08020062 CITY OF CUPERTINO °�>e.�t+x7+t est o _
BUILDING DIVISION PERMIT EyIj RA.C�'�QR"�TNEO M T<TQ�V
PERMITNO.
BUILDING ADDRESS:
22126 DEAN CT KITCHENS BY MEYER 08020062
PERMIT ISSUE DATE
ER'S NAME:
ARMSTRONG, SHARON 278 CASTRO ST 03 04 2008
PHONE: SANITARY NO. CONTROL NO.
(415) 968-8318
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG EIFCT PLUMB MECH
ti00 LICENSED CONTRACOWS DECLARATION Job Description
i U 1 hereby arm that 1 am licensed under provident of Chepm
mr 9 to mencing
g
with Section]pk3)Of wd 3afdm Buunessarld Professions Code.andmylkuorus RMDL & REPLACE KITCH,BK SLDNG DR, 2 NEW
u in full force end effec
,qzp
License can
m Ltci or 2 � SKYLTS, EXTND GASLINE & BRNG ELECT TO CODE
1 W ARCHITECTS DECLARA ON
e7e I underuend my plain shall he mcJ as public msaNs
)yU
'c� Licensed Professional
OWNER-BUILDER DECLARATION
1.2 ig I hcrchy affirm Not I em exempt from Nc Convenors Licenu law far the
:08 fallowing mason.(Section 7031.5,Badness and Pmfesdum Cade:Any city or county
329 which mouims a permit an consumes,umc impmw,demalush,or repair any Rmetere
prior N ie issuance.also inquires the applicant for such permit In rile a signed summut Ft. Floor Area Valuation
that he is licensed purwanua the pmvisiov of the Contractors U.C.Law(Chspmr 9 Sq:
(commencing with Section 7000)of Division 3 of the Busi.and Profession Code)or $54271
4 mat he is exempt therefrom and Ne heals for the alleged exemption.Any violation of
Section 7071.5 by any applicant fn a permit subjects the applicanuo a civil penalty O( Number Occupancy Type
trot more Jun five hundred dollars(5500). 35709031.
V U
❑I,as owner of the property,m my employcea with wage,saNoir sole compensation,
will she the work.and theswcwre k natintended Or a@cod fame(Sce.70ta,Business Required Inspections.
and Pmressmv Cade:Th.Canmemra U—law does rot apply in an owner of
property who Milds at improves;thereon,and who dor,ouch work himselfm through his
Own employees.provided that such improvements ase not intended oroRcre l farsue.If.
however,Ne building ar Improvement m sold within ons yasr of completion.the owner-
builder NB Nw Ne MNon of proving Out he did nos MiW or improve for purpose of
❑1,as Owner of do propeny,am exclusively contracting with licensed contractors an
cautnsn the vmFn(Sec 7W.Business and Pmfesvons Code:)The Contruwrt V-
cove law docs am apply in an owner of property who builds or imProw tMnon,and,
who convects for such projects with arnnme aria)licensed paromml In the Convectors
Neve law.
❑Iamucmmunder See .BhPCrmlIdS—
Dam
WORKERS COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury one of due following declarations:
❑Ihave and will far by Section
37M of CmvemroCodc,farefmwarkeraCmnpon-
cation,ss proviticd fm by Section 7700 of Jrc laher Code,fm Jin performance of the ,
work for which this parmit is issued.
❑I have anti will munuin WarWs Compensation Ivmance,as regained by Section
3700 of Ne lather Code.for Ne performanceorthe wart for which this permit is itswd.
My Worker's Compensation Insurance artier pand Policy number are:
Cmmr.TLI r'Y In r n !f,'+fL'/t0c'VdicyNo.:D07�4U<4O%
CERTIFICATE OF MEM MON FROM WORKERS'
COMPENSATION INSURANCE
(Tait section sed mokcampkied Rahe permit Is forma hundred dollen(SIO()
Ices.)
1 cenify that in Nc per(ormuuc of the work far which this permit is issued.I Nal.1
employ any person in any manner an as m become subject to Um WorkcW Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making thus Certificate of Exemption you should
become sobjcet to Ne workers Compcnsadon provisions of Ne Lahor Code.you mum
.7. 0 forthwith comply with such provisions or this Ferrol shall M dccmW nvnkcd.
zN CONSTRUCr30N LENDING AGENCY
(-a lhemby M.Wtthem is a constrocdnn loosing agency for Jin performance of
G4
7 the work(tor which this permit Is issued(Sec.3(97.Civ.C.) -
W Q Lenders Name
D. Leaders Address
U 0 1 certify Nat 1 have mad this application and mute that the above information is
W Fcorrect.I agree to and comply with all city county aNinanas and sum laws rcbting u
U buildin(We).,son nion, ..indeyaifyand cop hareal sus of this citymcnteropen
ga tic
W above mentioned property for ivpecuou purrosees.
(We)agme m cast,indemnify and hap harmless the City of Cupertino against
Z in
fLhegran and expemv which may in any way against mid City
� l
IJz APPIL egrcace a(thc granting of this permit. Date �09s
.-t APPL ANT UNDERSTANDS ANO WILL COMPLY WITH ALL NON-POINT Issued by:
SOU RETIONS.
Re-roofs
Sig ur fnpvianucaninctor ----- f I Dam T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or forum Wilding acupantstom or handle havudov oatmeal
deRncd by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
±Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Dyes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the.,Pliantorfuture Wilding Occupant raseequipment mdevie,which
cine hoOl dans air canumimnd ss defined by the Bay Arra Air Quality Manacemces all new materials for inspection.
oisuin?
❑Yes Win
I have mad dm huvdous muerialsrequirentenes under Chapter6.95ofOmCalifo-
riaHealth WS tyCOde,S.dm2M5.75533am125534.1ondnmandthuifNe Wilding
des not currently have a moans,Nat It or my mspmnslhility u tmtil'y tic occupant of the
mqu' n hkhmmweemetp;ori.i.q .f,Cur"w � Signature of Applicant Date
—L M� — �i "r All roof coverings to be Class"B"or better
Owner&aothariud Him Dam'