06080109 CTTY OF CUPERTINOa e+as• a '*"''R' ' {• "` """''� ''
BUILDING DIVISION PERNUT COAI-TRAC'"T61R`TNT'O�tMt1. r ;N,
a Pxi3�3v�`m"'?YN+,»�'A. ;•.�*a$t'Si:Yet FAa sa"i. kms.
BUILDINGADDRESS: CUPERTINO KITCHEN DESIGNS P...... 0.06080109
11093 FIRE7HORNF DR
R'S NAME: PERMIT ISSUE DATE
(r MITCHELL JAMES A AND EILEE9 A10562 S D
1 NNE: SANITARY Nil. CONTROL NO,
(408) 257-4900
ARCHITECrIENGINEER: BLDG ELECT
BUPERM"INFO
CT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION Job Description
i u 1 bunny afford Nal I sed licensed under provisions of Chapter 9(commencing P
with Section 7000)of DivWan 3 of the Bud.and�Pyrofessions Code,and my license u
„ efullfe, soden G�(�y(� REMODEL SFDWL KITCHEN. NEW WINDOW FOR KITCHEN I
sUiZ Lave Cl Lic.R
Dam cmtractar EXISTING OPENING.
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
fyU
C Licensed Professional
w OWNER.BUILDER DECLARATION
I bunchy aRrm Net I am exempt form we Contractor',License Law for the
o o fallowing myon.(Section 703I.5,Business and Pmfesamm,Cade:Any city or county
f$ which requlref a permit w enmuum,alta.improve,demrdLvh,or repair my atorctum
prior bIts Woome.Wurequires the applicant for such Permit efile aslimedl emcnm Valu$1iDis000
e G that he is licensed pursuant wthe provisions orLive ConuacwfsLicenseLaw(ChaPter9 Sq.Ft.Floor Area
S $ (commencing with Section 7000)of Division 3 of tie Business ars Pmrcssions 0,k)or
that ha us exempt fMmfmm and Nr Nn e basis four alleged exemption.Any violation of
Section 70313 by any applicant for a permit subjects the applicant m a civil penalty of APN Number - Occupancy Type
not mom than five hundred dollen($5001. 32345056 . 0 0
p 1,u owner of the property.or my wployces with wages as deir able compcmdon,
andda the work.anile TheCmusanlmLicense awdooffamod snotRt salm yc.7014,BaLKef Required Inspections
pm profession Code:The Cantuemef Llanho Law see not apply lf an same is q P
amemployees.
who s.ildsaimpewsch improvements
ve ets tr esamb workbimsalfv Waugh bat
howemPloyeWildin for thathapr ver imProwmanu in orm c emwN moQemG forMe Owner.
however,the building or MProwmantg sold within ane yes of mpromfor Ne owner.
Wilder wIB have the burden ar proving Nat he did not build ar improve for purpose of
aale.I.
Q 1,as comer of the property,am exclusively contracting with licensed anbactma to
anstmct tha project(See.7014.Business and Pmfaslav Code)The Coouaem's Li-
inose low does not apply In an owner or proems who Wilds or wwu W me W mon,and
who moment for such projects vnNaantracmr(t)0aved pumwammNe Conuctotf Q >
Lana dmo
❑lam aempm undo See .BhPC fo Nia woo
Dam
/ WORKER'S COMPENSATION DECLARATION
SII hereby of inn under penalty of perjury ons of the fallowing decsratiomx
CI IhaveandwillmainsinaCe riimmof CavcnlmaelRlnsumfo WorLe sCompere
satlen.m provided for by Secdon 3700 of Na Us, r Code.far Ne pnoldru umecof Nc
work far which NuPermitPnit is issued.
0 1 have and will maintain Worker's Compensation Inmrana,as required by Section
3700 of the Usher Code,for Ne performance of the work for which NU permit is hound.
My Warkeei Compensation Inmance carrier and Policy num r aro:_ V O
cards � ` Policy No.:
CERTIFl ATEOFEXEMFTIONFROMWORKEIIS•
COMPENSATION INSURANCE
nous action need ant ho completed If de permit s foam hum mddoOm($100)
car Less)
I Mot Net in the performance of 0e work for which this permit is Wood.I shall not
employ any person in any Warner an as In became subject to the Workeri Compensation
Laws of California.Dow
Applicant
NOTICE TO APPLICANT:If.after making abs omillcow of Exemption,you should
become subject to the Worked Compevafen provisions,of We Lahr Coda,you most
.,O forthwith comply with such previsions or this permit shall be domed revoked.
Z CONSTRUCTION LENDING AGENCY
[—m4 I hereby affirm was Nem lea cosmmctims lending agency for Oce Performance of
Ll.> the work for which this permit Is issmd(Sec.3097,Cly.C.)
QLattices Name
.7. z Lcndees Addw
V Q I certify Nat I have mad this application and stave Nat Ne shove inrmmatiun Is
U, correct.I agree to comply with HI city and county ordinances and mw laws misting to.
QU building consuuction.and hereby aumhorim mpresentatim of this city to enter upon the
r Ll1 ahmomentioned property for inspection puryom.
(We)agree to saw,indemnify and keep harmless W City of Cupenino against
Fy Iiabinties.judgmenls.=osu and expenses which may in my way amus lsalnstsaid City
U vz in can" e grantiM��
/ 491
.. APPLICA U ERSTAITH ALL NONPOINT Issued by: Date
SOURC
Re-roofs
Slgnu l'ApplicattlO uacmr f Dow
HAZARDOUS MATE IAIS DISCLOSURE Type of Roof
Will the applictnt or future Wilding arupommore or handle haramous mawrtal
and by Ne Cupatno Municipal Cade.Chapter 9.12,and the Ha1N and Safety
smtim zss32(a)7 All roofs shall be inspected prior to any roofing material being installed.
C3 Y.
Will the applicant or future banding Occupant use equipment or devices which If a roof IS installed without first obtaining an inspection,I agree to remove
W'
rill W,.mdnux air contaminator as defined by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have road the hvarNws rdaeriausrequirements under Chap n,6.95 Of the CHifnr
niceialN sty o .Sccdav25S05.25533am125534.1mdmsmndthuirdw Wilding
docs not not aw a nant, I us my mspovihllllY m antil'y Ne amPanm of the
mqul or me r a encnirw.eer /' Signature of Applicant Date
G7z u sumeriraaap=cat pfa All roof coverings to be Class"B"or better