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CITY OF CUPERTINO/'�t�[!�wx.ra•�'aB.',Fxa'"m�
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BUILDING Division PERMIT
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BUILT ING AOD ESS:
).1590 F:CTZGERALD DR
SARATOGA KITCHEN & BATH
PERMIT NO.
08070152
NEWS NAME:
PERMIT ISSUE DATE
DICKMAN LLOYD I TRUSTEE & ET
140 LEWIS RD. #10
07/22/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)281-9250
ARCHDEC IENOWEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1beemb, son.ion700)of WIIam 1f under esof Chap.9(mmmcrcing
Job Description
the Bu promo
with Section 7gkB a(Oividon 3ofWBudev ad Prafrsdav Code.Wmyliccau
KTCH&FAMRM RMDL& UPGRD SVC PANL; KITCH RMD TO
ercm
g 3 Q
L".. Lfe.g
INCLD LIGHTNG, PLMB, ELCT&APPLNCS "
SARATOGA KITCHEN & ]3ATH RENEWED BSL 7/22/8
De¢ 7 o Comrwtor Swrw a
ARCHRECI'S DECLARATION �; „�
1 undersunJ my plain shill be used a public munoNs .S
$110.00
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Licensed Intensional
OWNER -BUILDER DECLARATION
I thereby affien that I M mourin from dM Commutes License Law for the
following mason. (Section 71131.5, Busies ad Profosions Code: Any City Or county
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which nocuous a permit an condroe, abet,, imprrw, dcmolmn, or miser any swctum
prior to its issuance, also tequims W applicant forsuch Permit o rile a signed stamm.m
doss h.iilianaad pursuant to W Provisions of the Contmctor's Lima Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of W Business and Professions Code) e
$80000
that he is etemp thacfrom and the War is f. W alleged eaempdcan. My NWatian of
Sttdon 70313 by any applianl for a Permit subjcesta W appecvtt to a civil Purely ofNumber
Occupancy Type
tel more than 0w bandred dollan(SIM
32647008 .'Cl7'
Pane Y
Q 1, u owhnr o(th popcdy, a my wplayw with wages u Wir sole compensation,
will de W work. and the awttum is not intended or offered for safe (Sec. 7066. Businems
and Pmftmic s Cod. TM Contractors Liana Law docs at apply to so owner a
Required Inspections
Property who builds Or improv th.mn, and who dot such work himself or through his
awn employee, Invested WI went imprommeats art not intended oroRered for sale If,
burrower. the building or'unpo.t is aid within arc year of ampledw, W ower.
builder will haw tin burden of favine the he did not build or impmee for Iuryose of
.to.).
1, as ower ar the Property, w acludveky contracting with Bcead conuwtes in
-
coalro of W project (Sec. 7066. Business and Professions Code:) The Contrsemh U.
cca Law does not apply to w owner of property who builds or improve W mom ad,
who comescu for such projects vied a contractole licensed passe to to Contractors
Licensetaw.
❑ Tamaempunder See ,BdPCfrethisreaa
Dose
WORKER'S COMPENSATION DECLARATION
I hueby earn under peWty of perjury ane of W fallowing deck.atirecc
❑ 1 num and will • ofCoant toCmie.fum for Wrforms Competee
aeon, a provided (e tion 337M
for by of the labor Code, Ire W perfamena of the
mi is isa el]00
wort fe which this Permit is issued.
'
❑ i ham and will mtinuin Worker, Compensation I.. as rmquimd by Session
3]W of du Labor Code, for W pdom m. offt wort for which this permit is imund
a Imre.q ani. ad Policy ber art:
My Workers Compematipp�
Carver: S,- /IAt/' IJLt.OL MJ Poliry No.: um1 27 II
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This wooden hound mmW completed lithe Permit b, feoe hundred dollar (SIOD)
or fess)
I Cedfw the, in the pesfomanco of the were for which Nu Permit is i.ued I still mm
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crnpley any Pursue In my matter a. in Women subject in Un Warkea' Courpewation
Laws of California. Date
Applianl
NOTICE TO APPLICANT: It. after making this Certificate of Eaemplion, you should
become subject to the Worker's Compensation provl,ireu N the labse Code, you mut
forthwith comply with such Provisions. this peed"I de deemed mvok.d
CONSfRUCnON LENDING AGENCY
1 hereby afOm that Nem u. construction lending agency for the perfammme of
the wort for which this Permit Is issued (See. 3.397, Civ, C.)
Lenders Name
'
Lenders Address
I every that I have mad this st,liwion and arm that the abow inforea ser is
Came. l agree 0 comply with all city ad county ordinances "some laws relating te
Wilding conaroction, and hereby radion. reprasenudses of thiscity to mtcrupon the
+how-mentioed pmpeny for inspection purposes
(We) agree to ind
are. ounify ad kap hamkss the City of Cup.num agtinst
lietilities,judgmcnu, cow ad gape•^n which may In any way accnn against aid City
of this peels
A usequAPPLICANT
of that UNDERSTANDS
APPLICANT UNDERSTANDS A D WILLCOMPLY WITH'2NON-POINT
Issued by:SMDate Z
%2/a
Re -roofs
Type of Roof
Shgnunre of AppOonrConranor + Dm
HAZARDOUS MATERIALS DISCLOSURE
Will the aPpli.,. future building ouvPat seem rehoundle Mande. matoriai
as defend by the Cupcnien Municipal Cade. Chapter 9.12, send the Health and Safety
orSection 25532(a)7 baa
All roofs shall be inspected prior to any roofing material being installed.
Will W a re future building a devices which
ea
If a roof is installed without first obtainingan inspection, I agree to remove
P� g
r coati
emll onsairemtaminsnn.defined byWBry Area Air Quality Management
by de, B A Aer Qua
all new materials for inspection.
Distinct? u
❑Yes C�Nu
I haw read W husea ons m durbesnequiremenu undcrL7upur6.95 of t o Califor-
nia Hal"S90yCodc, Scct.0 25505,25533 and 25534.1 undentwtl rhaliftn building
does not currently now a senOOOL WI it is my mspemibilily to unity rix oeeupanl of W
mgdmme whianm tit mea Of aurtirnu,or;P ptSy�
Signature of Applicant Date
7 Z/
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All roof coverings to be Class in"
g or better
s Dan � �
own.. wthari>ad, .m