06010015 'CITY OF CUPERTINO ,
BUILDING DIVISION PERMIT CONTRACTOR INFOT.tMATION:
Bu1lDING ADDREAS KITCHENS BY MEYER PERMIT N006010015
446 -AIM917ETPRT7. IN
O NER'S NAME: PERMIT ISSUE DATE
DUANE & ANN STEVENSON 278 T 01/04/2006
NE: SANITARY NO. CONTROL NO.
415) 968-8318
ARCHITECTMefGINEER: BUILE)ING PERMIT INFO
BLDGELECT PLUMB
0MECH
0 E PE!i
u0 LICENSED CONTRACTOR'S DECLARATION
ad U 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job Description
with Section 70M)of Division 3 o(dre Business and Professions Cade.end my[icon=is
m in full(one and effect.
>'qi Data, gClea _ I Lie.. 323091 BATHROOM REMODEL (NON-STR L�
�= Date Contractor V i"fCj4£NS Rk��
EE ARCHITECTS DECLARATION
C 1 undersand my plans shall k used as;public mmNs MAP
S o la Licensed PmfcssionaI MQ R I-X 2006
3 OWNER-BUILDER DECLARATION I 11
<F 1 hereby affirm that 1 am exempt from the,Contractor's Licca=law for the
COO following mason.(Section 9031.5,Business and Professions Code:Any city or county
5$� which requires a permit to ennswet.alms.Improve, monol W.or repair any structure0
_Iy pdormiuiuuanae.almrequimstkapplieantformehpemiuorileasigwdsummem wilew
xx<
that kislicensed pursua^uoftpmvisimuoftheCo^vacwr'sLicense aw(Chapter 9 Sq.Ft. Floor Area
yF$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that k is exempt therefrom and the basis for the alleged cxempdon.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
W,mart Nan Lim hundred dollars(5500). r Occupancy Type
❑I.a owner of the property,or my employees with wages as weir sole compositions,
will do the work and the structure is not intended or offered for sale(Sec.7(44,Business
shot Professions code:The Conuacmrs Licanae Law does oat apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
awn employees,provided thatauch improvements are hot intendW moffertd for a1n If,
however.the building or improvement is mid within ane year of completion.the owner-
builder will have the burden of proving that k did not Wild or improve for purpose of
sal.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Cade:)The Contractors Li-
cence law docs not apply to an owner of property.wW Wilds or improves Berson.end
who contracts for such projects with a eomractor(s)licensed pummi to the Contractors
LKen=Law.
❑I am exempt under Seo. ,B&P C for this mason
I Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pcmlty of perjury ane of the following declaatimts:
I10311.of
am and will maintain•CeruOamof Consent to self-insum for Worker's Compcm
,as provided fm by Section 3]00 of de labor Code,for the perfowance of the
for which this permit is issued.
ave and will maintain Worker's Compensation Insura en,as required by Section
the labor Cram,for the performance of the work for which this permit is woad.
orkers Campeaauoa Inwrsme carrier and Policy nmber tie:r.n'tf p LEASt1AA4A Info Policy No.:
CERTIFICA OTE MMONFROM WORKERS'
COMPENSATION INSURANCE _
(Thu scedan recd ram W cmnplemd Vile permit is fee.hundmAdullars(SIM)
or less)
1 anal,that in the performance of the work for which this Permit is issued,l shall not
employ any person in any manner an,u to Weram wbjmno the Workers'Compemoioa
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nu Certificate of Exemption,you should
kcume subject to she worker's Compensation previsions of the Labor Code.you must
.JO foMwish comply wish such provisions or this Permit shall W deemed mvokcd.
Z'y CONSTRUCTION LENDING AGENCY
Ikreby affirm that then is a conrmcunn lending agency for the Performance of
a the work for which this Pewit is is ad(Sec.309],Civ.C.)
aA lender's Name
=z Lenders Address
U 0 1 moify that 1 have read this application and sum that the above information u
CL P cowct.I agree to comply with all city and county onlin maces and some laws relating to
OU Wilding eonmumion,and hereby authorim mpmsenutives of this city to enter upon the
W above-mentioned property an inspection on which
.
F y (We)agree in save,indemnify and keep harmless she City of Cupertino against
to Iia.omxxucrmc rdm,,rasshdexpcnsca which may in any way ettrm agaivt aid City
U z 'n consegmncc of the Bracing of Nis Pewits.
A,,,P000LICANT UNDERS DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —�Q�/—
.. $Olid REG A y /
( g�� 6Da Re-roofs /]
at rtof ApPh onuactm Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant of future building mcupsht Tom or handle hasallous mamdal
az donsomaned by she Curtino Municipal Code.Chapter 9.12,and the Hcalth and Safety
do n zss3xpea)a All roofs shall be inspected prior to an roofing material beim
❑Ya 'a No P P Y g g installed.
will thea applicant or future Wilding mea ant am a If a roof is installed without first obtainingan inspection,I agree to remove
pp g p equipment m devices which Pe
7Dwne
azardous air contaminants as dcGncd by the Bay Area Air Quality Management all new materials for inspection.
❑Yes .RTNu
I have mad the lauxod ws-mamrialsmyuimme^s underChapmr6.95 ofthe Califonlth&SafetyCade.kcums25%5,25533=d25534.1unkrsundthatifthc Wilding
m cuwntly have a m t Nm it is my respomihiliry to miry Ile occupant of the
auwhs m m pnorwisi anceoracerd6cam i��i iSignature of Applicant Date
/ noraatharz d gem T
M. All roof coverings to be Class "B" or better