03100132 CITY OE CUPERTINO ., �a �• � "`�"
BUILDING DIVISION PERMIT CONTRACT R INFORMATION
nuaDINC ADDRESS CUPERTINO KITCHEN DESIGNS PERMIT No03100132
WNER'S NAME: 10562 S DE ANZA BLV PERMIT ISSUE DATE
NE: (408) 257-4900 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Oo LICENSED CONTRACIOR'SDECLARATION lobDeacri tlGn
l m I hereby affirm that 1 am licensed anchor provisions of Chapter 9(commencing P
i<W with Scvtq¢/1alt)of Division 3 of NC Bused Prolessiuns Code.and my license is
in full foraFoad,freer
qi
License Class Lie.a 6PO4-6 3 KITCHEN REMODEL
T'SDEe bUPE'F'-7/No KI�CNE afnl❑/1�
•aj As shall EGTSD ARATION
I undcraand my plans shall M used as public records
>a.0
u Licensed Professional JAN 1 3
J O v Oat I am exempt
from
DECLARATION 2�oA
j S$ 1 botchy affirm than 1 oro exempt from the Contractor's :License Law for the dI
o O o which ng reason,(Section?(In str Business and r Pre,demolish.
h.Code:Any city or county
4 m( which myuss a e,emit m construct.error,improve,demolish, fie asig any structure 00
�ai prior to issuance,also,squires the applicant for such permiuo file asigneJ summcm
< that he isliicensedpersurnttothe provisions(if thcCommcmr'xutsnse Law(Chapter 9 Sq. Ft. Floor Area un Valuation
(commencing with Section 7")of Division 3 of the Business and Professions Code)or
$
most he is exempt Ih urfrom and the basis for the alleged exemption.Any violation of 7 81
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than fin hundred dollars(5500).
1,ss awncr of the property,m my employees with wages as Weir sole compensation.
will do We work,end the Clan...is not intended or olfcred for sal.(Sec.70a4,Best.
and limitations Code The Convenors License law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided thauuch improve env are not intended proffered formic,If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving Chat he did not build or improve for purpose of
sale.).
❑1,as Owner of the propart,am.elusively contracting with licensed contractors to
conswct the project(See.7(1x4,Business and Professions Codc:)The Contractor's Li -
cmar Law Wires not apply to an owner of properly who builds or improves Wemon,and
who contracts for such projects with a contractor(s)licensed pursuant o the Conormo r'a
License law.
❑1 ran exempt under Sec. .B&P C for this rtsson
Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penahy of perjury one of the following declarations:
I haus and will maintain a Certificate of Consent m self-insure for WorkcrsCompcn-
u ion,as provided for by Section 3700 of the labor Code,for the performance of the
work for which Nis permit is issued.
1 ban and will maintain Worker's Compcnsnion Insurance,as required by Section
3700 of We labor Code.for the performance of the work for which this p,mrit is issued.
My orker's Compensation Intionm carrier and P r. numberare:
C 'cr. SPATE TL)f,)o, Putiry N., 410
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if Be,permit is for one hundred dollars($100)
less.)
I sonify Was in We Per6mnanoc of Ihn,work for which Wis permit is issued,I shall not
employ any person in any manner sn as to Mcomc subject to the Workers,Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alto,making this CenlBeam of Exemption,you sho.W
became subject to the Worker's Compcnution provisions.10.lnchor Code,you most
O forthwith comply with such provisions m this permit shall 6e deemed Conked.
Z y CONSTRUCTION LENDING AGENCY
I hereby affirm Wal Were is a construction lending agency for Oc perfurmancc of
L' the work for which this permit is issued(Sec.3(yI7,Civ.C.)
Z.] 0 Lenticr'1 Name
�Is. z Lenders Address
p I certify,that 1 haw ranch this application and sum that Che above information is
t• cmiret.I agree to comply with all city and county ordinances and said laws relating l9
=tU building eonsuvnion,and hereby mthorim representatives of this city to enter upon the
„ Wabove-mentioned
property for inspection purposes.
gi• (We)agree to save,indemnify and keep temple.the City of Ceram..against
TA liabilities judgments.casts and ca,cnscs which may in my way accrue against said City h
JZ in consequence of the gOmio,of this permit. CVS
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
5 ft REGULATIO
_�CPi c 2q/9/0 2� Re-roofs
Sign rtme of A,Vli...UCmromtor Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will We applicant or home buiWmg intermixture or handle havantous tracrial
az dcF eel by the Cupenino Municipal Code.Chapter 9.12,and rbc Hcalth and Safety
Ude,Section 25532(x)? All roofs shall be inspected prior to an roofing material being installed.❑Yes �Np
Will the applicant or future building occupant use equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
it incautious air commortants as defined by the Bay Area Air Quality Management all new materials for inspection.
7duo,noteurrently
trio? f7I�
❑Yes l No
1 have read the boandouuss materials mquimments unticr Chapter 6.95 of We Cahoot.
Health&SafctyCc ,SeNom25505.25533.d25534.1un&e .dWmifthe building -
haw a Imam,On it is my ocide mibllity mnnery dmoccuprnt ofthe
.n.wmrnmnstbem n,i:<y�^e.n�r c /r.at,nraetrp rye Signature of Applicant Date /
owmmaa
p, mmi.=dagmt All roof coverings to be Class "B" or better