06120012CITY OF CUPERTINO
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DIVISION PERMIT1�.®')AQR
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. BUILDING
BUILDING ADDRESS:
PERMIT NO. 06120012
I( ANEON AV
OWNER'S NAME:
PERMIT ISSUE DATE
ARI KATZ
12/04/2006
NE:
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER:
BUILDING PERMMNFO
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BLDG EIFCT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
IOb Description
h neby affirm Nat I Am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Dividon 3 of thc Box. and Protesoms Cook.and my license u
in full fore and effect.
KITCHEN REMODEL NON, STRUCTURAL
Litt. Clue L'c.•
Dam Contractor
ARCHr1ECIS DECLARATION
1 understand my plans shall W scd As public records
Licensed Pmfessia..I
OWNER-BUILDER DECLARATION
I W achy affirm than I em exempt from Nc Comrxmrs Liam. I-Aw for Ne
fallowing reason. (Section 793 1.5, B sines. and Pmfcsdom Code: Any city or county
which "on. A permit to eons k after, improve, demolish. or repair any swcmre
$10000
prior in os kmaac. also requires the applicant far such permit to rile asigned statement
that he is licensed pursuant to the provisions of Ne Contractor's Uceom, Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(eammenang with Section 7000) of Division 3 of the Business orad Prafeuias Cade) or
that he is exempt dcrefrm and the basis for the Alleged exemption. Any violation of
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r
Occupancy Type
Section 7031.3 by any applicant for a permit subjects the applicant to a civil Penalty of
not mom than five hundred dallam (M).
0 1, u owner of the prapmy, m my employ= with wages u theb sic compermdon,
- Required Inspections
e
win do the work. And thesuuctum is natimendcd monercd rmsaht(Sec. 7014, Business
and Ptoressiaru Cade: The Coutra. cmes LiceLaw does not apply lo an owner of
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property who builds m(mposm th ocon, andwW aoessmhwork himuelforthrough his
_
awn employees, provided that such improvements are not inamded oronmd for We. If.
however. the building or improvement is surd within one year of campkuon, the owner.
builder will have dace burden of proving Nat he did not build m improve for purpose of
rale.).
1. As owner of On, property, Am exclusively contracting with licensed cxm ac ss to
,
cosuvet the PmjeeL (Sec. 7044. Business and Pmrssiau Code:) The Contractors U.
cease law does not apply An an caner of property who builds or improm thereon: and,
.he emaracu for such project with A contracmr(s) licensed punuam to the Contractors
License Law.
❑Iam exempt under .BBPCfor this mason
Owner Date
\ KER'S OM ATION DECLARATION
I hereby afireunder penalty of perjury arc of to fallowing dalaradons:
1 have and will maintain A CmGfieam of Cont m self-insure forworker's Compen-
sa ion, As provided for by Section 3700 of the Latest Code. for the performame of the
work for which this permit is issued.
I have and'Mll maintain Workers Compehnamlon In91lNG', ax required by Section
3700 of the Labor Cook, for the performance of the work for which this permit is issued.
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My Workers Compensation Insurance carrier and Policy number m:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTissection need not be complemd if the Permit Is form= hundreddeilam (SIM)
m less)
I ttrtify that in the p Ron . of use wah Ire wM1iah this permit is issued. I mall tat
employ any person in any mannepsn az ;beco'le subjem to Ne Wmry�ers Compensadon
lsw]nf California. Dee_
f,TL'FJ—
NOTICE TO APP ofmr ak g is CcniOca¢raf strophic, you should
become subject m the workers Compc f Inc uthor Calc. you muse
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foMwith comply with such provisions or this Permit shall W deemed mrvvkcd.
i CONSTRUCTION LENDING AGENCY
IWmhy I.A amu
! Nem isacorwninn lending Agency for the performawcof
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cfinn Pe
the work for which Nu permit is issued (Sec. 3097, Civ. C.)
IcmleeName
Lenderas Aaareu
,
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1 I certify that 1 have rod this application and mate than the above infom ire. is
cancer. I agree to comply with all city and county ordinances and sum laws relating to
Wilding construction. and hereby authorve mprexentativo of this city to enmr upon thc
shove-memiunetl properly fur i of ed.n purposes.
(We) agree t0 save, indemnify and keep harmless the City of Cupertino against
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j Imbiliues.pWgmcnu, costs and expenses which may in any way accrue against said City
in co.quence of the granting of this Permit.
APPLICANT UNDER AN S AND ILL COMPLY WI [I L NNON,PO� W
Issued by: Z-27
SOURCE
Date —rte
REGULA NS, L/ Y�
Re-roofs _2
Signature of Appl' anUCon nor ac
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willy Cgoccupant atom or
t e Cup4mmfuture Municipal
and the Health And Safety As defined by the Cupertino Municipal Cade. Chapter 9.12, and the Health antl Safety
Code. Sanson 25532UY!
❑In- No
All roofs shall be inspected prior to any roofing material being installed. '
Will the Ipplicst or future Wilding occupant use, equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit havartos air camamimmus as dcGncd by the Bay Area Air Quality Management
all new materials for inspection.
District'
0y.
lhavccaddt mosudauA su:ristatequir enuundcrCbapmr6.95ordAcchrm-
niaHcaW&Safely Cod,Secues 25505,83 d8534.Ionemundthaifthe building
dos mat cunentI M1a cp ermrl dddyyy(((mmm h u ry r ponder m mufy the atter rt nr Ne
myuiremcnu whit uG be met p(iJur4fsu t—iCmdreae� e on0�
A
Signature of Applicant Date '
All roof coverings to be Class "B" or better
owner ar coma n<a asen, Dole .