10080156 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7553 HEATHERWOOD DR CONTI[ACTOR:6) 6.!,`,,L i-}r�P�S �- PERMIT NO: 10080156
OWNER'S NAME:
, PHONE NO:
Li LICENSED CONTRACTOR'S DECLARATION
BUILEING PERMIT INFO: BLDG ELECT r PLUMB r
License Class Lic.# �¢
MECH RESIDENTIAL r COMMERCIAL
Contractor�,(� (G, T('lit Date 2d
hereby affirm that I am licensed under the provisions of Chapter 9 JOB D'_SCRIPTION: REMODEL MASTER BATHROOM(72SQ)&CLOSET(64SQ),
(commencing with Section 7000)of Division 3 of the Business&Professions RAISE NLBED CEILING(268),REPLACE WINDOW;
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 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 provided for by Sq.Ft F oor Area: Valuation:$20000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35926056.00 Occupancy Type:
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating
to building conabove
mentioned
and hereby authorize representatives of(We)
a city o enter PE RMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accruAdditionally,
against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point egulattons per the Cupertino Municipal Code,Section
9.18.
/ Issued t y: Date:
Signature Date gh�f
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:the without first obtaining an inspection,I agree to remove all new materials for
inspection.
1,as owner of the
property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
1 have and will maintain a Certificate of Consent to self-insure for Worker's 1 have re;id the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Californi a Health&Safety',Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. complian ze with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Cc de,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Addition.illy,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by!the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,1 Owne �
become subject to the Worker's Compensation provisions of the Labor Code,I must 'Date-
_q A�L410
Forthwith comply with such provisions or this permit shall be deemed revoked.
COT
O STRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby a Iirm that there is a construction lending agency for the performance of work's
certify that I have read this application and state that the above information is for which .his permit is issued(Sec.3097,Civ C.)
;orrect.1 agree to comply with all city and county ordinances and state laws relating Lender's game
o building construction,and hereby authorize representatives of this city to enter
rpon the above mentioned property for inspection purposes.(We)agree to save Lender's address
ndemnify and keep harmless the City of Cupertino against liabilities,judgments,
:osis.and expenses which may accrue against said City in consequence of the
,rof this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
vi. non-point source regulations per the Cupertino Municipal Code,Section 1 understat d my plans shall be used as public records.
0.18.
signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:7553 HEATHERWOOD DR CONTRACTOR:d C_ 4(,k"S PERMIT NO: 10080156
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 16 Lic. # 564q kZ%
Contractor YJ�I G V1 TCttM0X _ Date 1-201. j)
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. ,�
APPLICANT CERTIFICATION
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point souffegulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
PHONE NO:
BUILDING PERMIT INFO: BLDG ELECT r, PLUMB r
MECH RESIDENTIAL r� COMMERCIAL r
JOB DESCRIPTION: REMODEL MASTER BATHROOM(72SQ) & CLOSET(64SQ),
RAISE M.BED CEILING(208), REPLACE WINDOW;
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 35926056.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.I2 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner a
CO STRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date