z Lcndcr's Addos
aV
U O 1 o ndy Nat I have read this application and sum WI the shove information is
Fcorona.1 agree to comply with all city and county orcirunas and state lawa reining to
�fJ building construction,and hereby authonm repmeenelives of this city in enter upon the
ahove-mendoned property for Inspection purposts.
G (We)agree o save.indemnify and keep humble N City of Cupertino against
Ffq liabilitiexjudgaro a,c which may' an ay¢erne again?said City
VZ APPLCucrmcUNth ti of Nis emit.
L O WITH ALL ON- OINT Issued by:%12�( Date
REGUL
Re-roofs
Vndo,�cdon
wantlContrector ate '
HAZARDOUS MATERIA ISCLOSURE Type of Roof
applicant or fuum building«cu IStore at handle losomi sea.time)
Cupertino Municipal Code, &plat 9.12,and the Health and Safety
532(a)? All roofs shall be inspected prior to any roofing material being installed.
pplicant or fwuo Wilding ottuWm sex equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit har mlous air commonn¢ 1,JCfTcd by the Bay Area Air Quality Management all new materials for inspection.
District? r\pj/y'\
Ycs
I have rerJJbahaes nusm rials mVuiremc rChepmr695 of the Glifor
nia H«INffi SafnyCM 2 5.25533.y, SJn undcrsuM thmif Nc Wilding
docs tIY t, tit's my r tai 'IY o nosily IW m an mf Nc
tri LSW mel n0 Ydll o erllfltile of e.
-J - Signature of Applicant Date
nF ter am ivcd agent /,th, All roof coverings to be Class "B"or better