00100035 (2) CITY OF CUPERTINO
nun.ulNc DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
Oww7R'SNAM20143 SOMERSET DR FRAN LEE CONSTRUCT @kickb t 100035
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209+7
PARG9 DR_ SANIIARYN0,10/04);;120@0
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I408I 996-2527 BUILDING I'LRMI'r INFO
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LICENSED CONTRACrOR'S]DECLARATION of CON Job Description,
O z—o I hereby alRrm that am Ilccnmd ander Previsions of ns Code)nd mmortmg
pm:obi "of. liaa]b1M1)ef. Uisi ion3 abbe business and lhnfe,siuns Cal.and my license
G z i.In full force at
Owl,
le Lieenm Cluss Lic.N p[_ ,
>S 3 z r Dale enl'traetnr KITCHEN REMODEL
ARCHITEC!S LECLIRATION
I,.0� 1 anderswtd shy)tuns,eau ne a,en cess)twee r,ta,ta,
o, /z 25 a Liceawd 1'n,fm,ionnl
OWNEWRUILDER DECLARATION
J i hereby union that 1 am o,etnpt boon the Ctmm,torl,License Law For the
1—z N following reason.Isecmer 7031.5.[wourena and Profession,Cole:Any city m emmay
2 o which requires a pencil m n00,nuer.ulcer,ilnpro,demuliso or repair any,truumm
pdo to its issuance,also requires the applicant for.such Pont to life a signed slmemenl
that 11,2 is Iicenscalpur,mal to the provisions otlhe Ctmnmm's License].aw(Chapter 9 Sq. Ft. Floor Area Va
mommenaing with Section 9110(11 of 1)i silica 3 of the business and Poinesslon,Calc)
ar ohm he is exempt ILcrefrnm i d the h:uis for the alleged e,emplain.Any violation
of Sooan 7031.5 by any applicant for a Penna aubjects the applicant Ili a civil finally PN Number Oeeu
of not to m than live hunre
dd dalton(5510). Apow
DAD
❑I,is owner of the property,or my umployces with wages as their sale aompensutioa.
will do the work.mal the stmeme,is col intended or oltered for vale sec.7IW4,
bu,mew and Prof,%oon,Calc:The Contractor,ucca,e Law doe.,nut apply m an - 36930005900red Inspections
p'CIIOHS
owner of p,i,,.y Who builds or impmvex thereon.and who does such work himself
,t lhnatgh his awn employees.provided that such impmocalc .,are not intended or
offered for sale.If,hncrevcr.the bili ding or amp...cownt is wild with'm ane y.,of
completion,the rener-builder will base the burden of proving that he did not build or 101 — FOUNDATION
nonfarm for parrawofvfea. 102 — PIERS
❑I,a,owner of the prnped,am exclusively contra......wire Iiccnwd el uannrs Io.
monurnl the project Ise,]IA4,business and P...mistrias ender)The Cnn mtlah —
103 UFE R
does Lice ,Law ds not apply to an owner o1'property who hard,or inmeoc,theremt. 10,4 — REBA R s
and who contracts for.such project,sides a eommoors)limned pursuant to the '
Contractoalaeen,eLaw. 105 — ANCHOR BOLTS
❑I sin clean,ander See .If&P C for this reason
Owner Date 106SEWER 8 14ATER
WORKER'Si COMPENSATION DECI.ARA'r[ON 202 —' UNDERFLOOR PLUMBING
Inenr'inrm onlerpenal,,,f slm,oneofde fobowiog deelamlimt, - 203 - UNDERFLOOR MECHANICAL_
Cnmhave anwill tnaittmin a Cetlaiente of Coosent to self-in.,tm Inr Worker's 204 — UNDERFLOOR FRAME
fcnwlmd as provided for by Section 3710 of the Latah CWC, for the
pere,rnanee nt the work fo vini,fl,hi,peony 1,issued. 205 — UNDERFLOOR INSULATION
❑I base and will remnant W..kcr',Con,cn,aaon lnsm:mee,a,ralaimd by Seaian 301 — ROUGH PLUMBING
3]01()of the Labor Code.for the a,rhad ince of the warn for xmieh this permit i, - �0� — TUB R OR SHO
„sed.MyL'wa�rfr�,{e�racon"' o m,ttmneeerdertmdrmicrntttnneran: SHOWER
anima ? PolieyNo .�� 303 — ROUGH MECHANICAL
CCRIIn CATION OP XINP 16N I RoM WORKI:RS'
COMPENSATION INSURANCE 304 — ROUGH ELECTRTCAL
In, cebotl nen)nest be eanplered.f the pnrmil i,for one bunched dollar, 305 — FRAME
(samor da,.) 306 — HOLDOWNS
1 century that in the pcTioni ance of the work for which this remail is issued,1 307 — INSULATION
shell not employ sty lerson in any tnanner so as ,,became,object m the WmIwr;
Compensation Laws or California.Da1e '308 — SHEETROCK
Apjall
NO,;CE'rO APPLICANT:11:aver snaking this Cenilicme of iixenrtinn,you,hnulJ sv,09 — EXTERIOR LATH
beconm,u,o,,,o the Worker',Contpun,mion pmckmas write Labor Cade,you most
O p mnhwidtcomply with such rm,i,ma,influs non.bull hedemnedreaokcd 310 — INTERIOR LATH
Z lin CONS'I'RUCrroNLENDING AGENCY 311 SCRATCH COAT
? I hereby xllion that there i,a construction lending agency for the performance
of the work for which fin,petrol is u,uca Sec.3(x)].Civ.(A 31 3 — ROOF NAIL
6. A I<ndcr'x Not,
ZD z Lender,Address 501 — FINAL ELECTRICAL ENERGY
U0
lcemymmIbaremadmk,appbcaemad,latethat'he,1bovemflmh'lionis 502 — FINAL PLUMBING ENERGY
W F., a rm,l I agree to comply with all city and county ordinance,and state laws relating
O URt :oto ponding constraction,and hereby auntmlac represenmdve,of this oily m caner upon 503 — FINAL MECHANICAL ENERGY
h baMwe-memtinned rropedy far mspect a puquse,.
a (we)agmetostim.inderatiryand ace)bawd-„tn,Ciyofeuperlim, airo, 504 — FINAL_ BUILDING ENERGY
) liabilities,judgments,costs and expenses which tnoy in any way aceme against said
Uz ntymcoll"mceonhegmntttgofmk, wort. 505 — FINAL ELECTRIC
^ PPLICAN'U+ RSTANDS ND WILL COMPLY WITH ALL NON POINT Issued by: � CJ, r-ST ale
SOUR�,n 'oanamor
;GU
Signat16/Intal Rc-roofs 507 — FINAL PLUMBING
MATERIALS DISCLOSURE
lding,ecopnt,tolearhanuchmmdott,mttteml Type of Roof 50B — FINAL MECHANICAL
as defined by the Cu s mmo swnicipal Code,Chapter 9.12,and the Health and Safely 509 — FINAL GRADE
Com.Seen x25532(,1):'
❑Ye' 0 N All root's shall btrIq,Vlededfpr V10.afjy.1rV_�Jhb1,Wy,ial being installed.
wuthe applicant orfuture building naapantuse ci,mparcmordevices which If a roof is installed without first obtaining an Inspection, I agree to remove
nit Iwmnlnus air cotnamin,1nta a,donned by are pay Area Air Quality Managctnenl
,strict all new materials for inspection. Applicant understands and will comply with
❑Ye, 0 N all non-point source regulations.
I have read m,bantnlnu,mnmrim,regnio,,nan,mover Chapter 0.95 ill the —
CaCode Sections Health&Safety CoSections 25505.25533 and 25534.I underslnnd that
I l the hulldi ng mw.s not corm only latvaalcn:au.that 11 is my au,anislilttry ,,notify the 514 FINAL PUBLIC WORKS'
occupant of the requirements which must be mel prior to issuance of a cer irc:tie of
O,c,m Sy . Signature of Applicant Date
oxner ora LT* All roof coverings to be Class "H" or better
OFFICE
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Pena Doo
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