06040022 CITY OF CUPERTINO
BUILDING DIVISION PERMIT >,C01ym�TRA0TORaINFU � �N
BUILDING ADDRESS: PERMIT NO.
7728 OBSIDIAN CT
ER'S NAME: PERMIT ISSUE DATE
KAVENY JOHN J AND DIANE W 04/05/2006
IN ONE: SANITARY NO. CONTROL NO.
ARCH=/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
l� I� 0 0
jco LICENSED CONTRACTOR'S DECLARATION Job Description
Araby affirm Nat 1 am licensed under provisions of Chapter 9(commencing
Mth Scedon 70110)of DivUma 3 ofUc Businnn and Prmfeuimta Csde.aM my license Is
in fullfmuandafreu KITCHEN REMODEL TO INCLUDE BLDG, ELEC, MECH, PL
j z License Class Lk.N
F, Dam Contender
ARCHITECTS DECLARATION
1 understand my plana shall be used as public records
J
g 0�a Licensed Pnttcuionel
3 OWNER-BUILDER DECLARATION
g I hereby.affirm(Su that 1 1. exempt from the Cssion o License Law for the
i o o following mawa Permian 7(D 1.5,Business and Improve,
dcaun Code:Any city or county - $15000
COO
which its
apermit recnrts thealter.improve,h candl t,fie a siganytatement
prior so its tensed oerequires the applicant for suchpenaltoiec asignedatatemenl
eone
— < (hat he comma ing wit purdant lathe prevision of tiro eBuinusandprfesio(Code)9 Sq.Ft.Floor Area Valuation
$ that he is exempt
with Sectionfrom and
the
basis
r th the egad cu pt Profession Code)or
that he 4 exempt Otertfram tad fix bash for me alleged exemption.Any violation of
Sudan 7031.5 by any applicant fore permit ubjecu the applicant m a civil penalty or A umber Occupancy Type
not more Nan fin hundred dollars($500).
Ido hwnrk,and
pmpeny.ac rc Is with wgee ed retic IS".
compensation,
will dothawmk,dtlthe The Contractors
rotintended Licaaeaw due
to 70",Business Required Inspections
and property
who
Cade:Tim Carnuecmrt.Ld who law dace nark apply lf an owner of q P
propertywho s,proarrirepmtea Hereon,andwho met out In work himulfed Wo ugh hu
own employees,provided provehimprenmentaartnest IntendedmoQered for mailer.
builder ,thebuildingcat or Improvement is Sold within arc year ofcompletlrarHeowur-
ale.). wiB hen He burden of proNng Hak he atl not Wild n improve far puryase of
tale.).
as owner of the property,am eaclualvely contracting with Iicesued contractors m
c [Net He prefect(Sec.7064,Business and Professions Cade:)The Connector's Li.
cense law does not apply to an mwnm of property who b ilds or improves Hexon,and
WW
contracts for such projects with a conuactesr0)licensed pursuant m the Contncrofs
License law.
❑Iaranunptumter Sec. ,B&PCfor SSk.
ser
MPEN TION DECLARATION
I hereby a(Drm under pens ley of perjury ore or the following declata0esn:
1 have and will maintain a Corollate or Crashed on selfdnum for Warners Compen.
udan,as provided for by Sudan 3700 of the labor Code.for the performance of the
wait for which this permit Is issued.
❑1 have and will maintain Worker's Compensation Insurutce,as required by Section
3700 all talon Code,for He performance of the work fa which Un permit la Wueed.
My Warker'a Compensation Insurance avid and Policy number are:
carrier, Policy No.:
CERTIFICATE OF EXEMFIION FROM WORKERS'
COMPENSATION INSURANCE
(This section road not d completed Irtite permit Is(mono hundmddaflam(SIM)
or leu)
1 unify Hot in the yerfarmaacc of the work for which His permit is issued,1 shit nark
employ any Forms In my manner an as In become subject to also Worker'Compensa lon
Laws of Califomla.Data c
Applicant Iv
NOTICE TO APPLICA ,efmr m kki�pp{{this Can ssigte of Exemption,you Should
become subjectm thew ,,'s Campmuatibmpwaisiawlof He labor Code.you muss
.J O forthwith comply with such provisions or this Permit N deemed revoked.
Z v~N., CONSTRUCTION LENDING AGENCY
'C~v I hereby a0em that there is a contraction lending agency for the perfufmuce of
a the work for which His permit is issued(Sar.3097,Co.C.)
Q lenders Name
z larders Address
V I unity that 1 haus reed this application and rete that tite above Information B
I'+ copeck.I atree to comply with tll city and county ordinsmes and Stam laws relating to
D V building conduction,and hereby authority representatives of His city to enter upon the
[T7 above-mentioned property for Inspection purposes.
(We)agree n save.indemnify and keep harmless She City of Cupertino agaWl
lap liabilities,judgments,costs and expenses which may in my way amu against said City
t)7 In canequence of the grating of this Permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLN N-POINT Issued by: O
Date 7`—
SOURCE REGULATIONS,
Re-roofs --�'
Signature of AppOan moor e
HAZ OUS ATERIALS DISCLOSURE Type of Roof
Will Heappliamurfu ilding occupant core of handle harardon material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety -
.Sectiesn 355334)7 All roofs shall be inspected prior to any roofing material being installed.
El Not X100
Will the applicant or future building occupant ua equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It heramous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DidicR
C]ye, ��141m
I ban read!the bam/ausmaarisk requirements under Chapter 6.95 of the Califs,
ria NeeW 8 Safety Cade,Secuom 75505,35533 cid 355311 understand Mifthe building
don not currently hen a meant that It is my responiblllty m Wdfy also ucupdt of the
mquimmem which moa Wreck prior he issuance of a Certificate of 0asu ter.- Signature of Applicant Date
ownm ardmmira gem Da All roof coverings to be Class"B"or better