05120144 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTtRA 'I'MINE(
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BUILDING ADDRESS: BATHROOMS BY REMODELING PERMITNo.05120144
1094 MILKY WY
S NAME:
ER'jjPERMIT ISIE IDATE
MATHEW MANOJ 1422 SARATOGA AVE 12/23/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 378-6700
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o LICENSED CONTRACTORS der provisions,DECLARATION Job Descri tion
i hemby a(frm Nat 1 am Ilcemed underndPcof chapter 9(commencing P
with Sectiom? t iofDivialan 3.f The BminemandPro(caainm Code,end my license Is
a� bmBmmeand0 p�3 REPLACE KITCHEN FIXTURES AND DO GRANITE TOP AND
n z D�knrc Clm[ Conurcbr
:.1 CABINETRY, UPGRADE SERVICE PANEL
? ARCHITECT'S LAR-ATIGN
I
i I undcnund my Plans[htll M used m public m.mils
;6
y cad�
Licensed Professiansl
5OWNER.BUDER DECLARATION
f I hereby eflirm ILNal I em exempt from the Convenor's license Law for the
O O following maann.(Second 71st I3,Business and Profusions Cade:Any city or county
$ which mquirea a Permit to construct,after.improve,demolish,or rtryir my muctum
—ZY prior an its imYlrcC,also mquitu the applicant fofmch Permit in file a signed statement
< Nm he is licensed pursuant to do provisions of the Contractor's License Law(chapter 9 Sq.Ft.Floor Area Vater i6®698
Cz$ (commencing with Section 7000)of Division 7 of the Business and Professions Code)or
3.. Net he is exempt Nemfrom and the bob for the alleged exemption.Any violaJon of
Section 7011.5 by any applicant for a permit subjects,the applicant to a civil penally of APN Number Occupancy
not mom than fiw hundred doll.,($M 36220008 . 00 P Y�T's,
)�
❑1,u owner of th,property,or my employees with wages As their role compensation.
will da the work and the structum It not intended"offered for We(Sec.7144.Business
and Profession,Code:The Contractor's License law does Amt apply in an owner of Required Inspect og,,,./(�y®®a
property roorlmpromsthemogmdwho donauchwoh himsel(arthrou&aMa C
man employees,provided that
pr techimprovemenuiamneUcuof completion.m lcmd for min r. (/
however,the building or Improvemant b hold within one year of othe owned
builder will have she burden of proWng Net he did not Wild m improve for pumose of
❑1,As..,of the property..B simaus velyand Professions
ns with licensed rmactoon U.
mase La dproject(Sec.nan nerofand PmftWom Cade:)The Conhemon.Ind /IKaVj{`y/]j1ryC°V
cense law deo not apply te an owner of properry.whe selids or Improves tlomon,and y
Lata.Lath for such pmkN With acontranm(s)licensed possum m site Canuanah
Lkcme Law.
❑lam exempt undo See .B6 PCfor this real n
Dame
WORKERS COMPENSATION DECLARATION
I hemby e1Rmu under penslty of perjury one of mhc following dulantions: � -
❑I have and will maintain aCeNfiute o(Consent tesel6insure fm Worker's Compen•
ration,As,provided for by Section 3700 of the Labor Code.for the performance of time
work for which this permit is Wood,
❑1 have and will maintain Worker's Compensation inconstant,m required by Section
7700 of the labor Code,for the performance of the work forwhich this permit is Issued.
My ✓Worker's{Compensation Insurance terrier and Polity number sure:
Carrler. VA ZW..S• eX Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbb section need set be completed if tin perms is(oronc hundred dollan($100)
or lest)
1 cerd(y Not in the perfmmsnce of the work for which this Permit U Wood,I shall not
employ enyperann in my manner an u an becomembject to Ne Warkcri Campewtion
Laws of Califomi,Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cerdfata of Exemption,you should
become Subject to the worker's Compensation provisions of the tabu Code,you muss
.,Z forthwith comply with suchprovisiom in this Permit shall W deemed revoked. -
ZO CONSTRUCTION LENDING AGENCY
vN-� Themis affbm Nn Nem is a construction lending a
F Y .agency for Joe performance of
rl, Ne work for which Nle permit Is immwA(Sec.7(197,Civ.Cd
LQ Lander,Name
z Lendeh Addm•v
U O I certify Net 1 Mm mad this application and state that the above Information is
LL F torten.I agree to comply with all city and county ordinances and suite lave misting to
DU building construction.and hereby auNarim representatives of this city in enter upon the
W shovcmemioned pmpery(m Inspection purpates.
gy (We)agree to an,indemnify and keep harmless the City of Cupertino!&ain't
Tat liabilities.judgmcnui.cats and expenses which may In my way assns+against said City
t)7 inconsequence of the granting of this permit.
APPLICANT UND ANDS AND WILL COMPLY WITH ALL NOWPOINf Issued by: Date
SOURCE REG S.
"Q3 Re-roofs
Signature of AppliemUContrmtnr Date
HAZARDG.IS MATERIALS DISCLOSURE Type of Roof
Will use applicant or future building occupmtttom orhatAele hazardous seam"
m defined by the Cuperdm Municipal Code.Chapter 9.17.and the Health and Safety
.Seetionzss72(nT All roofs shall be inspected prior to an roofing material being❑Yes ON. P P Y g g installed.
Will the applicant or future building occupant use equiPmmt or deVIM which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardom air mnmmmin a as delimit by the Bay AMA Air Quality Manaycmcm all new materials for inspection.
District?
Oyes ❑No
I have mad the harardousmaterlals mquimmemb under Chapter6.95 ofthe Califor•
M.Health"Safely Cod.,S cdons25505,25533 md25534.1 understand Nu lithe Wilding
it=not currently 44 a testam Lou It 4 my msponsibility in notify the occupant of the
mquircmcnsswh bemet prior InisaammafaCcmfi`7am Signature of Applicant Date
Ownei ar wthodmd agent / Dnte All roof coverings to be Class"B"or better