08090005 CITY OF CUPERTINO •? �+ax.� w+*u s x3'5-� *. � y-
BUILDING DrvIs1oN PERMIT COIV�TRATORIIV'k'UItMATIOO N
BUILDING ADDRESS: PERMrr NO.
10303 MINER PL KITCHEN WORKS INC/DBA 08090005
vANE0.'S NAME: PERhffI ISSUE DATE
%10i?MAN ABRAMOVITZ 615 IRWIN ST 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
(415) 456-9696
ARCHr1ECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
G ij LICENSED CONIRACIOR'S DECLARATION O O O O
U 1 hereby affirm Chat 1 w licensed under provisions of Chapter 9(commencing Job Description
4� with Smtion701R))oIN— 3 fOm Beas
uunmdProfcame am
Cole. dm ..ylic.. RPLC 10 WNDWS & 2 PATIO DRS #718 LWR STILL 8" FOR
m
n full faram C=
nq D�nacc e �� LGolo�vamor a�8 ` RESS& ALL OTHERS LIKE4LIKE
et ARCHffE=DEC ON
? U 1 understand my plan Nall he used as,public records
C in Licensed Professional
3 OWNER-BUILDER DECLARATION
.� f 1 hereby affirm that 1 an exempt from the Comonam s Lic rid law for the
i
no fallowing meson.(Scum 7071.5.Business and Pmfc Om Cmlc:My cimy m County
$ which requires•permit t0 comwct.alter,improve,demolish,m remit any structure
_ty prim an its issuance.aha requires the applicant for such Permit to Ek a signed aaemem
taut he is licensed pursuant in the Provisions of the Comracwls License Law(Ch ma9 Sq.Ft.Floor Area $23000
Valuation
the
9 (commencing with Section 7000)of Division 7 of Business end Professions Colic)Car
Nat he is eumpt therefrom and Cha basis for the alleges exception.Any violation of
Semi.7031.5 by my applicant form permit subjects the applicant m.civil penalty ofypN Number Occas ane-Type
no,mare thti five hundred dollars 316 4 6 0 31. .'V(7' P Y
❑I,as owner Of the pmvpeny.m is o,imad dwith wagca as ste'v role m4.Bud on,
will dothe wary.and1Mawcturehme.Lic d maw do frestapplytoa wnero.
and Rofesuans Code:The Conunacmh Licwe law dam not apply br an mwmr err Required Inspections
Own ewho employees,pro mirepries Chxmn,and wM doessuch work Himselfm Uuough bas
honemeWildngori hnsmhim is memmuarene earoedmO@rrA for scat,r.
however:Ne building aimpmovemmt h sold within one year of mporme for the owner-
.k.). MB haw ria lords of proving CMI he did not build m imprme for purpose of
❑1.u caner of da Oopen,an ucluuwly contracting with Bmnsed Contrsnors On
Communism the project(Sec 7044.Business and Rafessions Code:)The Conuaem's U.
Commtaw does not apply m an Owner of property who Wilds or improves thereon,+rid.
who contracts for such projects with a convacros(s)licensed purswat On the Co axeme3
I se-...Law.
❑l an exempt undo See ,B B P C for this mown ,
Due
WORKERS COMPENSATION DECLIRATION
I baby millions under pe silty of perjury arc Often following dechOstloas:
❑Ihs oadwillnCtmUina Ccrdr.c c.f C...tmself-inaurefmwmiate.compen-
s Mona as provided for by Section 5700 of the labor Code.for the peAormanm of the
wart fm which Nis permit is issued.
0 1 Mw and will muntalo Workers Campensation Insurance,as rtqui,ed by Senior
57th a ded labor Cade.for the perform.of the work for which this penitis Casae '
My Workes COmpemsdi Insurance peri,adi Poliry.Crober
Cartier,f31"J /e— F" "I Policy No.:
CFImFICATH OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
mus modest named our be completed lime permit is fmone hundred doll.(SIM)
or less)
1 Comfy Chat in the performance Of the work for which this permit is issued.I shall Cort
employ any penen in any mmner an at On become subject to the Wmkess'Cm mmundoo
Laws Of CalifOmia.Dam
Applicant
NOTICE TO APPIUCAM:IL slier making this Ccnificam of Exemption,you shaumd
become subject m the Wcacrs Compensation provisions of the labor Cedc,you muse
.J O forthwith comply with such provisions or this Permit shall be deemed rewked,
.za l'I CONSTRUCTION LENDING AGENCY
(—m I hereby affirm dot Nem 4.cmusncuun lending aguoy for Chrep lconame.f
R,a >
the work for which this Permit is issued(Soc.7097.Civ.C)
QLcndn's Nage
Z Lenders Address ,
U O 1 comfy that 1 Mw read this application ad sum this the above information a
L4 came.I agree m comply with all city and county ONinan:es and sun c laws mlating to
-0 building constratian.and hereby a,lmiw representations Of this city to coax upon da
L31 show-menuarcdpmpeny fmhtspenim pury0¢s
gy (We)agree to man.indemnify and kap hamlets the City of Cupertino against
I,, liabiliuetjudgments.esu and upensu which may in my way urnaagainstamid City
in cmmeyuemm of the grating of this Permit.
ti SOURC A U�ERSTA�AND ILL COMPLY W17H ALL NON-POINT Issued by: Date
Sgwure Of Applicmr Date
Re-roofs
xvZwRDOusMATERIALS DISCLOSURE
Type of Roof
Willy the Cupertino
or future Wilding Cw mcupapt Gore Or handle h easdons material -
as 4fiSed Section
the cupenino Mwicipd Cade.t]npar 9.13,talo Cha Hnith and Safety
.sermon ss7u+)7 , All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the, lieanorfuture Wilding am anture If a roof is installed without first obtaining an inspection,I agree to remove
Can Pp g p e.Ail Quality
m dMana a hien g p -
Disunim nus air canuminmu as defined by Ne Bay Arta Air Quuity Management all new materials for inspection.
❑Yca �pAp
II
mal the haallommsma Crisis requirements umler Cbepar6.95 of the cm ifm.
ni.H."BSafdycade.SUUmts35505.35577cave25574.1mgersundthaifda building
Coca not curoady Mrc.ansnt then it u my responsibility On notify do=opal of the
reyuirt tswhichmusiWmet05w%issuance, uoofQc ^ Signature of Applicant
//((''(((((( p Date
es oCl.l mth.oled.gem Daa All roof coverings to be Class';W'or better