05090136 CITY OF CUPERTINO '""
BUILDING DIVISION PERMIT CONTRACTOR�INFORMA'CION•
BUILDING ADDRESS: PERMIT NO.0 5 0 9 013 6
10081 PHAR LAP DR
OWNER'S NAME: PERMIT ISSUE DATE
WILLIAM KUNCZ 09/20/2005
g; SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION lob Description
rd I hereby aMmn that I am licensed under provisions of Chapter 9(commencing
with Section 70110)of Division 3 of the Business and deutons Code.and mylicenmis
n mlull snmeandermct. � �(efp I KITCHEN REMODEL, ADD BEAM W/POST,
D cl I Lm.g NON—STRUCTURAL WALL
e�r- Dam T'S DECLARATION cxlTEcrsoEp ox CONTRACTOR: IMPROVED PORPERTIES
I uMcrmnJ my Ptsns shall be used u publicnx:ords
5y
b0
Licensed Prof nsWool
OWNER-BUILDER DECLARATION
CO 5 hereby reaso.Affirm that I am exempts an the Cssions o :Any c Law for the
COO which re moan.Permit
t 7th 1.5.Business and professions Calc:Any tiny or county
$ which rets mot •pewit b uiruwe6 attu.Improve,de permit
i ri repair any structuprior re
�^ me,he its cense a,AM nemoton ftrcei theapplicanto for cchpermitso0cusele a,Law(Clugned cm
pyo (carne isR[eroedptsewarelaNeofDialaoaofmanB�nmsandPref�entCodmr9 Sq.Ft. Floor Area Valuation
y,SC
(commencing with Section 7000)of Division3 of NC Business and Professions Code)or
$`550000
$$ that he is exempt therefrom and the buss for the alleged eumpden.Any violation of
Section 7031.5 by arty applicant for a pewit subjects the applicant to a civil penally of APN Number Occupancy Type
wt mom Nen It.hundred doll.,(5500).
❑1,u owrvj of Ju property,or my employees with wage u Neo sole campmedon.
winmtimwork and Neawnum(anmielcnaedaartcmd foraam(sec.7Do,,endnea
and Professions Code:The Contneson n w
License law dot appy Required Inspections
to an owner of 9 P
property who bu(Idsuimprow thercon,and who doessechmed himselror through his
own employees,provided that men Improvements m not Intended oroRered forum.If.
however,the building or Improvement is old within one you of completion,the owner.
builder will have the burden of proving that he did not build or Improve for purpose of r to
sal.). t1:s
❑1.As awrcr of the property am exclusively contouring with licensed conoxton m
construct the project(Sec.7044,Butanes,and Professions Cade:)The Contractor's Li-
ft
- L4 1005
eerie law does not apply m an owner of property who holds or Improves themen,and
who contracts for such pmjcm with a contruwr(s)licensed pursuant m the Conu econ's
Linen..Law, Won❑I ore eaemDt under sec .B e P C for this recon W�� tJ�t ,rasa
Owrcr Dau Tlrl➢(
WORKERS COMPENSATION DECLARATION
I hereby,afRrm under Penalty of perjury oro of the following deelantlon:
I have and will ammuin a CeAEnm of Consent so self-insure for WorkefsCompen-
aatdn,As provided for by Section 3700 of the Labor Code,for Ne performance of the
work for which this Permit is booed.
❑1 have and will maintain Worker's Compensation Ins.mce,As required by Section
3700 of the labor Code,for the performance,of dm work fwwhich this Permit is bound.
My Worker's pe Nov 1 rant artierYnd Pahcy number m:
Carrier._ Polity No.: �002- rol_t
CERTIFICATE OF F(EMPI7ON FROM WORKERS'
COMPENSATION INSURANCE
Obb section reed not be completed If tit Permit is foromhunthed dollan(SIr10)
or loss.)
I ani%that in the performance of than work for which this permit is inued,I shall not
employ any parson in any mmnerm As b become subject to the Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Continue of Exemption.you should
become subject to the Workers Compensatlon provisions of the Labor Code,you most
.J zz forthwith comply with such provisions or this permit shall be deemM waked.
'Z ` CONSTRUCTION LENDING AGENCY
(r I hereby 4EIrm that Vert i,a consuuctim lending agency for the performance of
(Y, the work for which this permit Is issued(See.3097,Ci,C.)
GLender's Name
= z Londeis Add^•••
U0 1«nify Na 1 haw mad this application and mu Nu the above information is
{s. town 1 agree as comply with all city and county cardmanews and sou laws re1Nng in
O building construction.And hereby mNonm RpRfenallwf of this City in mW upon Ne
yy Lf7 ahow-mentioned pmpeny for inspection purpoUL
(We)agree to save,)ndcmn)fy and keep batteries,the City of Cupertino against
Iiabllides,judgments.cuts and expcnua which may in my way acrnc against old City
U In consequence of the granting of this pewit.
APPLICANT UNDERSTANDS AND WILL COMP WITH ALL NON-POINT Issued by: Date
SOURCE
�Zd `O
Re-roofs
Signature of ApPlicmUConDm
HAZARDOUS
S Mding we MATERIALS DISCLOSURE Type of Roof
WIII ys apCu ent or forum building e.Chapter
err handle h Health
anmamrisi
As td0ned by the Cupertino Municipal Code.Chapter 9.17.and the Hce1N anti Satety
Code.s:ly.2ss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu Na
J� W 11 the applicant or tomo building Occupant use equipment or kWces which If a roof is installed without first obtaining an inspection,I agree to remove
.t hazerents air comantu mus M JeMcd by the Bay Area Air Quality Management all new materials for inspection.
ipnclT
C Yea KOO
I haw read the har.dnu materials requirements under Chapter 6.95 of the Califor•
.is 11.1"SafoyCede.Sections 25505.25533 And 25534.I mdenmM rho ifda building
does rpt currently haw a tome that It b my res nsihtltry m naury da oceupmt of Ne
require wh muaM ilm a nlnesmarOcupm[Y. Signature of Applicant Date
ow onutho ed agent All roof coverings to be Class"B"or better r,