04020105 CITY OF CUPERTINO11 5•r�al
BUILDING DIVISION PERMIT dCONTRACTDRINIa,QRMATION"e� ,
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PE ""0' 4020105
O10151 71TRWOOD GR
WNEWS NAME: PERMIT ISSUE DATE
E:
SANITARY CONTROL NO.
ARCHITECIyENGINEER: BUILDING PERMIT INFO
BLDG EIECT 0
PLUMB MECH
0 0 0
LOo LICENSED CONTRACTOR'S DECLARATION
w I hereby affirm Nat I am licensed under provisions of Chapter 9(commencing Job Description
-< with Section llR "Division Sof NC Businessand Profcssiou Code.and my license is ®�
in full force and efrttl
$'q_ Lfullto tau L .x �3 BATHROOM REMODEL (MS . & HALL)
Z-p Dole r.2 r>h Contrulor CJf'f-R�N_ 0 6j�
al- rsuin ARCNITECTS usedasrecordsCLARATION DtGlsr MAY 2 6 100q
1 undcnJ my plans shell W used u public records
0yU
iLL Licensed Profcuianal
05 OWNER-BUILDER DECLARATION
1 hereby rm I�D�gtl
Thal 1 am exempt from the Comment's License Law for the p�
a o affi
rollowing (Section 703 1.5,Business and Professions Code:Any city or county
Sic! which inquires artnsnn.permit to comlrocL eller.improve,demolish,or repair any slmctura
pd.,to its issuance.alsu mquiru Neapplicanl for such Femnit to flea signed summcnr
Bw he is licensed pursuant to We previsions of the Canl icles's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 of the Business and Professions Cade)m
C. that he is exempt therefrom and Ne basis for Ne alleged exemption.Any violation of A.�7vq7��,.,.g�
Section 7031.5 by any,applicant for l permit subjects We applicant to l Civil porosity of 342'a.3`3`l9sLaay'e�0 Occupancy Type
not mom than Eve hundred dollars(5500). r2.3 3`l9`L��'
0 1,as owxr of the Property,on my employees with wages as Beer to corepense0on.
will do We work and We structure is not intended or ofercd fonale(Sec.7W Business
and Professions Cods:The Contractor's License law dee,net apply to an owner of Required Inspections
property who Wilds or improves thereon,and who doessuch work himself"nough his
man employcu,provided Out such impmvemants are not intended orCRcred forsale.If.
however.We building or improvement is sold within one year of Completion.the owner.
builder will have We burden of proving Nn he did not Wild or improve for purpose of
sale.).
0 1,as owner of Our property,am exelwively contracting with licensed Contractors to
contract the project(Sec,70aa,Business and Profusions Code:)The Contractors U.
curse law does not apply in an owner of propeny who Wilds or improm thereon.and.
who contracts for such projects with a eonmector(s)licensed pursuant to Ne Contractors
License La-
0 l am c.mpt under Scc ,B k P C for this mason
Owner Dale
p1WORKERS COMPENSATION DECLA0.ATION
1 hereby ammt under penalty of pstb ry one of the fallowing dwlarations:
ban end will maintain a Certificate of Continua to self-insure for W rrkeraCompca-
cadon,as provided for by Section 3700 of on,labor Code.far We performance of the
work for which this permit is issued.
M'1 ban and will maintain Worker's Compcnsadon Insuranes,as"dimd by Section
37W of the labor Code,for We performanw of the work for which Nis permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carder. 5IL4— TUTJP PoOeyNO.:0000.}}D-2eD3
C RTIFICATEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection wed not he complied if the Permit is rmow hundred dollars(SIM)
or to .)
1 certify Nat in We performance of the work for which Nis Permit is issued,I shall out
employ any person in any ma tuners i as to become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenibca¢or Exemption,you should
become subject m the Worker's Compensation previsions of Oc labor Code,yon must
.J O forthwith comply with such provisions or this Permit shall he deemed mvoked.
Z h. CONSTRUCTION TENDING AGENCY s
'e. I hereby afrOm Net Note is a construction lending agency far We perfmmance or
(Yi 7 the work fur which this permit is Wood(Sec.3099,Ci,C.)
I31 Isnder's Name
C Under',Addn•_cs
�z
U Q 1 terrify Nu 1 ban read this application and ser¢Nat the above information u
U. F corttl.I agree to comply with all city and county oNinanas and suite laws relating to
0U building construction,and hereby suNods¢preentatim of Nis city to enter upon the
r W above-mentioned progeny for inspection purposes.
(We).,me m save,indemnify and keep harmless the City of Ca,mne against /
F'h Iiobili0u.jodgmcnui,costs and cxpc.which may in any way act.against said City r
U Z PC f this
APLINUNERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �(a Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppliuDam
HAZARDOUS
S MATERIAupa DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant nom or handlem
aous material
as defined m We Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.SCOBen 25532(')?
❑ins `014. All roofs shall be inspected prior to any roofing material being installed.
Will We applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
7d�
havardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
rict?O Yes1 ban mad Ne bamm�us materials mquirementeuneratupto,6.95 or Ne[alifor-
Health k Safetyco le,Secdons25AM5,25533 and2553a.[understand Nuifthe Wilding
not currently ban a tenam,Nat it is my rnapmmihility to nudity the acupanl of Ne
trire nm which must be me w issuance Ora Ccmfcate of Occupancy. Signature of Applicant Date
o> rYeonva � � aa... ) De All roof coverings to be Class"B" or better