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CITY OF CUPERTINO
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�-GONPRACWTOR INFORMATION "%
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
CUPERTINO KITCHEN DESIGNS
PERMIT NO.
1662 EY RD SPRING CT
10562 S DE
PHONE:
SANITARY NO. CONTROL NO.
(408)257-4900
ARCHITECfyENGINEER:
BUILDING PERMIT INFO
BLDGE PLO
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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1 hereby affirm that I w licensed under provisions of Chapter 9 (mmmcncing
with Section 701k)) of Division Sof the Business and professions Cade, and my license is
in roll farce and effec / �g)s�4?
Llatc-- Lm.g__
KITCHEN REMODEL- UPGRADE PLUMBING ELECTRICAL
Dote
AND MECHANICAL, INSTALL NEW WINDOW IN EXISTING
T'SDECr
As shall use DECLARATION
1 undcrsmnJ my plans shall be utsJ as public records
OPENING, NO STRUCTURAL WORK
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractors License law for the
following town, (Section 71131.5, Business and professions Cale: My city or county
which requires a permit to construct, aper. improve, demolish. or repair any structure
prior to its issuance. also requires the applicant for such Permit o file a signed smtemem
that lie is licensed'aromns m the pmvimmou one, Comrxwri limvc Low(Chapter 9
Sq. Ft. Floor Area
Valuation
(commend, with Section ]000) of Division 3 of Nr. Business and Professions Code) car
3 O O O O
Nat he u exempt therefrom and de basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
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Section 7031.5 by any, applicant for a permit subjects the applicant to a civil penalty of
no, ..than five handled dollars (5500).
❑ 1, asowher of the property, or my employees with wages as their salt compeusxdon,
366 40tt.00 Required Inspections
will dothework, and roe awnam ia.,intended «aBered larsale(Sec.]014, Buttress
and Professions Cada: The ContraeNra License law dao not apply in an owner of
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pm,aml who builds orimprovou thertan, and who doessuchwork himselfor through his
awn employers, provided that such improvements are not intended craReresi farsale. If.
however, the building or impmvemen, u sold within one your of eampietian, the owner -
Wilds
builder will have Ne burden of proving Nzt be did rias build or improve for puryots of
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�LE
❑ I. as owner of the property am exclusively contracting with licensed mnaactus b
cchmul the project (Sec. ]064. Business and Professions Code:) Tae Cmmuc hoes Li
cents taw docs nut apply to an owner of property who build, or improves thereon, and.
who connects for such projects with a contractor(s) licened pursuant to the Convssrors
nse
Licelaw.
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I am sem p, under See. ,B&PC for this reason
WORKER'S COMPENSATION DECLARATION
I hereby aRm under Penalty of perjury nm of Ik following declarations:
❑ 1 haw and will ofCove fm Workers
3me comf me
cation for bySectionb r Cade, far
provided far by Beckon 3]00 of he labor Code, far the perfarmanm of Nc
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work for which his Permit is issued.
❑ 1 have and will maintain Workers 00mpmed0a Insurarme, as moulted by Sc roan
3700 of the labor Cade, for the performance mf the wart far which this permit is issued.
'
My Worker's Com+pkcvation Ivunnec Omer and Policy number art:
Cartier. �� / — 07 f{�(i Polity No.: .57N
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scctim need oat he cample.d if the p .it is fur one handled dollars ($I010
or Itis.)
I certify Nat in the performance of the, wart for which this Permit u issued, I shall not
employ any perron in any mother so as to become subject o the WorkersCompensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: IL alcor making this Certificate of Eacmption. you should
become subject to the Workers Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this Permit shell be domed ..red.
CONSTRUCTION LENDING AGENCY
1 hereby aQim Nat there is a constructim lending agency for the perfurmance of
Ne work for which Otis permit u used (Sec. 309/, Civ, C.)
Lenders Name.
Lenders Address
I certify that I have mad this application and scale that the above information is
cortex 1 agree to comply with all city and county ordinances and state laws relating leo
building conswction, and hclehy authwira representatives of this city to enter upon thc
aluvc-mentioned pmmrty for Inspection purposes.
(We) agree I. save. indemnify and kmp harmless the City of Capenimu against
Iiebilities,Judgments.cosuand expensou which may in any way same against said City
in consequence of the granting of this permit.
APPLICA ERSTANDS AND WILL COMPLY WITH ALL ON -POINT
SOU ATIO
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Issued by: Date 5- ZdS'-ol
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Re -roofs
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Sgnmum of Appban AZARDOUS MATERIALS DISCLOSURE Date
Type of Roof
Will the applicant orfuwle building acupantuore or handle hmardous material
deNmd by the Cupertino Municipal Cade. Chapter 9.12, and the Health and Safely
. Section 25532(a)?
❑Ya *No
All roofs shall be inspected prior to any roofing material being installed.
Will de applicant or future building occupant use eyuipmmt or device which
If a roof is installed without first obtainingan inspection, I agree to remove
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emit havardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes —Caku
I have read the heaardousmaterials mquimmcou under Chapter 6.95 of Ne Calife>
niceHealth&Safety Cade. Sections 25505, 25533 and 25534.1 urukrsavd dtatifthe Wilding
does rot c have a tema l mat it u my responsibility to notify the occas ent of jhc
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¢quirt must Mme prmrmissuamcor2Ccofican,ofCzj
re of Dale
All roof coverings to be Class "B" or better
0 uth ed nt D,m .