05110068 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: HOME PROS PERMrr NO.05110068
1022 KENMORE CT
ER'S NAME: PERMIT ISSUE DATE
GEORGE MCLEOD 245 E LAS PALMAS.
P ONE: SANITARY NO. CONTROL NO.
(510) 440-1609
ARCH(TEC(ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 t�
30 p LICENSED CONTRACTOR'S DECLARATION Job DesC
F 1 hereby 1 of that 1 w of
Bu under And
Rai ata o Cade. 9(my rices is ��
yj with Section7001iofDivWan3of the BuanwaM Pra(cuih.code.am mYlicenmt,
n� inrhllrarenaneerc KITCHEN REMODEL
FN
ig� LicertmCl -@.i� Lie.» �s�y36. [`
Dam ARCHITECTS ECmIARATION FES
I understand my plana shall W used u public reaorw
P
Licensed Pm(esaianal ��
OWNER-BUILDER ameDER DECORATION _
C 7i 1 hereby.(Pato on 1 at. wain Ism Pr Contractors e:Any Law for tite
0 o following matan.(Station 71D IA,Buanw and Profesmam Cade:Any illy or county rV 2 0 0 0
which enquires a permit W cawh4 alter,improve,demolish..repair any-,,a..
-='y^ priorAtitsissuance,alsoacquiresweApplicatorforfuehpermitWRle&signed=semen, W lu_`ation
< Net he islicensed Forecast bthe provisioNofthe CommcWr',LiccueLaw(Chapmr9 Sq.Ft. Floor Area
k�0 (Commanding with SeNDn 70DO)of Division y of the Business ad Profwiana Cade)or
i $ this W Is m.npt therefrom and the hull for the staged eaemptiw Any violation of
Scotia 703I.5 by airy applicant far a permit subjects the applicart to a dvil penalty ofOccupancy Type
an,mart Nm R.waited dolWa(SM
0 1•u^sones(tM pmperty,ter my employes with wCu u dcG mlecompewd^^,
will do wewoalL and the stmmu,t,mlintandcd ora(rued 1-11210(SCC-7044.BLWAAU Required Inspections
and PmlCmiana de:coTho C^n..el UJe Law does Am apply W an owner of q P
property who bWIW orimproves tiutrmn,and wh^dmauch vert Mmadr.thmughbis
awn employees,provided this such Improvement,tie not landed mortared for Ask.I(.
however.the building or improvement is mid within one car of cm^pletim,the wnm-
builder MB ave the Waden of parting tat W did rot how or imp—far puryme of
ale.).
❑1.u..,of the property.am eaclusvely cormsakg with Ilanaed mmw.sore W
mnatrud an project(sec.7044.Bnainw sten Pmfeaaana Cade:)The CmhmWr's Li-
mere law does And Apply m An ow.r or pmpwy,M Wfloa or Wprnas dmmen,son.
wha m nswat for such projects whh amwasam(s)licensed pumuant W the Crntrataes
License law.
Q l ort eampt miler Sm .B A P C for at.resam
Date
WORKERS COMPENSATION DECLARATION
I hereby artme under penalty of perjury arc of the following dmWad^w
0 1 haw and will maintain aCeati(kxta a(C.t,em W self-Iwo^fa Woraces Compan-
mdi As provided for by Section 7700 M f Labor Cede.for the Performance of that
work for which Nis permit is issued
❑1 haw ad will maintain Walkes Compensation laarraam,u mgsred by Section
37M of the TaborCode,for the peRanamamfele work for which this permit is Wend '
My Worka's Compensation bust ance Cartier aim Policy number are: _
Cartier. Palmy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
ICOMFINTION WSURANCE(Tilt,semistoad the peamtt,(.aahudreda0en(5100)orkas)
I certify Wt in me PedTor hich this Permit t,W 1 mallnemploy my person in wbjeclw=
Iowa of Califomi
AppB4 F4
NOTICSCE TO APP CA f•ager making this CeniRam of Exemption,you should
become subject tha Whalers Compenaadoto provisions of thc lab.Coda.you mw
Oforthwith comply with each pmvttlona.this Permit mall be deemed remiacd.
s� CONSTRUCTION LENDING AGENCY
f'+ IWroby.from that them is a mnwtctinn lending agency ren dm paaf.mnwe of
fL> the were(a which this permit Is island(Sec.3197,Civ.C.)
fW E Landers Name
z lenders Addrw
U 0 1 cutify that 1 have read this application aced ern dal the above inrartatia is
camtt 1 aper m amply with all dry and county Ordinances ate mW laws ne uing W '
Q SU' building construction•aim thereby Authorize mpmunutives of this city W cmcr upon We
k�t77 slave-mentioned Property for impaction Purposes
I y (alc)acme to sew,i aiIy ad lecp humku th City of Cupertino agsw
rr rA liabilities.judgment,,caw a soh 'a my
way anme agsw mid City
CJ z in eonseque.m Of the g n I .a
^^ APPLICANT UND AND ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU
ft Re-roofs
Slgwum
N
afA IieanVC Zow e
A2ARDOus MATERIALS DISCLOSURE Type of Roof
Will oApplicant.forum building occupantaom orandle hamrdaw material
"An by Ne Cupertino Mumeipal ,Chapter 9.12.aim the HWa ad Safety
section u55T a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
WIII the applicant ter Tut building occupant use equipment or Jerlw Mich If a roof is insta d without first obtaining an inspection,I agree to remove
Amit havrdaus air cmWninan ocd by that Bay Arts Air Quality ManaCCmcm all new mat • 1 inspection.
District?
❑Ya
I have roadwehaaNa mam4aismquimmmmunderCapmr6.96ofthe Cdifor-
.I&HmlthkSafdy Codc.Sacdmw2SSo5.25573i"5}I.iundcr=A ml(thc building
deal rot cmmmly haw a¢runs.that It a my responsibility W mth'y the uccupmt of dm
mquiremcnu which moa Wmet prior W Wham of a Cndllam of Occupancy. Si t ppiicant Date
All roof coverings to be Class"B"or better
Owner or Authorized agent race