03100042CITY OF CUPERTINO
"
CONTRACTQR�INF„pOBMATIQN:
BUILDING DIVISION PERMIT.
BUILDING ADDRESS:
0220 Rn
BRAND KITCHENS & DESIGN IN
"'U "'.03100042
RIITT�I&RA
WNER'S NAME:
7.TTn
13715 QUITO RD
PERMIT LSSUEDATE
,TEAM
"E'
(408) 871-8190
SANITARY NO. CONTROL NO,
ARCHITECT'/ENGINEER:
BUILDING PERMIT INFO
BLDG ELELT PLUMB MECH
O O o D
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing,
with Section 7000) of Division 3 of the Business tool Pmfdmione Code. and in, license is
mfall m e4naereal.g X
El<a 6-102123
RAISE CEILING/PATIO
IkI E L{gI�n99ACEMtptpa�EwWNT
Commerce.
Daten`�
-
LS:# s
ARCHITECTS DGCLA ION
1 untl<(mand in, plans shali be used u public records
JUL 22. 2004
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from Ne Contractors License Law to( the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
BU
which requires a permit or construct. Aller, improve, demolish, or repair any structure
ILDING
prior to its iscuanea. atm requires the applicant far such permit to files signed statement
that he is licensed cement the provisions of the Contractor's License Law Chapter 9
tt
Sq. Ft.
Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Co!1e) or
Bear he is exempt therefrom and N• basis for be alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars (SS00).
❑ L owner of property, employees with wages Nei( sole com.
101
- FOUND d Inspections
r Business
andre is Business
will o end
a
Cols License,tended
Pr lesions La do snt apply to an
and Professions : he Con Law
The not apply to an owner is
brown,
102
— PIERS
builds or marrows and dods such
h improwndwho wenotctende himselred for mgh e. If,
Isomemploym,try who provirid that suchorte(ed for
own tic0 that wenotyew
lO3
— UFER
mor
owner.
of completion. Ne awnco-
however. theesilding old wi of
however. Neavetieurien diinot
build
sunder will have the harden ser Proving dot be did not band of improve for puryoae or
of proving that
104
- REBAR
aalc')'
105
- ANCHOR BOLTS
property, , B exclusively confessions with :) Theetl convacmu to
71 I, as owner of project Li
come not (Sec.7044,wnerossand Professions
106
— SEWER & WATER
ds orhThovesdomlors
Law does man who centra,and
202
- UNDERFLOOR PLUMBING
sedporimproves
aontrecorty
who coawdufor suchapply
ufor such projects withaconuacmr(s)Iicenx0 pursuant to dm Convector's
with
whonseI—
License Law.
203
- UNDERFLOOR MECHANICAL
I lam exempt under Sec. .B&PCfor this rcsson
204
- UNDERFLOOR FRAME
Data
205
- UNDERFLOOR INSULATION
_
WORKER'S COMPENSATION DECLARATION
I hereby affon under penalty of perjmy one of the following Occlusions:
301
— ROUGH PLUMBING
I have and will maintain• Cenificaa of Consent self -insure for worker's Camper-
302
— TUB & OR SHOWER
mo,u provided for by Section 37M of the Labor Code, for Ne plefortnance of the
303
- ROUGH MECHANICAL
lwnc,
k for which Nis permit is issued.1
3 04-
ROUGH ELECTRICAL
have and will maintain Workers Compensation Insurance, as required by Section
0of Ne labor Coe,for Ne performance ofNe work for which Nis permit is issued.
305
— FRAME
WorkersCompamdonlnsurentt carticrand Poor u�mfbedr are:v%r. Poliry'i��• I
306
- HOEDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
307
— INSULATION
COMPENSATION INSURANCE
308
- SHEETROCK
(This section need nut to completed if the permit is fnrmnchundreddnllwa(g100)
309
- EXTERIOR LATH
till less.)
310
INTERIOR LATH
1 certify Nal in the performance of the work for which this Permit is owed, I shall not
-
employ any person in any manner an as to become subject to be Workeri Compensation
311
— SCRATCH COAT
Law Ap,doiam canmmia.Dale
APPlic
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT: If. after making this Cenifewe of Exam prion, you should
become subject on the Worker's Compensation pmvisiem of the labor Code, you must
forthwith comply with such provisions or this permit shall he deemed revoked.
502
— FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
I hereby affirm that there is a construction lending agency far the performance of
504
- FINAL BUILDING ENERGY
the work for which Nix permit is iuucd (Sec. 3097, Civ. C.)
Lender's Name
505
506
- FINAL ELECTRICAL
- GAS TEST
Lende'aAddress
1 certify Nal I have read this application and sole that is, above information is
cancer. I agree to comply with all city and county ordinances and suite laws misting to
507
- FINAL PLUMBING
building construction, and hereby aulhorive representatives of this city to enter upon the
above-mentimisd property for inspection purposes.
We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costa and expenses which may in any way accrue against said City
O 9
CAL
F I
FINIgNW
in Nc
-5
conuqucncc of graining of this rmu,
APPLICANT UNDERSTANDS WILL COMPLY WIVHAL NON -POINT
Issued by- 5
ORKS Date
SOURCE REGULATIONS,
Re -roofs
Type of Roof
D
Sig rc of APPlicanVC0 tract Dealt
HAZA 0 S MATERIALS DISCLOSURE
Will the applicant or fu building campantsmre or handle Outside.., namohl
as defined by the Cupertino Municipal Code, Chapter 9. 12, and the Health and Safety
.oda. Section 15532(.)?
All roofs shall be
inspected prior to any roofing material being installed.
❑Ycs PIN"
~
cquipmern
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occapant use or test which
iI hamnious air contaminants as carried by the Bay Area Air Quality Management
all new materials
for inspection.
vier?
❑Ycs ,We
'
It 11va read the havaNnusmamrials rcyuimmenu under Chapmr A95 of the Cali(nry
nia HcaM4,SafetyCede,Secuons255l15,25533amd25534.1undcrsmndthntif Nc building
docs not ermenly haw a tenant, tha y responsihility w notify the a upmt of Ne
m cots ichmuslbomailoissaanccoracenlfmammf uP.er.
SignatureofApplicant
Date
lO
All roof coverings to be Class "B" or better
11
ner or auNoriucd agent new
V