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CITY OF CUPERTINO
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BUILDING DIVISION PERMITCONTRACTORJNF.ORMATION
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BUILDING ADDRESS:
CUPERTINO KITCHEN DESIGNS
PERMIT" 05020060
OWNER'S NAME:
MIT
PERISSUE DATE
STEP
ONE:
SANITARY NO. CONTROL NO.
08 257-
__L408)257-4900
WCHI'I cmpiGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSEDCONTRACTOR'SDECLARATION
Job Description
1 affirm that I am under provision of shaper 9 (commencing
p
withSection]IX1U)of Division Busine and PmfcasiunseodC, and my license is
ion 7 fthe En
In form and cffea 6
REMODEL MS BEDROOM/BATHROOM
License Clu fAc. ,t ._
Dam /w
REMOVE BEARING & NON-BEARING WALLS
p ION t�p,AsejjYa
7SDECr
As'hall
be soul public
1 understand my plans 'hall he used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 herthy affirm Nat 1 am awlept from the Ca.,gClor'. Lleene Law for the
following moon. (Secuun AEI 1.5, Business and Professium Cade: Any city or county
which requires a permit to construct, alms, improve, demolish, Or repair any ssrucmm
prior in its issuance. also requites she applicant rat such permit to file a signed snmmens
that he is licensed pursuant m the provisions of the Contractors Lt... Low (Chapter 9
Sq. Ft. Floor Area Valu,*§(n 00
(commencing with Section 7000) of Division 3 of the Business, and Pmfessiom Code) or
that he u exempt therefrom and the hues for the alleged eaemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
five hundred dollars 500J.
APN Number
Occu ane Ty
Occupancy
perutmort
than (S
^
3i428�5M Pes\\;
❑I,uawncrofhepropmy,armycmploycewithwgesutheirolecmpnstion,
will do Ne wan and theSwcturt unat inmMed oo@mA fosek (Sec. ]044, Business
U 'u V(/ VILeII� L r
Required
and Professions Code: The Conoactor's Liame Law does oat apply m an owns, of
Inspections
property who builds or improves 0aroon, end who does such work himselrar through his
awn cmplowee. provided that such improvements are not mammal of offered fursam.If.
however. Ne building or improvement is sold within one year ofcompleuon. the owner-
D�
A 21 2005
builder will nein, the burden of proving Wt he did rot build or improve for pu,puse of
ai
O 1. u owrcr of the property, am escluivc" contracting with licertsed contrxmrs in
�1IryflIIII
comsmct the pmjem (See. 7064, Business and Proreuians Code) The Contractors Li-
f
\\
cone Law does not apply to so owner of property who build. or improves thereon, and
who concocts on, such projects with a conuaaor(s) licensed pursuant in the Consnctoes
License law.
O l am essmps under Sec. ,B&PC for Nu won
Owner Data
- -
WORKER'S COMPENSATION DECLARATION
I hereby afOrm under penalty of perjusy one of the following declaration:
nave and will maintain a CeniReste of Coming to elf insure far Worker's Crimper.
n, as provided for by Seldom 37W of the Labor Cada for the peAormvrce of the
for which this permit is island.
O I have and will maintain Workers Compensation Insurance, as required by Section
37W of de labor Code. for thin, performance of the work for which this permit u issued.
My Worker's Compensation Insurance carrier and Policy number am:
varier: 'T FuNO Pmicy Na.:D000 0-2eOQ�
'CE MCTI(t ATEOF EXEMPTION FROM WORKEIIS'
COMPENSATION INSURANCE
(This section need not he cmnplcmd irthe permit is for one hundred dollars (sla)
nr less.)
I ceNfy the in One performance of the work for which this permit is issued. I shall no
employ any person in any mannsrso u in become subject to the Workers Compensation
Laws of California. Dae
Applies.,
NOTICE TO APPLICANT: If, of making this Ccnireae of Exemption, you should
became Subject m the Worknr's Compcmation provisions of the Labor Code, you must
forthwith comply with such Provisions; or this permit fiall be decmcd revoked.
CONSTRUCTION LENDING AGENCY
1 hemby afrom that more is a construction lending agency for the pcolotmNCC of
de work for which this permit is issued (Sce. 3097, Co. C.)
Lender's Name
Lenders Addw
I comfy that 1 have read this application and etc that Ne above information is
comes. 1 agree in comply with Al city and county ordinances and mm laws relating to
building construction, and hereby authonp tepeenutims of this city to enter upon the
liaavc-mcnuorcd properly for inspection
(We) gtce m use, indemnify and keep harmless the City of Cupertino against
which may
costs ad expeneswhich may in any way accme against said City
in or dic ing of this permit.
of UNDERSTANDS
A APPLICANT
APPLICANT UNDERSTAND$ AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR REGULATIONS.
ek h..n-.b.jaow� ? 12) 6 S
Re -roofs
Signature of Apphca t/Coneractar Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building Occupant stare or handle huallous material
u dcfnncd by the Cupertino Municipal Code. Chapmr 9.13, and the Health and Safety
Yrs ❑ NO
ititWill the applicant or future building occupant use equipment ar device which
h..dou air comominants as defined by the Bay Area Air Quality Management
iaT
Oyes ON.
1 have read the harardtms materials requirements under Chapter 6.95 of the Califon
nix Health&Safety Code.Sccuwu255f15.25533aa1255Ja.Iun& and Nuifthc Wilding
does not curtcntly hoc a tenant. Nat it is my msbousu lily m and fy the Occupant of the
requirgments which most M met prior tu issuance of a Cenlfcam of O ri,nanev
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better