03030129 C TY OF CUPERTINO
PERMIT OW1121,
]BUILDING DIVISION
,U"7,]NG ADDRESS: PERMITNO.
CUPERTINO �KITCHEN DESIGNS
OWNERS NAME: 10562 , S DE I ANZA BLV niiMIT 11 ft2A
T-TRTRTTNR F, 7PTr gAn n.q n n-A
SANITARY go.- CONTROL NO.
(408) 257.-4900
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUM MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby Mrm that I am licaund under previsions or Chapter 9(commencing
mitsSomi 7") leh,1410.3ortb2sift"and 7 �C;dygylnmls
in fall to
Cl iie.,
Lima., C. REMODEL KITCHEN/
Z Dme.,� QiR - 1 FINAR�ED
ARCHITECTS 1) LARATION
I unjmmnd my pl...a hall he used a,public recond,
Licensed Professorial OWNER-BUILDER DECLARATION JUL 2 8 2003
I I hereby at that I am exempt from the Contractors License Last for the
nO following return.(Section 7031.5,Business and Profersions Code:Any city or county
which requires;a permit to construct.altar.improve.dervolush,or repair any structure BUILDING,
prior to its issuance.also requires,the applicant far such Permit to rile.signed statement
Law(Chapter 9 Sq.Ft. Floor Area $7EYO�6jon
(commencing with Section 7")of Division 3 of be Business and Proftesiona Code)at
e;M that he is licensed pursuant to the powislons of the Communes Licerm,
that he Is ucmpt thencroom,and the basis for the alleged exemption.Any violail on of
Section 7D31.5 by any applicant for a permit subjects the applicant to a civil penalty of
out nume than I,.hundred delta.(1500). 3A9112)'b9kheT00 Occupancy Type
E]1,as owner of ft property.or my employees with wages as their sale compensation.
will do the work.and the structure is not balanced or offered for sale(Sm.7044,Business .'101 - . FOUND
and Pretensions Cods:The Conductors Uccruse Law does not apply in an owner of PIK;Oid Inspections
propenywhobuildscrimproves thereon,and whodmi iuchworkhmselfor though his 102 - PIERS
man employmal provided that such improvements ans not mounted mortared formle,If,
however,the building or improvement is sold within one year ofourpleflon,the owner. 103 - UFER
builder will have(he burden of pronving that he did not build or Improve for purpose of 104 REBAR
.]a.).
. 105 - ANCHOR BOLTS
[3 1,as no,of the property,am exclusively contracting with licensed contractors to
.1131.0 me Praiser(SaC'70,t4,Business and Professions CWe:)The Comactar's U. 106 - SEWER & WATER
came Law does not apply 1.an owner of propusy who Wilds or Improves;Jumon,and
who contracts for such parjecus with a cousurmtor(i)licensed pursuant to the Contractors 202 - UNDERFLOOR PLUMBING
License Law.
[3 1 son,exempt under Sm. B&P C for this memn 2 03 - UNDERFLOOR MECHANICAL
204 - UNDERFLOOR FRAME
Dits
owner WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION .
owner
c� I hereby affirm under penalty of pedury on of the following claclamfims: 301 - ROUGH PLUMBING.
I have ad wHI camirost..C,rdficate of Comes,1.saff-lose.for Wmian'.Cooper. 302 - TUB &: OR SHOWER
tion.as Provided far by Saction 37W of the LaWr Code,for the Performance of the 303 - ROUGH MECHANICAL
�for which this Permit I.issued.
0 1 haw and will maintain Workers Compensation Insurance,w required by Section 304 - ROUGH ELECTRICAL
37W of she Labor Code.for the performance of the"A for which this permit Is issued.
my W k e C 6 1 305 - FRAME'
y d Pot be 306 - HOLDOWNS
a'.
7ar
or;X"`x`mx a j1Z poll cY
am"
C nick 1 ,47 - man
CERTIFICATEOFEXEMPTIO OMWORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or lass.)C,rhis sectiont need not be completed If the rnmh is But=on.adnAdollanOS1010) 309 EXTERIOR LATH
I eatery that In tho puflumano,or the work for which this Permit Is issued,I shall act 310 ..INTERIOR LATH
employ any person in any mannerm as in laccorneubject to the Waskinar Compensation 311 SCRATCH COAT
Laws of California.Dam
Applicant 313 ROOF NAIL
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should 501 FINAL ELECTRICAL ENERGY
bessams,subject to the Worsces Compensation previsions of ft LAM,Code.you most
f0rhwilh comply with such proviumns or this permil 0111 k seemed revalued. 502 FINAL PLUMBING ENERGY
z CONSTRUCTION LENDING AGENCY 503 FINAL MECHANICAL ENERGY
I hereby arlon,that them is a conasuctino lending agcnY,ror the or
> the work far which his Permit Is issued(Sm.3097.Co,C.) 504 FINAL BUILDING ENERGY
Leader'.
e, cl 505 FINAL. ELECTRICAL
;) z Le di Add. 506 GAS TEST
U 0 1 cartilly Jb.1 I he.need this application and We last the serve I.Norition I.
P: moons.I agree to comply with all city and county ordinances and sale law mlatinj to 507 FINAL PLUMBING '
U building construction.and hereby authodac representatives or this city to cam,upon the
h.....lksmadl property for rappeChOn PUIPOWL FIN MEC CAL
FI
(We)Agam to nw,indemnify and lump hanorles,re,City of Cupertino against 09 FI
Lo) ti&bilifim.judgments,coast and expenses which may in Any My 2mmC aillifulL said City 4 1
U F:: in connexiscrt the granting of this Permit. 5 JaNG
' " 9 C W(
APPLIC U DER�STANDSAND ILL COMPLY WITH ALL ljobi-polvir ssued by:59 C WORKSDate
L
SOUR R LATIO
Re-roofs
Si o(Applicanvcommuclar, Data /f
H,Z
AZARDOUS MATERIALS DISCLOSURE. Type of Roof
Will t1m.peplicant or future building occupant nam or handle hazardous material
or
as definedd by the Cull Municipal Crude.Chapter 9.12.and ft Health and Safety
LP
C se y,
;Code,Scefion 25532(0)7
C]Yea N All roofs shall be inspected prior to any roofing material being installed.
Oyu f-
f um
Will the applicant f one building occuticant me equipment of devica,wider If a roof is installed without first obtaining an inspection,I agree to remove
b./andous air concert fired by the Bay Area Air Quality Mantagconem all new materials for inspection.
or
turict7
0y.
textuircroomaunder Cooper 6.95.fthc Califor.
'=.25505.25533 and 25334.1 understand buirds,Wilding
nhiical"2�1'C
ext in umo y have a"am.shut it 4 raymponsibility,0 tuil"..P.t a the
ne, h r k
N., rux noP Met mot W issuaree Of a ccrorksote or 'c2natur
e of Applicant Date
WIV11— . X&V,
7-P
&�Lhoru
Oftfin a.borixed ,am All roof coverings to be Class "B"or better