08020019 CITY OF
CUPERTINO
BUILDING DIVISION PERMIT C01Rt�,CT(1RI1�ik',O,RMA1'Irl!
PERMIT N0.
BGILgn1c!ffRnAFFORD DR KITCHENS BY MEYER 08020019
NER'S NAME: PERMIT ISSUE DATE
W
DON FERRIE 278 CASTRO ST 02/04/2008
PHONE: SANITARY NO. CONTROL NO.
(415) 968=8318
ARCHITECT/FNGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
moo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby of on Wt I am Homiest under provisions Of Chapter 9(mmmeneing P
dOs Lion7oftpafDlvialon3ofd BusinmmdProreeeiomCaag andmylketamis RMDL KTCHN & 3 BTHS,REPLC ALL INTER DOORS,NEW
?ME Lle seclaforce andcRttY31 - 2�p 9 / CABNTS & COUNTR TOPS, TUB SURRND, SHOWR SURRND &
q Lkenw Clue Lu.t
l a Dem Oontrecwr FG raw Nt tae ./
AacHrrEcrs DEcuA WTRCLST
I understand my plans shall he used as public records
gwu
�o Licensed Professional
OWNER-BUILDER mDECLARATION
QI hemhy.(lite than 11. exempt from the C items rs :A License taw for the
O following maven.(Section](131.3,Business and wn,dem li Code:Any eM or county
S$ whish requires a permit re Cores Ik alwt improve,demolish,nr repair ed ammum
F;y pat he is eented c,aim tngaim thprovisions o for such Como rmiuo ftl nse La N stslemcm
< (commescCanwit parsaml tUdue ofDviof dueeHuhiman CetsC1AW(C Code)or
Sq.Ft. Floor Area C Valuation
as4 (commencing wishSttlian]000)ofDivisionSoflhaBuminmandProfminnsCade)or $112000
g 5 g at he k exempt therefrom and des,buts for W alleged ermption.Any viohtion of
Section 70313 by any applicant for a Permit subjects the applkant to a civil penalty OfNumber OGGn
mm more N3003.an Ove hundred dollars(536207013 . Occupancy n'Pe
01.uownerofthepapery,ormyempio withwagesuftGwucompen Uon,
will do the work,and themecwre h naimanded moffered fertile(Sic.]Om,Business
and Pwfershms Cade The Conuwmre License Law doe sot apply an m mvmr of Required Inspections
property who builds or im pave thenon,and who does such work himsel f or through his
own employee,provided that such improvements an not intended orolfnrE forssu.If.
,Cwevm,the building a Improvement is mid within aro year of completion,due owner,
builder wit have due burden of proving telt he did tet Mid or improve far purpose of
.Is.).
0 1,u awns of the Property,am Creatively conmmaing with liaved enmentas in
autsun the Project(Sec.]pan,Business and Professions Code:)The Cantnalnds Li-
cenm Law dens at apply wan owner of progeny who holds m impmw Newer,ted,
who contracts f e such projects with a conuanor(s)licensed punoant m the Contractors ,-
Lic"m Law.
O lareeemptuode Sea ,B&PCf.dfls wn
nee Dam
WORKER'S COMPENSATION DECLARATION
1 hareby afOm under penalty of perjury am of tel fallowing decimations,
❑I haroond will maintain•CeNOcamol Canmmmssl6lumefarWorkcrmCampen-
utian,uprovided far by Section 3]00 of the Isbor Code.far the perfomena of due
wok for which Nit permit is humid.
0 1 have and will maintain Warkcri Compensation Insunnce,as requited by Section '
37M of the Labor Coale,for me performance of the work for which this permit is issued.
My Worke�rsT.CCmarrami historic.hisurc.Carrieand Policynumbr a n
e :
carrier: O Policy No.:.UA yzy-SL� 1S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mm;smite rad not be computed If tis permit it Intone hundnd clonus($100)
or les)
I cenify Not in the performance of the wark fa which this Permit Is human.l"I tet
employ any Penin in my mannerse as to become subject w tite Workers'Compensa0on
Laws of CalilnmiL Date
APPllent
NOTICE TO APPLICANT:If.after making this Ccrdfncam of Exemplar.ym should
become subject 0 ate WorkrYs Compcea tion provisions of the Lat or Cede,you must
.J O forthwith Comply with such previsions or this permit shall be accused!remkcd.
,z.t r CONSMUC ION LENDING AGENCY
Iltemhy.ffirm that then Is a ennma0m lending agency for the perfammw of
C.>. the want fa whim this Permit Is amid(see.3097,Cir.C.1 .
A fenders Name
Q z Lenders Md.
U Q I certify dual I have and this.,Iicadan and mute Nu dw above itdamatian is
U, COoCCL I agree In comply with all City and county cohnaMe Md sum laws nhdng w
.Q building construction,and hereby someone representatives of this city to enter upon due
fi] above-mentioned pmpcny for Impaction purpoms
6r (WC)agree la cave,indemnify and keep harmless the CITY of Cupertino again,,
y Ilabilitia,judgmenta,CastsendexponmswhichmayinmywayaccmcagainstmidCity 2-
tJ Z in conuqu mac of the gnpilot of rs prmll
ti APPLICANT UND STA D AN COMPLY WITH ALL NON-POINT Issued by: Date
SO ER L O
Re-roofs
Signuun of Appllcan
HAZARDOUS
Oeta
HAZARDDOUS MATERIALS DISCLOSURE Type of Roof
Will dueCupentat( uni Walling acopanlswm or handle ardoumeteal
ri
as MmOte Cup
Bd by enia Municipal Code.Chapter 9.11,and duHe
e Health and Safety
Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye 15(No
Wit]the applicant or futem building Occupant use equipment or device whim If a roof is installed without first obtaining an inspection,I agree to remove
emit husrdoa air conuminams as dcrined by Ota Bay Ana Air Quality Management all new materials for inspection.
District?
0YCa on
Iham mid the haraldaos nM5, requirements 4.1 UQuttv6.95alae Caking
nus C.Ith&SafcyyCadc,Sections 25505,35 Y m m12553e.I W aOdIYtd dun cept Wilding
ams tet currently elw•m the I y tepon,ihility w redly IK occupant of due
oquire tsw 'h tpio ' urea Of.Certifaate of Occupancy. Signature Of Applicant Date
Owner or authorized.,,at DamAll roof coverings to be Class t'B"or better