08010092 CITY OF CUPERTINO
BUILDING DIVISION
PERMIT G�OIYTt2AI. C1R.x1 �Q', M.t�T7(J!�. .� :
BMIT NO.
mLDJyLc c14$FS DR CUPERTINO KITCHEN DESIGNS P�08010092
OWNElR'SS NAME:
PERMITISSUEDATE
BRIAN & BETH BARRY 10562 S DE ANZA BLVD 01/15/2008
NE: - SANITARY NO. CONTROL NO.
ARCHITECrfENGINEER: BUILDING PERMIT INFO
KITCHEN REMODEL, 265SQ BLDG ELECT PLUMB MECH
o LICENSED CONTRACTOR'S DECLARATION
m0 JobDescri tion
rd 1 hereby affirm Nal 1 am of the
Bu under and
Profession,
of Chapter 9(commencing l7
with Share. ad affect.Divislon3ofdm BuvnmswdProfa®ism Codc,and my license ia.
^M s in full force and effect 'j,
j�4 Data Is Lim.
�q
Data can.'-
eSO7W CHf1ECTS DECLARATION
y U I nand my plans shall he used u Public records Pet
g tsd�a Licensed Professional
's S OWNER-BUILDER DECLARATION
Con cls
COO hmean .(Seco mal I am.Bumpe from he Cashom, o :My c Law for my
COO O which mo muoa(Section 7(01.7.Business and ow.de ons Cade:Any city or county
�a which ouquiru•permit a cores the alcor,nt ansa,demolish,,or repair any to umum
N pas,
pow mits issuance.also requires the Oovisios of rorsuchme Contractor's
pormisu fensele gwdstatemont
< that be isliecnsedp rmset ampmvisiomaftheConwcur'sLce se Law(ChaPur9 Sq.Ft.Floor Area Valuation
$ (commencing with Societe 7000)of Division 7 of the Business and Profmsitens Code)or
NO
.. Nat he is amours tomorrow,and the basis for the alleged examples.Any violation of
Section 7071.5 by any applicant for a permit mbjecm Its applican.to a civil penally of APN Number - Occupancy Type
not mon this five hundred dollars(5500).
0 1,as owner of the property.ar my employees with"gnu their wen compensation,
will do thewak and the scomue is wllmendeder ORtmd formic(Sec.70/4,BWIMd1 Required Inspections
and Pmfeanion r Code The COnmcues Liam Law does not apply u an ownnser of q p
property who builds or i mproves diseases.and who does such work himself car through his
awnemploymes,provided that such Improvements are not Intended oroRered forule.if.
however.the building or improvement tswld within ane year of cmnpledon.the ewmr-
builder ,MB lave Ne burden of proving Nat he did not build or improve for purpose of
i uuJ.
0 1,as an=of the propMy am exclusively cenvwning with licensed contracun u -
construct Ne projep(Sac.7044.Business and Profossiom Code:)The Conoacur's U. '
come law dam not apply to in owner of property who builds or impmvas absence,and, -
who contracts four each projects with aconvactor(s)licensed pursuant m are Convector's -Lk-me Law.
0 l con eareps under Sea .B k P C for this moon
Owner Data
WORKERS COMPENSATION DECLARATION
oaI hereby arum under penalty of perjury oro of tiro W
following daclmom:
have and will maintain a CerdOaw of C wni a wlf-Insum forwwk escompen-
n.u provide0 far by Section 7700 of the Debar Code.for the Performanceof the
work for which this Permit is ivacd.
0 I have andrwill maintain Worker's Compensation Insurance,as required by Section
3700ofthe labor Coda to,the purformwceef the work for which thispennit is luded, '
My Wor an�psen—talon lnwramm cartiand Policy numberam: b�A
my` � at.r.4 Policy No.:
CERTIFICATE O EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This soman med not becompleted if the permit isforanc hundred dollen($100)
or less.)
1 certify that in the performance of the work for which thin permit is issued.I shall not
employ any person in my mannerw as in became subject to the Worlmrs'Comp mentor n
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cer incase of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Labor Cade,you must
vJ O forthwith comply with wen provisions or this permit shall be doomed revoked.
CONSTRUCTION LENDING AGENCY
[—b 1 hereby alTvou Nat Nen its comuectinr lending agency for the performance of
Cv> the work for which We permit is issued(Sec.3097,Civ.C.)
W QLunches Krone ,
0 z sander's Address
U 0 1 certify that 1 have read this application and sum that the above information is
kr!' correct.1 agme in comply with all city and county Ordinances and state laws missing to
_0 SC^J building cenawction,wtl hereby authorim mpremnutiva of this city m enter upon the
W ahovmmentioned PmperlY fur inspection purpuee, -
D. (Wc)agme a cove,indemnify rod keep hnceleu the City of Cupertino against _
CM Iimilitice.judgments.costs and expenses which may in nay way acorac against mid City
O z to consrquewe of the gaming of this permit. �I'�
APPLICANT UNDERSTANDS D W COMPLY WITH ALL NON-POINT Issuedb y: Date —/J —b d?
SOURCE. ULATIO B. _
A /���i� Re-roofs
Sb'�n of Appli.X a 'Date
N DOUS MATERIALS DISCLOSURE Type of Roof
Will the appliam car futaw building occupantnom ormndle harandow armorial
as de0no0 by the Cupertino Municipal Code.Chapter 9.12.end the Hona,and Safely
Code,Scotian 25532(a)?
❑Yos All roofs shall be inspected prior to any roofing material being installed.
0
Will the applicant or futon building Occupant naw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hardens air contaminants as defined by the Bay Ama Air Quality Management all new materials for inspection.
❑Ya u
I have mad the hamrduux materials requirements under Chapter 6.95 of the Califor-
niaHalth&Safety Codc.Sccaam255D5,25533w n534.1und mdthalfthc building
dem Trot curtenaY w a tenwL that it u my respomiMlisy u notify the ocouput of the
requimmenu whi mmtln met or le a cedrieamof Ocap Signature of Applicant Date
l OY All roof coverings to be Class"B"or better
Owncror au mind agent Dam'