04120070 'CITY OF CUPERTINO yy��yv*'/� *•r'�czr k�+ ?0q, 6
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BUILDING DIVISION PERMIT U'iI -01`�!l l:'�10Rj5NF6' '��- 0 --
BUII DING ADDRESS: PERMIT NIb4 12 0 0 7 0
,7949 RAINROW DR
ER'S NAME: FERMD ISSUE DATE
DEAN &MARIAN TATSUNO 12/10/2004
ONE: SANITARY NO. CONTROL NO.
ARCHrMCT/BNGINEER: - .. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�O p - LICENSED CONTRACTOR'S DECLARATION r •.. ,- _ ' . Job Description- Descri
tionthe tnffmsZndeii� Nwth 70M)ofDivWon3othf : chop
insI .and effect. d REMOODEL KITCHEN /2 BATHRMS
N4 Cl
Dole - c wear CONTRACTOR: CLEAR CHOICE -
q�q A CHITECTSDECLARAMW
W I undersand my Plana aIWI be used u public
o.
s std Licensed Professional
OWNER.BUILDERDECLARATION -
<F 1 hereby M.Nn I airs ucmpt from the Canumror,License IAw for the - • - - -
O O following won.(Section AO 10,Busenea,and Profusions Code:Any city or county
K$ which requires a permit to amnrom.alter,improve,dom irsh,or rtlWr my RNctum �y�,/�
+tl prim,cal its issuance.also requires led m fi
applicant for such permit le a signed statement
•/�y/y OO
�< thot he is licensed pursuant m om the pmvisiof we Cmnuxort License law(Chepo,9 Sq.Ft. Floor Area :Valµ
$ (comaddengwhh Secdon7ODMo(Dfvfsiod3mthe Busino Pmfuaiem Cede)ur. '
Bus hula modern therefrom and the bub for to alleged exemption.Any violation of.
Section 703IJ by any applicant for a permit subjects the applicant to a civil ponsky,of APN Number ,(� Occu an Type
or fs
nmesa than w hundred dollars($500).
36210013 . 00 / �n P_.y ...
❑I.u mvner of de pmprny,or mY wPloyera w'ub wapea a their Gale eompemadon, _
will do the work,and we smnum is Out intended or offered for sale(Sm.7044,Business . .. nn o 'In
r ^•
And Professions Cam:The Cmuenors License saw does rot apply b an owner or -- Regwied sPectlons. . - -
propcnywhobuildsorimprove,thereon,and who doessuch work himselforthrough his
oweemployeu,provided that such im7rowments are notitmnmd caro@sed for sale if. �t4�l�r -
however,she building or improvement is mid within one year ofcompcdon,the owner.
builder will rove Louburden of proving that he did not build or Improves for Purpose of
saw.). . . #
❑].as oweri of the property am exclusively,comming with licensed contras or,on
construct ft project.(Sec.70/4,Business and Professions Code:)The Contractors u- ... ... ,.,,t,';''/
come Law mu not apply to an owner ofpmpeny who build,or improves thrown.and. '•-• _ ... _ . 1 f
who contracts for such projects with a convenor(,)licensed Pursuant to the Contractor,
License Law.
Ilameoolnunder Sec. ,B&PCfUrwu.n
Dau-or
WORKERS COMPENSATION DECLARATION-'- - nv ,.,, ,•
I hereby affirm under penalty or perjury cam of the following declarsdom:
lu.md will mainWn a CemBLae of Come,tca self-insure for Worker,Campen•
n,u provided for by Secvon 370D of de labor Codes for the performance of de -
for which this permit is issued. . .,. ,. .._ .
hoe arb will maintain Workers Compensation Insurance,u required by Section -
of the labor Cada.for the performance of the wok for which this permit I,Issued.
Worker.Cnmpenaadon tmusance carrier and Policy numhheer am: q ,
er.
(3Q .` W117 - PoIkyYN/
CERTIFICATEOFEXEMPION Flt MWORKERS'COMPENSATION INSURANCE
(This motion wed not hecomleud Bibs,permit b Forane hundred dollare(SIM)
or[e„)
1 certify that in the performance of the work for which thb permit is issued.[,hall nut
employ any porton in any manwrso As An become abject m the Workan'Compenudon
Lawsof Califomla,Dau "
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should -
WOM subject o the Work 'l Compemadon Provisions of the Ubor Code,you mute
O Forthwith comply with such provisions or this Permit shall be deemed ovnked.
Z CONSTRUCTION LENDING AGENCY .
F+ Thereby AM.that there isacomwNnn[ending agency for the perfumance of
lYi the work for which Nb permit b issued(Sec.3M.Co,C.)
Q Under',Name -
=z Under,Address
O 0 1 cenify that I have need this amicadnn and shoe that the show InfmmNen Is '
U,r' com0.I agree to comply with all city and county ordinances and sum laws miring to
0 SV' building construction.and hereby authorize mpoomatlws of this city to ernes upon Nc
,bow-neenvoned property for inspection purposes
"y (We)agme to cave,indemnify and keep harmless the City of Cupertino against
,n llabilidea.judgmcn0.cow and eapcsuna which may in any way aeruc Against saidCity
U 7 in consequence of the granting of this permit.
r7 PLICANT UNDERSTANDS AND WILL COMPLY WITH A -POINT Issued by: Date O
OU $REGULATIONS.
�to Re-roofs
Si ,(App t/Conuecmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will da applicant or future building occupant nom orhandle,hundous material
As mfiwd by de Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
c.Seniors25532(a)? / All roofs shall be inspected prior to any roofing material being installed.
pYu Q1vu
Will the applicant or fissure building occupant use equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
I
t haimmut air com sednants u defined by the Bay Area Air Quality Management all new materials for inspection.
rict7
❑Yu e
I ham mad the haurdous mwrudsomin menu under Clan erd.95 o(the Collier.
Hcn W h SafnyCom,Secams 25505,25533 and 25534.1 undoes"Ihetirthe building
s n Wtly hew a tenant.Nu It b my ruwmihility a wdfy the occupant of the
: m b[ehmaube met primratiameoce or a condition or Occupancy Signature of Applicant Date
Ofriler or A.1h.6.cd a Sont _ Dae All roof coverings to be Class"B"or better