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DIVISION PERMIT
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POSSIBILITY KITCHENS
PERMIT 11005010065
88 POSEGARDiN LN
iN
ER'S NAME:
PERMIT ISSUE DAIS
JACOB WU
330 B LINCOLNAVE
01/11/2005
NE:
1SANITARY
NO. CONTROL NO.
(408)924-0204
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
_
BLDG ELECT PLUMB ' MECH
LICENSED CONTRACTOR'S DECLARATION
1 Mmby .Bum Nat 1 am licensed under provision Chepmr Y (commcndn{
wish ecdon7")of Division3of Oe Besin,asand Pr .i C andmyliccnscis
Job DCSC 7P��yyRy�gaasssararar��t1pp a ���ppp
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nr°" "1
Liccn
KITCHEN/BATHRM REMODEL IXj 7m*,.
D Convenor
tun undmyplansshallbeusedu uCHITIECT'S DEC�creen Lal" (
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8 2005
)f INLI
Licensed Pmrcasional
OWNER -BUILDER DECLARATION
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I hereby affirm that I am exempt from the Conlractes License Law far the
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BUIL
following reason. (Section 7031.5. Business and Profession[ Cosh: Any city or county
if A "4''jo
p IIIIII
which requires a permit to rnmuucr, after, improve, demolish, or repair any structure
L'
O
Sq. Ft. Floor Area Valuation
prior m its issuance, also requires IW applicant forsuch permit to Glc a signed statement
that he is licensed purmam to the provisions of the Contractor's lJevc Law (Chapter 9
(commencing with Section 7000) or Division 3 of tW Business and Pronasions Cnde) or
IMI W u exempt therefrom and thebasis for the alleged exemption. Any violation of
Gr00 Occupancy Type
Section 7031.5 by airy applicant fon permit subjects dee applicant be a civil penalty ofT`fh
mol more Nan five hundred dollen (5500).
❑ I, u owner or the property, or my employ. with wages As their sole eompcossimn.
willdothcwork.andthe.wnumisnotimm�dorortcmdf.,.M.(S .7W,Business
Required Inspections
And Professmm Code: The Con racmfs Liecrue Law dors not apply m an owner of
e q p
property who builds or improve. therm, end who don such work himself or Ihrou{h her
oweemployces, provided that such Improvements are mmUmmnded oroRered for sale. If.
however, the building or improvement is sold within one year of mmpledon, the owner.
builder will have the burden of proving that W did not Wild or Improve for purpose of
sake).
❑ h as owner of dee pmpeny, am exclusively contracting with licensed contractors to
consumer Ne project (Sec. 7044, Business and Professions Code:) The Cootnnoes Li -
cerise law union not apply to an owner or property who Wilds or improves thereon, and
who contracts for such projects with o conwmorfm licensed pursuant to dee Contricloe s
ns Lew.
sme.emprunder Sec. ,B&PC for this reason
net Date
WORKER'S COMPENSATION DECLARATION
1 hereby a firm under penally of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent m self insum fur Workeh Compen-
'
.tion, an provided for by Section 37W of the Ichor Cade, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insunna, u required by Sectio
77M Or lin labor Code, for dm performance or the work for which this permit is Issued.
O,kcr tC:onpanamon Insurance eerier and Policy number art:
Cartier: .J Pol
CERTIFICATE OFEXEMPI.XF IIIOMWORKERS'
COMPENSATION INSURANCE
Mi. section ..it not he compacted tram, permit Is Owen hundred dollars ($IN))
or lea.)
I ecnify that in the performance or the work for which this permit is Issued, I shall not
employ any person in any manncrso as to become subject to be Workcn' Compcnadon
Laws of California. Date
Applicant
NOTICE TO APPLICANT: Ir, after making this Cediffcsm of Exemption, you ahuuld
become subject to the Worker's Compensation provisions of the I-ahar Code, you must
fonhwith comply with such powlsinns or Ni. permiuhall be decmcd revnkcd.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance or
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do, work for which Nis permit is issued (Sec. 3097, CO. C.)
Lender's Name
Lender's Add.
I certify that I have read Nis application and sum that the above Information Is
correct 1 .&= ,o comply with all city and county ordinances and sum laws relating to
building convection, and hereby Authorize reprcrentativea of this city 10 enter upon IM
alma -mentioned property for Inspccdon purpoaes.
(We) agree to ave, indemoi ry and keep harmless the City of Cupcnom against
liabilida. udgm nu, costs and expenses which may In any way acme against toId City
in coAWcrNm the Inch g of r i '
ANS
APPLICA NOSES T 5 L MPLY WITH AL7N-POINT
Issued by: Dat
S0UkC -R LA /
l
i
Re -roofs
Type of Roof
car of pplic.ndcnnv.r r Dem
HAS MATERIitt9B LOSURE
Will the applic rfuwm building WouWnl mom or handle ha mous material
fined by IM Cupertino Municipal Cork. Chapter 9.17. and the Health and Safety
Section 155320)? k�
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
mit haardnus air contaminants As defined by the Bay Area Air Quality Management
all new materials for inspection.
DWrier?
[3 Yea
I have read the loosol msmateriaa requirements underChapterti.95 of the Calif"r.
.is Hen lth&Tly Code, Senicand , 75533 and 2553x, 1 understand! thin irNe Wilding
dos not 0y how nt tint" m pomiMhty m Wdrydee eceup o(dte
regal nth bemet I meaCerdGeateof ancy
Signature of Applicant Date '
All roof coverings to be Class 11B" or better
er or authorircd age Dam