04060166 (2) CITY OF CUPERTINO ry/' f"g.= R �g7��f�p ,,nnJ}}Ja's .y5 /'"�'1�i
BUILDING DIVISION PER 0WNTkXCT�9 *F,4jA�MA.li w
BUILDING ADDRESS: SHOWCASE KITCHENS INC PERMITNO04060166
7571 LOCKFORD CT
OWNER'S NAME: PERMIT MUEDATE
rA ' RONALD CLEMENT 12333 SARATO — YVALE Of;/1R/2n04
SANITARY NO. CONTROL NO.
E:
(408) 253-0412
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
+IOp LICENSED CONnsedunder DECLARATION■ �®
U 1 thereby affirm tele 1 am licensed under pry iaiare of Chapter 9(commencing Job DBSCflptl0 L
wiNS ,ion7sXXB of Divixion Sof the BasincssandPmfcaslom Cotic.and my liana is
� � mmB�PAanderfec` 5� KITCHEN REMODEL/SKYLIGHT UP
g? Licen less Lic.#
qq Dem Contractor
�W A CHITECrSD ON SFP 3 0 2004
eyS 7
lance and my plsm,mil he used rs p c metas
J U
3.L; License.)Pmfassionel B U I L D I N
OWNER-BUILDER DECLARATION
I hereby
afftrm
that 1 1. exempt from the Contractors License Law for the
my
zoo following mason.(Section ZI)3I.5,Business and ow,de ioas h,or:Any tiny or county
m 0 which its ims a permit to aures th L pilo,improve,demolish, fi leash any suuctum
r.Zt Priormitsissuance,auomtto the provisions
of rhe Co Permit m ElcaeLaw(Chaptecnt
Not menlicartand cingwitpursuanttotheofDiviaas 3NeComrmessandcnaLaw(Cheplor9 Sq.Ft.Floor Area Valuation
�C❑$ (commencing with Section 7")of Divixion3of the Business and Professions CnAc)ur
3..
that he is exempt u,emfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Pertain subjects Ne applicant On a civil penalty of ser Occupancy Type
not mom than Bve handled dollars(ML
❑Lasowner ofthe property,armyemploytas with wagesm theirmlecompenmdon,
will do O..,k,end theswmum is nut intended oroffered formic(Sec.70da,Business
and Professions Cods:The Connector's License Lew docs not apply he an owner of Required Inspections
property who buildsorimproves Hereon,and whodueasuchworkhimself ser through his
own employees,provided Nmauch improvements art not intended aroRered for til&if,
however,the building or improvement is sold within one year of completion,Ne owner.
harder will have the burden of proving Net he did not build ser improve for purpose of
meJ,
❑1,as Owner of the properly,am exclusively convecting with licensed contractors m
cOMMUOL the project(Sew 7044.Business and Professions Code:)The Connections Li.
come law docs not apply to an owner of property who Wilds or improves themon,and,
who contracts for each projects with a convect n(s)licensed purmenl w the Curbstone.
License Law.
❑I am exempt under Sao .B&PC far this mason
Owner Emu,
Ai6hj" WORKER'S COMPENSATION DECLARATION
I hereby,Errs unser penalty of perjury one of the following declarations _
have rad will mtain aina Certificate of Consent to self-lama for WorkeesCompen-
F[m.,as provided for by Section 3700 of the Labour Code,for the performance of aha
work for which this permit is issued.
❑I have and will maintain Worker's Compensation hammock.as leyuired by Section
37M of the Labor Cotic,for the performance of the work for which Nis permit is issued.
My Worker'aC open.tion lase nm no and Policyn mherane:
Cartier. Poliryry No.:
CE FICATEOFEXEMPTION`yGGM WORKERS'
COMPENSATION IN3SUURANCE
(Thu section need not W completed lithe permit is for one hundred dollars(SIM)
or lass.)
1 certify Nen in dee performance of On work for which this permit is issad.I shill not
employ any person in any mother an as an become subject to On Workeri Compensation
Laws of Califamia.Date
Applicant
NOTICE To APPLICANT.IL sAcr making this Certificate of Exemption,you should
become subject to,he Workers Compensation provisions or Ne Labor Code,you must
7. forthwith comply with such previsions or thin Permit shall be deemed revoked.
zO CONSTRUCTION LENDING AGENCY
[—i (hemby effort deal Nem is a commucuon lending agency far the Performance of
1:4 Ne work for which this Permit is issued(Sec.3037,Co.C.)
W�Q landees Name
z Lender's Address
U J Q I anify that 1 have mad this application and slam that the above information is
e, H comet I Bgme to comply with all city and county ordinances and mac laws misting la
0 U Wilding convection,and hereby aurborim representatives of this city to color upon the
W shove-memioned properly for inspection purposes.
(We)agree m leve,indemnify and keep harmless the City of Cuperrino against
H Iiebilhice,judgments,costs and expenses which may in any way acmue against mid City
U Z lawn quence Of thegrantingofthispennit.
^ APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: a
SOU E GULATIONS.
C6 Re-roofs
rc of ApplicanOCantreclot Dale
HAZARDOUS MATE ALS DISCLOSURE Type of Roof
Will the applicant Or futum Wilding Occupant store or hand c hmardous material
as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
Codc.Section 25532(4)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Iro
Will the aPPfieaan or future Wilding aceapant nee egwpmem or device,wroth If a roof is installed without first obtaining an inspection,I agree to remove
ha amava ler contaminants as Outland by the Bay Ama Air Quality Management all new materials for inspection.
;vice `J
❑Yea pgvu
I have mast the ha.mdousmakerials requimmerm under Chh ter 6.95 often Collor.
nuFitalO&Sa1ctyGDde.Sectioas25N)5,25533 and 25534.1 understand lhatlrWc Wilding
J of cuncndy have a lonana Na,it is my rasponihiliny m notify the eccuPann of the
m I mcntwhichmustbc priormissan racertincamofOccap Signature of Applicant Date
mor,ntharizt Stn, let All roof coverings to be Class "B"or better
_.