04020067 CITY OF CUPERTINO t °#""'�' ' a-j" ^• ""' `"� •
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: r
BUILDING ADDRESS: PERMIT NO.
04020067
R'S NAME: PERMIT ISSUE DATE
SANffARYNO. CONIBOL NO.
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDG EIECr PLUMB MECH
.hoz LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 em oP
Hearted under provisions of Chapter 9(commencing
wiNgeedo ").Di 'on Sof the Busirmoand Profnsioa Code,en mylicensm is
'a� mmnrat �lo ADD 13 S/ FT. /KITCHEN REMODEL35625008 . 00
i Lken CI Lk.K
Cl 4canton IWONTRACTOR: ARTISTIC KITCHEN DESIGN
AR HIM C D ATION
I understand my plana shell he used mind
c rtcnrds
U
aG Licensed Pmfessimnel
OWNER-BUILDER ncurnDECLARATION
EQ F I hereby.(Scum Nat 11. exempt from the Committees o License Low for the
p o following reason.(Section 703 1.5,Business and rm.derma Cade:Any city st county
$ which its Issu a Permit re uirsuueL that.impmsu demolish,fl mash and nmeae
F p:<
prior in its issuance,abuseroguish diveapplicantfor such permit to Bles LAW natemem
(commencing
comma licensed pursuantto she7")provisions of the Commuter Lkenselaw is Code)9 Sq.Ft. Floor Area Valu
$t"000
g (cot he Is i see with Section s and the
Division f r the
the egeinesempt and Prohnsor.Any
laden or v
Nal he h eumpt therefrom and the bola for the alleged aempton.Any violation of
ne�o2031.5man bbymyppBaeemoraperrs .itsubjeaulheapplicantInaenRPenalyOf APN Number Occupancy Tl pe
❑I,uowner of the property,or my employcn with weguatheir role campevatlan, 35625008 . 00
willdothe..,Land documet.brotimended or offered(ouale(Sec.7044,Business - Required Inspections
and Professions Code:The Contractors License Law don e ns set apply to an owner of q p
propenywho hotels or improws thereon,and who dousuch work himseaor through his
own employees,provided that such Improvements ane not intended uroEewd for sale.Ir.
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving Nat he did not build or Improve for purpose of
salk.).
Q I,a owner of the property,am exclusively contracting with licensed contractors to
consumer the project(Sec.7(X4,Business and Profeeons Code)The Contmetor's U.
Lean law woos not apply b an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)Iianutl pursuant to the Contractor's
License law.
❑lren exempt undo Sx .B&PCfor this resort
137MData J
WORKER'S COMPENSATION DECLARATION Y
I hereby affirm under peaky of perjury ane of to following dnhusul ons:
ave had will mountain stCenificaa of Consent to self-imure for Woraces Compc.
,a provided for by Section 3700 of the labor Cade.far the performance of the
for which this permit is issued.
haw and will maintain Workcfs Compensation Inwrance,a required by Section
of tar LaorCortfar dus pcdo...of the work for which this Permit is rated.orker's Compensation Insurance carrier ad Policy number art:
r: S�m Te IPLI, Z Pollu Eb-11 -
CERTIFICATEOFEKEMPTION WORKERS'
COMPENSATION INSURANCE
obis auction need not be completed fork permit is(mom hundrW dollars($1110)
or Icse.)
1 certify that in the performance of the work for which this permh is commit.I shall not
employ any person in any manner so as,te become subject to Ne Workcur Compeaadon
Laws of Califomit Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become Subject to the Worker's Compensation previsions of she labor Code,you muse
.J Z roMwith comply with Such prow sima or Nis permit 041 an deemed revoked.
?O CONSTRUCTION LENDING AGENCY
[—r I hartby infirm thin there is a construction lending agency for the perfurmaac of
Cls> the work fur which this permit is issued(Sec.3097,Civ.C.)
4 Q Undcr's Name
Z Lenders Add.
U Q 1 comfy that I haw mad this application and state that the shove information is
L4 U correct.I agree to comply with all city and county ordinances and ewe laws minting to
C) building construction.and hereby amhmIX tepmunwivel of this city to coon upon dM
r move-mcndoned property for impaction purposes.
(We)agree to ase,indemnify and kap harmless the City of Cupertino against
t:CAA liabilitiesjudgments,costs and expenses which may In anyway accrue against aid City
U 7 in consequence of Ne granting of this permit.
G APPLICANT UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU Ep EGUTATIONS.
1�A.ulU 1"1l Z' D P Re-roofs
jdft'flnadbydwCu,crdmMurdcI
me of Appl sm/Cmuaer /�h4
HAZARDOUS MATERIALS DISCLOSUKE Type of Roof
Will the applicant or future building occupant store or handle haardom mmerial
plCode.Chaper9.12,and tar Health ad Safety
Se y.zss3z(.n All roofs shall be inspected prior to any roofing material being installed.
❑YuWill the applicant or futom b 'IUing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
h trardousair common- doOacd by the Bay Area Air Quality Mrnagcmcm all new materials for inspection.
e?
Oyer Nu
1 have mad the hnardous materiels requirements under Chapter6.95 ofthe Califor-
ma Hal"Safety Cads.Sec0aos 25505,25533 and M534.1 undemand ths if the building .
dos nor euremly haws temna r it h my reapomibitity m notify the oecupat of the
mq'm which must t dorusiouanccofaccurica¢orcin anL. Signature of Applicant Date
owrathari naasen, All roof coverings to be Class"B" or better