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BUILDING DIVISION PERMIT
COPITRACTQR IAFF'ORMATION'
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BUILDNO ADDRESS:
1558 ROSARIO AVE
CUPERTINO KITCHEN DESIGNS
PERMIT NO.
08050099
R'S NAME:
PERMIT LSSUEDATE
HOBDY WILLIAM B AND CAROL A
10562 S DE ANZA BLVD
05/29/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)257-4900
ARCHITECT[ENGINEER:
BUILDING PERMIT INFO
BLDGEIECf PLUMB MECH
t� E E (�
LICENSED CONTRACTOR'S DECLARATION
Chapter
Job Description
I kmby affirm that I am licensed under provisions of 9 (Commencing
with Section 70M) ofDivWon 3 ofthe Business and Professions Code. and my]I==is
RMDL KTCHN, HALL .BTH& MSTR BTH
in full fame and e(fw[ G
License Clm Lica
-Commencer
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Dam r
ARCHITECTS DECLARATION h
Via
I understand my plans shelf W used as public records 7
Licensed Professional
OW NER-BUILDER DECLARATION
1 hereby affirm Net 1 am ucmpt from to Contractor's License Law for the
fallowing ream.. (Section 71D 1.3, Bumces and Prof ssions Cock: Any city ur county
,
which requires a permit to consouct. Alan. Impmve, demolish, or repair any structure
'
! prior th its issuance also requires the applicant forsuch permit Be file a signed amemcm
OnWii licensed In On of the Contrumr's l3oc� Law (Chaptn9
-
Sq. F[. Floor Area
Valuation
poraunt pmvieiom
(commencingthe with Section 7")of Division 3 of Business and Professions Code)or
$68500
I
• Nat he u exempt therefrom and toes, befm On alleged ciempuan. My violation of
Section 7031.3 by airy applicant for a permit subjects to applicant in a civil penalty of
5 619 0 21 AN� Number
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Occupancy P Y yPe
rot m
mom them fin hundred dollar ($5=3
❑ I, n owner of the pmpeny, m my emplayco with warm a Her sole compewdon,
will do Nes work and the souelum4 not intended or offered for ale(Sec. 7061. Business
Required Inspections
trmes Liecnrt Law dm ro an comer of
and Professions Code: The Cmm Class appy to or
ns
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property who bui W s or imposes thereon. and who doss such wart himsel f or though Its;
own employees, provided that such improvements are not intended woRered for sale If.
however, the building or improvement is sold within ane you of completion, the owner.
Wilder will have On burden of proving that he did not build or improve for purpose of
sal'.).
❑ 1, u owtler of On property w mclulively contracting with licensed Conornors to
emummt the project (Sec. 7014. Business and Profession Cade:) The Conuaemrs U.
Co. Taw dam oat apply to am owner of property who builds or impmws Herron, and.
who Contracts for such projects with a Contrsmr(s) licensed pursmnt be the Conwatoes
License taw.
emmempt under See .B&PC fm this recon
Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty, of perjury oro of to following declarations:
❑Ihive and W111 mBInYIaaCCf4BC01e Of(:anKnl lOfel�-ImYrt fM WOrkeei0empcn-
wim, as provided for by Section 3700 of use Labor Code. for the performance of Ibe
wart for which Of. permit, issmd.
.
❑ 1 have and will malmam Workmen Compcnsatm Insursnce. se tcqund by Section
.,.
37M of Nes Mbar Code. for the performance of the wok for which this proms, is issued.
My Workees Compewtim hamratae Cartier and Policy numher ere:
-
5t«fv- F�»1.
CmriW. PoliryNa.: yG7-A000'4VIO
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
TTh,seNm teed an becompleted JNe permit, fwom hundred dollars (SIM)
l'uJ
I sertify Od in the performance of the work for which Nis permit, issued, l shall nem
employ any person in any manncrm as to berome subject Be use Workers Compematon
Lave of Califinei . Dare
Applicant
NOTICE TO APPLICANT. If. after making N, cmifncae or Exemption, you should
become subjM to Ne Worktes L'ompC.V tion provision of Iht lahar Code you mntl
forthwith comply wit such prmviain a or this permit shall In deemed Invested.
CONSTRUCTION LENDING AGENCY
1 hcmby affirm this Nem c a..mmucdnn lending agency for Nes perfumance of
the work for which Itis permit, isaucd (Sec. 3097, Civ. C.)
lender's Name
lendees Address
I sonify Nu I haus reed this application and time Nan dm above information is
conn. 1 agmen m comply with all city and county aNinueos sM sons, laws relating to
Wilding construction, and hereby aulhwrR mpmamntativm of this city to enter upon Nes
.hove-encntamd property for hnspec'tioo pwpurts
(We) agree to an, indemnify and trep hamlers to City of Capmino against
liabilities, judgments. cause and eapensrs which may in any way actor agent said City
I- comequcnce of the granting of this immin.
APPLICANT UND STANDS AN WIV CO LY WITH ALL NON -POINT
Issued by:
SOURCEREGU ONS.
Date
Re -roofs
Signature of ApplinnVCon Oak
HAZAR US MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding attupentvom or handle haardom material
Med by the Cupertida no Municipal CaChapter 9.12, and to Health and Safely
fv/
. �Ya 25332(x)?
All roofs shall be inspected prior to any roofing material being installed.
Will the applicrnl or future building wcupent um equipment w devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit harammor eir contaminants as defined by On Bay Area Air Quality Management
all new materials for inspection.
Districts /
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Iban &Sdct Neha. SeCdo 21505.25533 mcrosumkrChapur 6.95ofte Wilding
ramd2553d.l Wilding
nu HcolN&Srdyyhim. scnlauhea
I, is
dram rot [umntY him • Troon. that it, mY responsibility m mtifY to oceupent of the,
my LO nedandnoccup
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mQulRments whK LLrtbC Iprlam�aumeCafaGCnlfcam of G[N
Signature of ApPliciv Date
All roof coverings to be Class's" or better
ownmr sur oat adamda n Dae