04010108CITY OF CUPERTINO
BUILDING DIVISION PERMIT
�xCO1V'CR`ACTOk*FOR, MATIQN, e
BUILDING ADDRESS:
jinn PT D42RORD DR
SARATOGA KITCHEN & BATH
PER ""04010108
NERS NAME:
PERMIT ISSUE DATE
NE:
SANITARY NO, CONTROL NO,
ARCHITECTIENOINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hoot, AM. Net 1 am licensed uadc, proionvisof Caere, 9 (commcncln{
p
with Section 70110 of Division 3 of the Business and Professions Code, ad my license is
in full force and arta -�T�
KITCHEN & BAHTROOM
L;tenlpfl , t.e!n?.3,lU
,REMODEL
Date Comraclo
I understand my p �� u �•
Licenced Professional
OWNER -BUILDER DECLARATION
I hereby affirm Nm I em exempt from Ne Contractors License Lew for the
following reason (Section 703 1.5, Business and Pwfossiom Code: Any city or county
which requires a Permit to Construct. alum, Improve, MORoEsh, or repair any structure
pilaf to its iSaNM, also gains the applicant for such Permit to file a signed Ann car
thatheisliccnudpurmanttothepmvisiomofftContnetor,LittnuLaw(Chap¢r9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professinm Com) o
Nat he h exempt therefrm oand Ito basis for tiro alleged exemption. Any violation a?
Section 7031.5 by any applicentfor a Permit subjects the applicant to•Civil penalty dV
s
,e.,g,
W��bQ
Occupancy
p y Type
m
MI an door rive bandmd dollars ($500).{/,
I
❑I, as owner of the property, or my employees with wages u their ank Campo.a�Iron,
r �/ '• Required Inspections
`J
will do the work and Neawnurtis not insended aro@red fatale (Sec. 7041, Buglmu
and Prefesvions Cade: The Conuactmi Lknve Law dors not apply to an awar of.
property who Wilcisor improves thermn,and whadoesesch work himulfar NntItiht,
awn employem.provlded that such Improvements An, not l0undfAmoRercd far ule.lf.
however, Ne building or impwment is sold within one year Clean [oil n,paowner
builder will have Ne burden of proving Nu rte did not Wild or imp raw for spau of
\/
Asia
❑ 1, a owner of Jc property, am exclusively communing with licensed contractors to
construct the project (sec. 7044, Business and Professions Cade) The Commences Ll.
Cram Law does not apply to an owner of property who Wilds or impoma themon, and,
who convaet for such projects with a eonmctar(s) licenced pursuant to the Commerce,
Licalaw.
❑ I am exempt under Sm. B & P C for Nis.mon
\�
ter Data
WORKER'S COMPENSATION DECLARATION
I hereby An. under penalty, of p do, one or the following declarations:
❑ I have and will maintain a Certificate of Consent to sel6ltnum for Workers Compen-
mtion, As prnrided for by Sestion 3700 of the labor Cade. for be performance of the
wwk for which this Permit is issued.
1I have And will maintain Workers Compensation Insurance, as required by Section
700of Ne Labor Code, for the performance of Its, work for which this pooh;. Issued.
My Werke Came auom Iunnce cartier and PaltryCnu�m,bor art:
1QBePF.3'lfi1.
Carver. No,yf
CE IFICATE OF E%EMFri FROM WORKERS'
COMPENSATION INSURANCE
mol section need trot hecompleted if tic Permit;s (mane hundred dollars (SIM)
or leu)
1 ecrtify that in the performance of the work for which thin permit i, issued, I shall not
employ any person in any manonr ALL As w become subject to the Woro m' Corepenmtion
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject to Ne Worker's Compensation provisions of the Labor Cade, you must
forthwith comply with Such Provisions Or Nis Permit shall In deemed molted.
CONSTRUCTION LENDING AGENCY
I hereby affirm that Thera lar co^atoNnn lending agency for the performance of
the .,it fur which Nis permit B issued (Sm. 3097, Civ. C.)
Lender's Name
lenders Address
I certify that 1 have read this application eM sum that the above information is
Ila
cornet. ) agree to comply with all city and county pmdlnanees and slat laws orating 19
Wilding comuuction. and hereby anNome representative, of this city to enter upon tin
above-reentiura d Property for impecuon purlwea.
(We) eCme to save. indemnify and keep harmless the City of Cupertino again
liabilities, judgment, coats and expenses which may in any way accrue against mid City
in consexp enc^ of the granting of this permit.
APPLICANT UNDERSTANDS Aa WILL C MPLY WITH ALL NON -POINT
Issued by: Date
/6 -
SOURCER ATIONS /
a
All //
Re -roofs
Signa itXVNiplii5taX'er Loatc Dat
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
will tho applicant ser foot bellding occupant stem or hendk han,dous metrial
As de0ned by the Cupertino Municipal Code, Chapter 9.12, and IW Health and Safety
otic, Section 255324)?
All roofs shall be inspected to any roofing material being installed.
❑Yes -Qm—
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will Me applicant or future building omWant use equipmentor devices which
emitnus air
all new materials for inspection.
District?
District?
❑Yes yabl
wv
In.. read Ne hammms metrial, requirements under Chapter 6.95 of the Califor-
iia Health &Safety Coda. Sacdum 255(15, 25533 and 25534.1 unwmwd thatlf0e Wilding
dean net currently haw a t ane the, it t my nsponsibility w notify the mmmon of the
^me
nyuirtme hk:mn w i�of a Cmusnateof Occo anry.
a%%y�2
SignatureofApplicant Date
m7('
T3e4
All roof coverings to be Class "B" or better
Ower m ewbo J ag�cnl�