05070005 CI TY OF CUPERTINO •x^m� a •- �""'� '�" `' '
BUILDING DIVISION PE$]VIIT ��, 1ZAbT2YNTb2A' ATIOl ,t
BuILDINGADDRESS: CUPERTINO KITCHEN DESIGNS PERMIT N005070005
7491 TIPTOE LN
f^` WNER'S NAME: PERMIT ISSUE DATE
MARK PEERCY 10562 S DE ANZA 07/01/2005
E: j SANITARY NO. CONTROL NO.
(408) 257-4900
ARCHr1E(.TIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1� o
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
rt a hereby 0)of Nal 1 am of the
Bu under And
FKAha of Chapter 9(commencingsI. p
nNSectian]g10)of Division 3of NC Busanrss end Profculuas Code.end myllceaseie
^ in full forte W eRect I
ueenm Clue Lia• eR 3 _ KITCHEN REMODEL ( /C UNTERS &
met &i Iry 144 ffwyei REMOVE SOFFITS/RA ten &
Dau ARCHITECI'SDECLARATIt N J?jd-ijn ADD' WALLS Q LAUND L
i understand my plane shall W sued u public mc.rN
k Licensed Professional `'-
5 OWNER-BUILDER DECLARATION �Q �/ 2005
1 hereby aRsm that I am exempt Iraq,the Contractors License Lew for the b L
O O following mean.(Settle.703 1.5,Sum.said Pufesaloas Code:Any city or county
$Pi which mquima a Permit to construct,alter.Wpdw,demolish,or repair try structure ni mum
Z ry^
prior to its Wuancc,old requires Ona applicant forsuch permit to Glc a signed statement
< that he I.licensed mucestrit In me the Contractor's Uemm Law(Chapter 9 Sq.Ft.FloorAr Valuation
(commencing with Section](OD)of Division 3 of the Businrsaand Pmfeuimu Cre)or _ $30000
IJ
that he 1.Gempt tMfn
^' n and the basis for de alleged eumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy e
set come than 0w hundred dollars(5300). p y Typ
0 1,As owneraf Ne property,or my employee;with wages As their sole compenuNon,
will de the work,and Ne atrucum la not intended Go1arc4 for We(Sec.7044,Bu dims
and Pmrea;iaas Cade:The Comment's Liam Law,daes Int apply to an owner of Required Inspections �-
property who builds ar tmprows thercon,and who dace such work himsul f ser through his
own employees,provided thm such improwmenuare not intered,roRered for sale.If,
howavG,the building or Improwmmt is sold within one)eta W completion.the owner.
builder will haw the burden of pmvtng that he did an,Wild or Improve for purpose of
tele.).
❑1,as owner of the property,am cwlGiwly contrasting with licensed comruun to
construct Use Project(Sec.7044,Business and Pmfesdaas Cade:)The Contractors U.
cease law da;not pply in an owner of property who Midi or imp ow;thercon,and
who contracts for such projects with a canuutar(0 licensed pursuant to she Coni muses
license Law.
0 l am exempt undo Sec. ,B k P C for Ni;..an
ter Data
WORKER'S COMPENSATION DECLARATION
'•v I hereby Arms under penalty or perjury one of Ne following declensions:
0 1 haw end will maintain•CeNftauof Consent nself.t.m.for WarkersCompen-
sailor,u provided for by Section 3700 of the labor Code.for Use Performance of the
wart for which this permit is Wised.
0 I haw And will maintain Weaker'Compensation In"=.u required by Section
3700 of the,labor Code,fes Ne performance of the work for which this Permit is issued.
My Worker orafl�e�uation Insure.Gl carrier and Policy number am:
Carver. TCi VI❑ Policy Na:4 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlon teed not becompleted If tin Permit Isforone hundred dollars(5100)
or Ics )
1 certify that in the parformance of the work for which this permit is banned.I shall not
employ any person in try maremrd As to became subject to the Workcta'Compcasadan
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,AMr making this Certificate of Exemption,you should
become subject N Ne Workers Compensation provisions of Ne labor Code.you mum
.J Q forthwith comply with such Provisions or his pefmlt;hall be deems ranked.
CONSTRUCTION LENDING AGENCY
(~i 1 Wmby alflrm Nal New la a conduction lendingepeacy,far the performanea
LYi r�i me work for which this permit is Tuned(Sec.3097,Cu,C.) '
Under'Name -
� Lenders Address
U Q 1 certify that I have read this application anal sue ft,the abuw tar..don It
{T. bored.I ogres to comply with ady city ser county oradws of and rate lent r upon{tobuildi -
Q sho.ng nionod construction,and hereby of Nle city menus upon tie
W aWw-mentioned se ertyUK for indemnify
An keep ea
G (We)agmensaw,indemnifytedhich harmalessIn
tie City of CupcNnoid City
rA labilidesJualitmeinconsequence thmeamudofthisGmit. may In uywy ucsue against said City
U 2
APPLICANT
PLIC NT ofD granting of This permit. /1 1
F7 SOURCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date !- ,VJ
SOURC�REc ULATIONS.
(r �� tiz105 Re-roofs
Elgnmur A su o.trumr F Oats
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupdt sure,arbandle hazardous material
u defined by Ne Corpsman,Municipal Code.Chapter 9.17.and tie Health ted Safety
cone*Sectionxss3x(.r. / All roofs shall be inspected prior to any roofing material being installed.
❑Yes �!(
Will Nc applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harsN.0 air conuminuu As defined by IW Bay AmaAir Quality Management all new materials for inspection.
Dldict7
O Yes MAI
I have rad Ne herardaus mau alis m4ulmmcnu under Clupur 695 of the Califor.
nu Health A Safetycre,Secdmu 35506,75533 end 35534.1 understand Nm if Oe Wilding
does not currently have a unenL Nat It is my unarroodby to mndfy de occupant of Ne
requbem 0w prior mWants,or&ccru0caeofCm Signature of Applicant Date
N ' S All roof coverings to be Class"B"or better
Owner or suthamcd a em Dam
iJ