03040085 CITYOFCUPERTINO
BUILDING DIVISION PERMIT �xCONTRACTOIi,INT4',.f.)I2Mt1TIUN .
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BUILDINGADDRESS: KITCHENS BY MEYER PERMITNG.03040085
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ER's NAME: 278 CASTRO ST �� ���A�7/2003
ICELL
"E� (415) 9 6 8-8 318 SANRARY N0. CONTROL NO.
BUILDING PERM7INFO
ARCHITECT/ENGINEER:
BLDG BLECT PLUMB MECH
t� 0
L O p LICENSED CONTRACTOR'S DECLARATION Job Description
1 burtby affirm Np I am licensed under provisions of Cheerer 9(commcncin{
n�1 with Secumo 70f10)ar DiAdon3of Ne Busiwas and Professions Code.and mylicew is r� {I ® (��5
'n roll and effect. G °�fG L4/1
^8z Clw�—c�n�r..N323cSi KITCHEN REMODEL 7
ARC'MCrS DECLARATION JUL 0200
1 undcmeand my plain shill bu=it u public no mils
3i v. Lk:cnttO Pmfcuinnel BUILD
ING
30 OWNER-BUILDER DECLARATION
�f f 1 hcmM1y affirm Nal 1 am eacmpl(core Nc ConuacraYs Licence I�w for the
eT c O following moon.(Section 7(131.3,Business and Pmfesamn Cade:Any city or county
$ which requires a pernil In ennswcL ager,improve,demVlish,lir rtpair any slswmm
fZin prior br in issuance.also requires,the apPlicanl for such permit m file a signed statement V IOn
tZ CdA,heisllanscdforms,todtepmvisiomoftheConuacmhLiaveUw(ChamerF
9 Sq.Ft. loor Area c 22d�Y�
te€$ (commencing with section 7")of Division 3 of N.Bun..and Profoamu Colo)or _
.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit suhjecs the applicants tP a civil penalty of 3 2RN90"el0 0 Occupancy Type
not mo.than Own hundred doll..($500).
❑1.as owner of Ne propeny,or my employees with wages as their tele compenauon, (��T
will do the work and the suunum is not intended or offered Russia(Sec.7044,Business iui — rnTEd Inspections Pmfwimis Code:The Contractor's License Law does oul apply m in owwr of 102 — PIERS
propenywhm builds orimprows thereon,and whodouauchworkhowelf ortWou$h his
owncmployees,provided that such improwmenu are not intended oroffaed formle.If, 103 — UFER
however,the building or improvement is sold within ore year of completion,Ne Owner.
builder will hew the burden of proving Nal be did not build or Improve for purpose of 104 — REBAR
ale.). 105 - ANCHOR BOLTS
❑L as owner of the property.am exclusively communingwith licensed contractors m 10 6 - SEWER & WATER
construct Ne projectw(Sec,7044,Businand profession,Code:)The Coomacter's Li.
moseLaw it=not apply toanmanerorpmPenyWho builds orimprovers themon.and. 202 — UNDERFLOOR PLUMBING
Lwho n�sfor such project with tm
acmnmr(U licensed pursuant co
uade Cantranora
ic'nu203 - UNDERFLOOR MECHANICAL
❑Iamexemptunder Sec. ,BkPCfur Niartuon 204 - UNDERFLOOR FRAME
Data WORKER'S205 - UNDERFLOOR INSULATION
COMPENSATION DECLARATION
�I 301 _ ROUGH PLUMBING
7 hereby affirm under penalty of perjury oto of to following declan0om:
Ihaw and will maintainaCeniReateof Covent toself-insure for Woh.rs ComPen- 302 TUB be OR SHOWER
.Jon,ss provided for by Section 3700 of Ne UWr Crede.for rite pertonnantt Of We 303 - ROUGH MECHANICAL
Work or which this Knoiusissued. 304 - ROUGH ELECTRICAL
❑ I haw slid will maintain Workers Compensation Insurance,as required by Section
37 the Labor Code.for Ne performance of the work for which this permit is issued. 305 — FRAME
We,
Comps, oo num annerand Policy nnu�umbb�era2�m: �Qpp4s 306 — HOLDOWNS
anis, AT£ PoIII
No.:aLL_s,L—LJ— 307 - INSULATION
CERTIFICA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
r (rias section wed not he completed lfNe ferns is forow hundred dollars($100) 309 - EXTERIOR LATH
ones'.) 310 - INTERIOR LATH
L certify the,in the performance of the work for which this p.mtit u humid,1 shall not 311 - SCRATCH COAT
employ any pawn in any manner an u m become subject to No Workc.'Compensafion
Laws of California.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.If.after making his Cenifiate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject in the Workers Comp.vauon provsions of th.Uhnr Code,you in=
.J,Z forthwith comply with inch provisions or Nis permit shall he locoed revoked. 502 — FINAL PLUMBING ENERGY
00 CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(:+.. IherebyefOnnhe,themsamomuctionlending-PIfnfleNornmmteOf 504 - FINAL BUILDING ENERGY
w> the work for which this parmsbissued(Sm.3097.Civ.C.)rs
W 0 Lend505 - FINAL ELECTRICAL
eName
7z LondersAddress 506 - GAS TEST
U O 1 arufy that L have read this application and sum Nat the above mromuu ni is 507 - FINAL PLUMBING
comecL 1 agrte to comply with VI city and county aNinanas and sate laws mining m
building cones,to
and with all
city
rimand mpmscounty nmivesmf this,city to trial upon in N MECHAN CAL
t-'W ahmeng conned property rte by author purposes %FI
F I Na (Wc)agree m save,indemnify and kap h mnlw Ne City of cupcnino against14 liebilides,judgmcn ,evs and expenses which may in any way acerae against said City A G
U inconsequence of granting of ibisISSUed by: WORKS ' 7�J3
APPLI DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Date
OU ER CATIONS.
'7Re-roofs
pimcow fAppOcandCmUslctor D•te Type of Roof
HAZARDOUS MATERIALS DISCLOSU E
Will the apPlianl or future Wilding occupant pore or handl.hevallov material
ss defined by the Cupertino Municipal Code.Cbapter 9.11,and de Health and Safety
Jc,Sccuon 155310)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes poo
Will the applicant or future building=upset w equipment or device which If a roof is installed without firs[obtaining an inspection,I agree to remove
it hevarEov oil contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection.
Daniel?
❑Ya t�NV
Ihevcread ahvaNnus mneriab requirements under Charter 6.95ofthe Califor-
riaHcalthASaf Code,Swuov15505,27733and2l534.lunde.reod Nmifthc Wilding
don c y how a tenant Nil it s my responsibility te wufy sire aoupant of Ne
rimcn hichmug bemet prior to issuance ofaCcrtt(ica¢ �c ry. Signature of Applicant Date
0 onuNeriaed agent \ ,te All roof coverings to be Class"B"or better