04020063 CITY OF CUPERTINO "' -' "'�# + .�^3��?-wx `"*'%�' `'�` n" ^
BUILDING DIVISION PERMIT CONTRACTORWURMATIOI'
N:"
BUILDINGADDRISS: SHOWCASE KITCHENS INC PERMIT NO 04020063
ER'S NAME: PERMIT ISSUE DATE
ANDREW IANC AND TUNE TRUS E712333 -
ONE: SANITARY NO. CONTROL NO.
(408) 253-0412
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_Op LICENSED CONTRACTOR'S DECLARATION Job Description
y tel C 1 Mmby affirm that I am licensed under ProHsiou of Chapter 9(rnmmencing P ffton�g� 1r�^��
wiN Sccuan7")of Division 3af the Bus�d Promasm.Code.and my license is ll N n L�L�
in fall faR'C a L C u U V(}� Ly
5'qi Linse Cl, ut.x �S KITCHEN REMODEL
-° D;;
Co. MAR 2 3 2004
ARCHITECTSD AT10N
of t 1 undersand my plans shell M used u ttrds
public rn
oyV
LL LICCItSed PM1IfCSalnmal
a'03 OWNER-BUILDER DECLARATION
Cmimmu
00 I hereby.('firm Not 1 1. exempt form Nr Convenor's License Law for the
00 which ngmason.Permit
2UJL9.Business and w.comasCode:Anycity nrcounty
01:00
$ which rtquims a e.also
re emnsweL aIRC nt for she demolish,our e a sig any tatement
print toits issuanm.also requires the applicant for such permit in file asigmdsuament
that W is licensed pursuant to Ne monsioes of Ne Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
td�$ (commencing with Section 90W)of Division 3 of the Business and Prefammus Crum)or
_
that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 3 e gt"crO 0 Occupancy Type
am more than five hundred dollars(5500).
1,u owner df the p e sones,m my orinumces with ages u theirmle compeusines,
sum da mowons Crude:
awctartiemoesLiWede Law do,mot apply 2044.Owner
Of Required Inspections
and Professions Code:The wsdoe lots ndwho Law dors not apply lf an owner of q P
propenywhobuildsdrimprovas Ch iMp andwhddeusuchwork oroffe dthrough his
own employers,providrd thmsvem improvements are not intended oroRmed for Sala If.
however,the building or improvement issold within on year of mprove for Ne owner-
builder will Rave the burden of proving that he did not bald or improve for purpose of
salt.).
❑1,as owner of the proPeny,am exclusively contracting with licensed contractors m
construct Ne project(Sec.7044.Business and Professions Cade:)The Contractors Li-
rem law does not apply to an owner of property who Wilds or improves thereon.and
who contracts for such projects with a convector(s)licensed pursuant to tW Contractors
License law.
I am exempt under Sec. ,B&P C for this moon
er Dam
WORKER'S COMPENSATION DECLARATION
I hereby allium under penalty of perjury arc of the following declensions:
1 hale and will maintain a Cenifcahe of Coment to self-insum for Worker'sCompen-
cotion,as provided for by Section 37M of One land,Code.for Ne poommunce 0f tW
work for whim this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as tequirtd by Section
32000f the Latour Code.for me performarcc of the work for which not permit is issued.
My Worm/e'C-ym—P�—upayy'an Insurance carrier and Policy number are.
or:YGivCs% —et�p -AMC OXY 4/J P-,CERTIFICATE OF EKEMPTIM WORKERS'
COMPENSATION INSURANCE
(Ohs sectionseed ndtbecomplched if tbe pertnit is fnronc hundm-0dnllan(SI W)
or less)
1 certify that in the Performance of the work for which Nis Permit is issued,I shall our
employ any Person in any manner m Or m become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcare of Exemption,you should
become subject to tbe Woher's Compensation provisions of the Labor Code,you most
.,Z fonhwitn comply with such provisions or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
'pw IWr thy which thi thethere issued(Se.construction10 lending?, agency for the perfurmanm of
(� the wash for whim tits permit is issued(Sec.J092,Co,Civ.C.)
GQ Lender's Name
Z) z tsnticr's Address
U C) 1 certify that 1 have mad this application and sure that the above information is
f' comet.l agree to comply with all city and county oNutions and sure laws Mm ing to
p U building construction,and hereby authorim reprisenutivcs of this city in toter upon the
W ahove-mcntimud!Property for ine ccu.Purposes
d lem,
me
ty of
mon
Fy Iiabilidesjudgmcnts.costs andcmnify expcnscss which my in any ayhmcmc agpainst said City LL
U Z in consequence of the granting of this Ptmhit. O
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
50 E REG ''ATIO
Re-roofs
tort of ApplianUComnaor tic
NAZA0.DOUS ATEIUALS DISCLOSURE Type Of ROOF
Willtcapplicantorfumm wilding occupant storm or handle habardous material
deBred by once Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Section 25532(a)? �y� All roofs shall be inspected prior to any roofing material being installed.
0Yes SRNO
Will the applicant dr future building mcupam use equipment dr devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h r.dous air contaminants u defncd by me Bay Area Air Quality Management all new materials for inspection.
tris?
0Ycs u
"Ove
toad tic baraNhmsmaurialtimcmucrosnu undo,Chapter 6.95 of the Califm-
niaHcalth&Safely Code.Sectims25505.25533 and 25534.1 undersand Nat ifthe Wilding
does not currently hale a cram.' at it u my ospdnsihilily ha notify the Occup.,of dc
mu' mtswhitnmustxmddrtaissa cenihmtedfOccutimmy Signature of Applicant Date
e,or aatnnnya gem D a All roof coverings to be Class"B"or better