05060002 CITY OF CUPEIITINO '�«• � a "�` "" ��y�`
BUILDING DIVISION PERMIT ,CONpTRAC';TOR�,INF�ORMATION
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMITNO05060002
1565 ASTER LN
ER'I NAME: PERMIT ISSUE DATE
JACKSON & NADIA TU 10562 S DE ANZA B 2005
PHONE: SANITARY NO. CONTROL NO.
(408) 257-4900
ARCHITECT/ENGINEER: BUILDING PERMITTNFO
BLDG EIEC! PLUMB MECH
0 0 0
X00
LICENSEDCONTRACTOR'SDECLARATION
u+❑ 1Wmbyaffirmto,Iamfte,BuunderprovisionsofsCChapter de. 9(Comm
encing lob Description
wiNsmion]000)ofDivixion3ofte Business and Professions Code.and my liccnu is
;„ in full to=andeffecc //-�yov83 REMODEL KITCHEN & MS . SUITE Sc
D Ij z License Class Lia/ Y
n-p Dale n 1/ on cnmmewr ,elf NEW WINDOW @ KITCHEN
-F'3` ARCHITECT-S DECLARAION '��f�,. n
m< 1 understand my plans shall W used u public merm s '1
Licensed Professional P!f'pI'n�`\A' r I ic-
,03 OWNER-BUILDER DECLARATION �a res \�� I�
y fN
1 hereby alTirm Net I am excmpl from 0u Contvmos's License Law for the
a O following reason.(Section](131.3,Business and Profeaions Code:Any city or county
K S 8. which nequims a permit to construct,alcor,improve,demolish,or repair any swnute
prior to its issuance,alwsequims the applicant(orsuch penditm fileasigned statement Fn
££ < Nal heishcomcdpursuant inWeProvisions OfMeComnctor'sLiComlaw(Charter 9 Sq. Ft. Floor Area Valu*))5000
y~$ (commencing wit Section 7")of Division 3 of the B usinna and Professions Code)or f - ❑ g I)
a _ tat he u exempt therefrom and W e bussu for the alleged exemption.Any violation of I :1 it (�
Section 7031.5 by any applicastfor a permit subjects to applicant to scivil penalty of AJIN Number
V''�;,J�(,o EOcetipaticy Type
not mare tan five hundred dollars($500). 36624010 . 00 U U \r
❑1,in owner of the property,Or my employees wit wages in their sole cme,cnssuon,
will do We wont,and to strumule u not intended or offered for side(Sec.](da,Bnir..
and Profusions Code:The Commodes License Law don not apply an an owner of Required Inspections
property who builds orimpmacs tenon,and who doessuch work himself or trough his
own employees,provided Nat such improvements are not intended mortared for use.If,
hsiwever,to Wilding or improvement is sold witin one year of rnmpletion,Ne owner.
builder will have to burden of proving tat he did not build or improve for purpose of
sato).
❑1,as ow.,of to property.and exclusively Contracting wit licensed conoacmrs m
construct to project(Sec.7044,Business and Professions Code:)The Contractor's Li.
tonne law don not apply to an owner otproperty who Wilds or improves Woman,and.
who Concocts far such projects wit a cdntractor(s)licensed pursuant in the Conuanar's
License law.
I am exempt under Sec. B k P C for tis mason
Dau
WORKER'S COMPENSATION DECLARATION
1 hereby M.under Penalty of perjury one of to fallowing declaration:
❑I haw and will maintain a Cenifiau of Consent to self-insumfor WorkersCompcn-
Saiian,in provided for by Section 3700 of to labor Code,for Me performance of to
work for which this permit is issued.
❑1 have and will maintain Wmtets Compensation Idem.,as roquimd by Seeuoa
37W of Me labor Cade.for to performance of to work for which tis permit is issue).
My Wmker's CloImpJJenaat�igf�Insunn�ce Cartier and Policy number am:
Carrier. �sT6AV l-s+•wR . Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W compecad if the permit is for one hundred dollars($100)
or less.)
1 certify tet in the performance of to work for which tis Permit is issued,1 shall not
employ any pawn in any manner u as to become subject to to Worked Comperdation
Laws of California.One
Applicant
NOTICE TO APPLICANT:If,after making to Certificate of Exemption.you should
became subj.t to the Wodefs Compensation provisions of Me labor Code,you must
.JO foMwi t comply wit such provisions or tis permit shall W deemed mvok,d.
Z ` CONSTRUCTION LENDING AGENCY
I hereby affirm tat Nese is a construction lending�--� y agcmy for to Performance or
IY� tc work per which this Permit is issued(Scc.3fi9'l,co,CJ
flia.Q Lenticds Namc
=z Lender's Address
L) 1 cedify tat 1 have mad tis application and state tel to above Information is
Fcomet.1 agree to comply wit all city and county on iddnces and state laws rolating to
0 V Wilding construction,and hereby aateriae sepresenutiwa of this city to enter upon Me
G above.menuonod proltony for inspection purposes.
(We)agree to save,indemm fy and keep harmless to City of Cupertino Fagainst" N liabilities,judgments.cents and espenus which may to any way accrue against said City
f)z in concgmnce of to granting of this permit.
^'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ssued by: Date
SOURCE GUL ON
S Re-roofs
Sigmayfic of plica o rector Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tc applicant or fuure Wilding occupant vane m handl,hazardous material
de0ned by the Cupertino Municipal Code.Chapter 9.11,and to Hcalt and Safety
Sauon 25532007
❑Yes All roofs shall be inspected prior to any roofing material being installed.
�No
l
Will tea scant or future Wilding mcn ant arae equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
I a OP B P Area
emit hazardous air contaminants as defined by to Bay Arca Air Quality Management all new materials for inspection.
Dixtrin?
❑Yes RNu
I have mad to harardous materials requirements under Cha=D.
te695 Cite Clif .
nice licalt&SemyCodc.Rod=25515.25533 md255M.1 on,k
does not currently have a¢nanL tat it u my sceponibilily m n
requimm,nts wMe mast met prior tis an,enr a ccniBcatSignature of Applicant Date
All roof coverings to be Class"B"or better
Owner or thori'r agent