08060046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAGT(3R IN.FURMATION
BUILDING ADDRESS: PERMIT NO,
21.660 FITZGERALD DR KITCHEN WORKS INC/DBA 08060046
W NER'S NAME: PERMIT ISSUE DATE
LAU BILL S AND MARILYN H 615 IRWIN ST 06/06/2008
,HONE: SANITARY NO. CONTROL NO.
ARCHf1ECrrENGINEER: BUILDING PERMIT INFO
REPLACE 5 WINDOWS LIKE FOR BLDG
O PLUMB MECH
u p 0 LICENSED CON RAC 0R'S DECLARATION Job Description
F 1 mroby of it Inst I,m 14ensed undo prouvmu of Chapter 9 mornmenring p
wiOSmdon7")ofOivion3ofroc Busincssand Profs om Code,a mylicc=13
in full to=and effas Lle.g �pB -6
LlcenSo CI
Dam Contractor
pp 7W ARCHITECTS D
C 1 understand my plans shall M used as public retards
SyU
t�t; L.iaved Prom.nal
OWNER-BUILDER DECLARATION
f 1 hemhy vRm that I am exempt from the Ci nlracmYs Leona law for do
00 following much.(Section 9DI1.5.Business and Pmlecsiom Cade:Any city or county
e SV which requires a permit to enmwct,alk,,improve.demmlmh,or mpur any structure
°zy prior b its issuance.&ISO requires the applicant(Of such permit to rile a signed statement
ss< Nnhcislicensed purmanuothe provisiamafthe Continuur'sU..Law(CNpkr9 Sq.Ft. Floor Area Valuation
EtFO (commencing with Section IWO)M Division J of the Business and Profeasiom Codc)or
y $ that he is exempt murtfrom and the basis for She alleged exampuon.Any vio"n of
Section 7031.5 by any applicant fm a parent subjects the applicant o a civil porosity of APN Number Occupancy T
not mom than five hundred damn(S500). P Y YPe
❑1,a O.vnes of Use pofperty,a my wplay=wire wages v Meir sok compenation.
will a the work,and mesuucturt u not rosined.,offered Tarsale(Sec.TOa4,Buuntss
and ProlcusI ns Code:The Courtesies L^•se Law does and apply N in Owner of Required Inspections
property who bui Ida or iroproves Bkr ren,and who does such work nimsel f m through his
own employ=,provided that such improvements ale not assumed oroQertd for ale.If,
however,the building or improvement is Sold within one year of mmpkdon,the most,
builder will have Use burdut of proving that he did Out Mdk or improve for parpoa of
ate.).
❑1,as awes of the property,am exclusively chairman,with licensed conrawors in
ComINLI
the Project(Ste.]Das.Business and Prami4am Code:)The Caatrasc es LI-
cenae law d=arm apply to an owner of property who builds or improves Norton,and,
who conrvui for such projeeta with a contncsor(s)licensed pursuant in Out Consrato's
Liames law.
O lamexemptunder See ,B&PCforthurosav
roe Dam
WORKER'S COMPENSATION DECLARATION
1 hereby&Mm under penalty,of perjury oro of the following declarations:
1 ham and will munuin aCe,tHi hm of Consent b self-insure for WorkeesCompen-
adon,a provided for by Section 7700 of the labor Cade.for Ne performance of On,
work for which this permit is issued.
❑I nave and will mainuN Wortres Compensation Imunna,as required by Section
5700 of NC labor Code.for She performeme of Ne swot for which this Permit is issued.
My Wortee,Compensation nsW.artier and Policy number art:
Carrier.of Policy No.:T5i P ION
FROM WORKERS'
COMPENSATION INSURANCE
(ITu sectim recd Out be completed if the permit is forme hundred below(5100)
or less)
I cesifv that in the Perfomunce of the work for which this Permit IS issued,)shut not
employ any person in any manner so v m become subject to do Warton,'Compcmadon
Laws of California.Dam
Applicant
Nonce TO APPLICANT:IL a(kr mating this Certificate of Exemption,you should
become subject in the Wortees Compensation provis om of the labor Code you must
.J z foMwith 10-01 with such Provisions or thu pcvnit shall be damod mocked,
z O CONSTRUCTION LENDING AGENCY
[—t 1 hereby afnrm that Nem I.,comtmctim lending agency for roc perfurmame of
lY roc wort fm which this permit is issued(Sce.3097,Civ,C.)
Qlandds Name
Z) z Lender's Address ,
U 0 1 certify that I have read LOS applicaum and suits thu Ne Shaw,informatim is
L4 Ptrench.I agree Uscomply with all city and county on inances and stale taws miming inU building construction,and hereby authorim mproanuitive,of this city in offer upon the
�W shove-mendomd property for exPea m purpose
,t 4 (We)agree to ave,indcmrdfy and keep harmless She City of Cubesino against
rn incoiosquengments,mats aMOf thisesmit. may in my way secret agunslsud City
U,z ro PLICA T of the panting of Nu Permit. v v J
'--' APPLICANT UNDERSTANDS 6ND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOUR99 REGULATIONS.
Reproofs i
gnuurt of ApphcanVConuacsir Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will not ePPliant car future building e.Chapter
orand the
hvallom material
v e Section
io roc Cupertino Municipal Code.Gapter 9.12 and du Flealth and Sa(cty
.Semon zssazt.>T 9
❑Ya o All roofs shall be inspected prior to any roofing material being installed.
Will me a liant of future building Occupant ma If a roof is installed without first obtainingan inspection,I agree to remove
PP d p co Air Quodity M=which p
�Dis�caiardnm air cmuiminanrs v efincd by the Bay Arco Air Quality Managemem all new materials for inspection.
❑Yes 19rNo
I haw mad the hvaodous materials rtquimmcnts under CluPter Q95 of meGli(or-
nuHealth&SafetyCae.Sabo,,5505,25577 Suit 25534.I undenund NuifNe building
d=retc ly hvveakeen t it u my maprrubilit,lo mdfy the Occupant of Ne
royurom nkn Ile darmiamanaar,cntirtaakaraetpyey/� Signature of Applicant Date
wmru orauNo, tgerd Dam All roof coverings to be Class'W'or better