06020146 CITY OFCUPERTINO
BUILDING DIVISION PERMIT iCO1VTRAiC,TQR;�INFORMAT UNM;
BUILDING ADDRESS: VANNI BROTHERS CONSTRUCTI NRMrr No.06020146
915 FERNGROVE DR
ER'S NAME: PERMIT ISSUE D
BOB & MARY KIRBY 914 HYDE AVE 02A724/2006
I'MNE: SANITARY NO. CONTROL NO.
(408) 253-7028
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
is 9
300 LICENSEDmetIamONTRdunderSDECLARAMON
alofCap Jp`�:Descri
1 hereby 0)d Nu 1 am f0.Bu under e!Pro as of Chapter a(commencing FF1l H T V
Z i flit Sudan of Dfvitlon]of arc Business oral ProfecnoKCode.end mylicaxie KITCHEN REMODEL G `I
Lotaanroe and eBa 53-2zv�
z liana cue, CO.. 2-
g
Dem — — TS DEC lATIONa` ��AY 0 2.2006
ARCHITECTS DECLARATION
Q 1 understand my plans Nall be ata u public rtcordt
rtes Licensed Pudicasonel '` {t{ .v
OWNER-BUILDER DECLARATION NOW
11 �����
aI 1 Maso .(firm that 11. exempt from the Contractor's o Licence law for the �{��J' tttlll l�. V VVC\\\���///Ninth
O O following naeon.(Section](131.3,Business and Professions Cade:Any say Or coumy $28000
$� which requires to construct,t a permitconstruct,dwr.hnPmwmalixhaw
,dc ,or repair any dm
u
�Ln prior to its issuance.aim require the applicant for such Permit to file utgned statement
C
that heislicensed pursuant inthe provisions ofthe Conuactor'sLiamLaw(Chapter 9 Sq.Ft. Floor Area Valuation
(cannotmingwilh S,cdon7D )o(Divtsion3afft Susineaand PmfemoMc, )or -
that be n,esempt therefrom and the bash for the alleged exemption.My violation of
Section 70315 by airy Applicant for a permit subjects the applicant to a civil pevlry,of r Occupancy Type
trot come than eve Eundrtd dollars(MM).
❑1,u owner of due property,m my employes with wages u mshr sok compensation,
willdo the work,and due structure la mulmembol mortered forale(Sec.7044.Bodnesa
and Professions Cade:The Cumin tes License Law does not apply In an Owner of Required Inspections
property who build,mimprowa theroon,and who doessuch work himulfortluough hit
Own emPloycell provided Nat such improw re es am notinanded araBued for ala If.
however.the building or impmwmmt is sold within can year of completion.the owner-
Wilda will haw tiw Woke,of proving but he did not build Or improv for purpose of
ark.).
Q 1,as owner of the property,am aclaiwly contracting with licensed contratwre m
construct the project(Sec.7014,Baines and Profaslov Cade:)The Conuader's Li-
ave law dace not apply W an owner of property who builds or improves flumen.and,
who contracts for such Project,with a contractor(s)Earned pursuant W the Cantrecmfa
License law.
❑I am esempt antler See. ,B&P C fm this won
Dem
WORKER'S COMPENSATION DECLARATION
I hereby aBimt under penalty of perjury one of the following dalantiov:
❑I hew end will msinmin aCW ftmmofCament m wlfdnsum fm WorkcraCompcn-
utiun,as provided for by Section 3700 of Ne tabor Cade.fm the performance of the
work for which this permit is utas.
1 haw and will maintain Worker's Ca pensumn Iaarance,u acquired by Suction
3700af the labor Code,for the paleamunce of the work for which this permlt is issued.
My Wmimes Compensation Insumme aria and Policy number art:
Center: €YCT:?f"' Policy No.: _
CERTIFY TEOFEXEMP 1UNFROMWORKERS'
COMPENSATION INSURANCE
fruit;seam and not W cmnplewd if due Permit Hformc hundo ddollart($1W)
of las)
1 ceNfy the,in the perf,,..O of the work for which this Permit is istwd,I dull not
cmploymyPcnoninany manne sora W become subject m the Workers'Compensation
Laws of California.
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Eumption.you should
become subject ro the Worker's Compensation provisions of the Lahr Code,you meet
Oforthwith amply with such provisions or this permit Nall be domed rewind.
Z,t► CONS RUCr10N LENDING AGENCY
[-t Ibemby Mmthet Namisaconmuctinnlendin5agcwyrorthtperformmmof
lYi> the work for which Nis permit u issued(Sec.3097,Civ.C.)
Ips 0 Lenders Name
Z Lendues Addw -
U0 1 certify out,I have mad mit application and slaw that the IWw information is
\O correct.I agree m comply with all city and county ordinances and rte laws relating M
() building commuction,and Mmby sothadre repre,enlatiws of thistly ro enter upon Ne
W ahme-mentioned proPeny for Wooden Pmp as
!C••'a (We)agree te saw,indemnify and kap harmless flue City of Cupertino against
to Ifabilides,judgmals.emu and expenses which may in my way save a Saint said City
(�7 in consequence of the goofing of this Permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C�
SOURC � TIONS
Sig _e -0
Re-roofs
ol'ApnuConumor
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant arorc or Modle has dnus material
as atoned by the Cupertino Municipal Code.Chapter 9.12.sod the Health and Safety
e,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
El yo, owe'
Will the applicant or folate Wilding mcupam eta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hilarious air canlaminants as defines by the Bay Arte Air Quality Mavgcment all new materials for inspection.
District?
❑Yet two
I have mod the hacerdtus materials requirements under Chapter 6.95 of due Califon
nla Health&SalayCode,Sodom 25505.25533 sod 25534.I understand that free,building
dors set currently haw a teen,that ft u my mepavlbility m odfy flat caupant of N,
t ocelot nts sob' y�nbemu art itaoce ora Catificaw of Occupancy.
�e �_2 u-oC Signature of Applicant Date
Owner onmhonsd agent grow All roof coverings to be Class"B"Or better