05060069 CITY OF CUPERTINO .s
BUILDING DIVISION PERMIT CONTRACCtIOR INIHURMATIOPi
. .,� ���, N` a._ rex
Bu1w1NCADDRFss: MASTER CABINET CONSTRUCTIO ERMITNo,050E00F)9
i OWNER'S NAME: PERMIT ISSUE DAM
E: SANITARY ONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
g BLDGO ELECT l� PLUMB MISCH
O O
3s0p LICENSED CONTRACTOR'S DECLARATION
11 haffirm oirm that I am licensed under provisions of Chapter 9(commencing Job Description
^� with Section 7")of Division 3 of the Business and Profession,Code.and my license is
in full force and effecL
'z LimmisClr. Lic.a KITCHEN REMODEL (CABINET &
�ggqg 08e ARCH DECLARATION GRANITE (E) ELECT. OUTLETS TO CODE
1 understand my plans dull be used As public records
dG t�vl Licensed Professional u ` IED�
n,3 OWNER-BUILDER DECLARATION
I I hereby onion that I am exempt from Ne Contractoes License Law for the
tG0 fallowing reason.(Section 713 1.3,Business and Professions
Cade:My city or county
sed$Iii which requires a permit to construct.slut hnpow,demolish or repair any Associate UJJ
prior us its issuance,also requires the applicant formch Permit a Ole asignedsuumenl p
yjF�F< that he is licensed punsumt to she previsions of the Conuumr's license Law(Chapter 9 Sq.Ft. Floor Area fin( pry / Yam 11J(�000
CS$ (commencing with Section 7000).(Dwim.r 3 of use Business And Pnfeakins Code)or O II �I� II 11 i� !'Y '; v
3 dust he u exempt therefrom and the basis fm the alleged exemption.My violation of Il ll J/ III ll/ //I p r
Section 7031.3 by any applicant for a permit subjects the applicant m a civil penalty of APN Number -—" "° Occupancy Type
not mart Nan Rw hundred dollars($So().
Q1,nownerofthepropeny,or mycmplowes with wage udulrsolecompenadon, 35709058 . 00
windeNewart.andNenmcmmisommrewedaoffarwlbreale(Sec.7a4.13ai as Required Inspections
and Professions Code:The Committees License Law does not Apply e m owner of q
prop arty w ho build,in impoow s demon,and who does such work himself m though his
ownemPloyces.povidcd that such Improvements Am notmended oroRered for sale It.
however,Ne building or improvement is veld within one year of conpletion.the owner-
builder will haw the herders of proving that he did trot Wild m improve:far purpose of
sale.).
gill,as owner of the property,am exclusively contracting with licensed mnsactors to
construct the project(Sec.7044,Business and Pofesdons Code:)Ths ConuanoYs Li-
cense Law does not apply to an owner of property who Wilds or improves dismiss.and
who conmaa for such projects with a commemr(s)licensed pursuant in the Connectors
License Law.
Q lam exempt under Sec. .B dk P C for this moan
Owner ..�(�,'py,./k� Dau
s1I0 K C A cLARAMON
1 hemby dri m under penalty of perjuryoro of the following declarations:
haw and will maintain aCeNOca ,of Consent in selbinsum for WorkefsCompen-
salion.m provided for by Section 3700 of die lab"Code,for the performance of the
work for which this permit is issued.
Q 1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the perfaource of the work for which this permit As mued.
My Worker's Compensation Insurance Garin and Paltry number ars:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section wed not be completed tire,pmmll H fnconchundmddollars(SI00)
or esu.)
I certify Nat in she perfommc.is de wish(or w1y'ch Nis Permit is hand.I shall not
employ any person In my manIWm�n jest to Ne Waken'Compensation
Laws of Calf rflnh A RADII PPPIIII
ApplianP Ails)A
NOTICE TO A LICAANTT:If,ahem making this CcNRuu of Exemption.you shwld
become subject in the Worker's Compensation provisions or the Ulsor Code,you must
wJ O forthwith comply with such provisions or this permit shall be domed revoked.
CONSTRUCTION LENDING AGENCY
Er 5 I hereby 4MM that Nen its construction lending agency for the Performance of
> the wink for which this permit b issued(Sec.3097,Civ.C.)
0..
Lender's Name
�Z Lender'sAddmss
U Q 1 certify that I ban read this application and suss Na the sWw infonnadon is
uL!'. coma 1 aV"to comply with all city and county ondinarues and sum laws miming e
O building convection,and hereby ambodre mpreaentstiwa of this city to enter upon the
W aWw-mentiowd property fon Inspection peritonea
(We)agree to taw,indemnify and keep hasmless she City of Cupertino against
IA liabilities,judgments Gouts and expenses which may in any way accmc aguml.Wit City
V ZIn consequence of th,granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC L TI NS.
Mr - CIL rel C Re-roofs
Signctu a ppBcmUConm.t t DA.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant in future Wilding=upset mom or handle huardous material
As deRncd by the Cupertino Municipal Code.Clasper 9.12,and the Health and Safety
IMLS"
ON. All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the a':iam or future Wilding execution use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Earhazardous air contaminants a dcfiwd by the Bay Ama Air Quality Msnagcmenl all new materials for inspection.
a rich
0Yes 0N
1 haw mad the hwsmmenal3 requirements under Chapser6.95af Ne Califon
nuHealth&SafctYCwc,Sadam23MU,25133and23334.1undenu UICdu Wilding
dura not curenlly haw a enmx Nal It is my mspomibility a notify the oceupmt of Ns
mile, wle mamWmelprimusiaAamc f cemnaeafoc pmry Signature of Applicant Date
own ran isillundixiagc I e All roof coverings to be Class"B"or better