08050177F
2
CITY OF CUPERTINO
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BUILDING DIVISION PERMIT,
CONTRACTaORIINF�ORMATIOI�
BURRING ADDRESS:
PERMTf N0.
10247 VISTA KNOLL BLVD
KITCHENS BY MEYER
08050177
OWNER'S NAME:
PERMIT ISUEDATE
ft EVA WANG
278 CASTRO ST
05/22/2008
ONE:
SANITARY NO. CONTROL NO. 7
(415)968-8318
ARCHI ECD'ENGINEER:
BUILDING PERMITINFO
'BLDG ELECT PLUMB MECH
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LICENSED CON RACTOR'S DECLARATION
Job Description
1 hereby &M m tat 1 am licensed under pmvidons of Chapur 9 (commencing
wilt Section 70M) of Divides 3 of to Business Add Pmfeuioa Cale, and my licensee
RMMDL BTH(50 1/2SQ)CBNTS CNTRTP SHWRSRRND
in full forte ane eR 32.3Cii 1
Lieenxe cla, Lle.a
TILEFLR
Rax • 1 - Contrusor L.anf W10� r!✓
ARCHITECTS DECLARATION 7
PLMBNG&LGHTNG FXTRS. ADD 1GFI OTLT RPLC1 EXSTNG
I understood my plan, shall he used u public moon
.
GFI OUTLT ADD ICN LITE OVRSHW RPLC EXSTNG LT OVR
Licensed Professional
OWNER -BUILDER CLARATION
m
1 thereby aRrm Wal 11. exempt from We Contractors lxux law for We
fallowing moon. (Sudan 7W L5, Business and iva Case: Any city ct county
whim w. de h, err repair swctm
required . permit re concoct a1Wn impmw,
iufuanu.alaantthe a roviSlondf to COnp WI's icenslo e ave wtemut.
ermi
its h Permitd
WommencmmNpunumttoWepmvivoion3of
Sq. Ft. Floor Area
Valuation
oBusinmhnittmclaw(Clupxr9
of doBusinessus and Prafea vi Calc) of
Sectionseam
$15394
and Meof
dual M s exempt basis for of
to io is exempt therefrom and to bass for to Alleged eaempdan Any
Semon ?011.5 by tory applicant (m •permit dbjero Ne Applicant m a civil pealty of
l Penalty
Sol mare two five hundred dolim ($500).
Number
3261312 9 tl 0"
Occupancy Type
❑ I. u owrcs altlie prapvty, a my wployen wed wage, u to'v ale campuauan,
will do to wmk, and. The Cam u rrot4tetWc0 m a@rod (orale (Sec. he . B neer of
Cao: The Law does rot apply
Add Pmfads,
Required Inspections
f towner is
W improves decors dvdOo himsedlm through his
pmncmplooWild,
awncmplMeu,pmg deat=bjmn,andwommtitaort
for ale.IL
dchimpmwmutate.yearr
oflmoRered
however,to building orimpmwmutiedid withinone year or cemoss,fo,Weowner-
or improvement
Wilda vi0 have de WNrn of passant thus o did net Wild m improve for puryase Of
ate.).
1, u Owner of tk pmpens, Am exclusively cmu acdnt w�W Iiceaed cannula. W
construct the pmjen (Sec. 7014. Business and PmfesvOa Code:) TW Contractors U-
ceae Law does not apply x an owner of property who Wilds or improves d room. and
who unrracto for such pmjecm wit a contractor(,) licensed pendent x to conaacloes
Fund Taw.
❑ I am exempt under See . B g: PC ran this mann
ne Data
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury ane of to following decle.uorts:
.have and xof tWCode, sore far Workers Compeere
action
Oban, Providedfor by 37
provided ran by Section 3?Oo of the Labor code. ran We peRonnance of dx
d.La
r
vmrt for wNeb Nis permit u isdM. '
0 I have and will maintain Worker's Compevauan laumem, u tequired by Section
)?00 M tc Labor Code, for We per(ormaxeaflhe work for which to permitu issued.
'
My Wm ,Compeaadan lau.nca carrier Po.qlicy number Are:
da.n,dp
caner, ✓In.Cfe/nCATEOFEX gTONFR.:
CERTIFICATE OF WORKER/SLP3i
EXEMPTION EA5
SAnONII
COMPENSATION INSURANCE
(This xcdm need net W completed lite permit R fmmWhuedred dollars ($100)
_
m ka)
I USWY tat in We performenee of to rood, for which tis permit is issued, I shall era
employ myperdn in any macer d u W become dbjccr m tc Worte.' Comfeauon
Laws of California. Data
Applicant
NOTICE TO APPLICANT: IL alter making this Certificate of Exemption, you should
Wcome,ubjm m to Workers Compensation prevision, of dm labor Cade, you most
wit comply wit such proviuoa or tis permit shall W deemed revoked,
CONSTRUCTION LENDING AGENCY
1 kmby AMda tat thers Me comtuvnn lending sgenry, for to performance of
We wart Ire which tp peoput u issued (Ser. 309?, Civ. C.)
Lenders Name,
Lenders Addmex
1 certify tat 1 have mad this applicoiu and sum to to move information i,
correct- 1 acme W comply wit sit city and county or arcus and sox laws relating in
Wilding coasuucdan, And hereby
autorisn repmxentouws of to city W user upon the
aow-mcnudgm pmpc for iexpecuu puryaea
(We) agree to saw, indemnify And keep harmless to City of Cupcnino against
IR costs andwhich may in my way amuse Ataiat cid City
Co.,..JudgmenR.eoen
of tape
of to permit.
A PLICAof to UNDERSTANDS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOU Rp�uIATIONS.
Issued by: Date
7 2z�d p
Re -roofs
P7--�'
SiiLxt ofApplica Montracmr Dane
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building ocevpduWm or handle IOM r4us material
AS defined by the Cupertino Municipal Cade. Chapter 9.11. aed the Hult and Safety
Code, Section 25571()? /
❑ver 24
All roofs shall be inspected prior to any roofing material being installed.
Will tea Bcd1 err form Wilding oecu nth use WuiirQwmdMana which
fro t
If a roof is installed without first obtainingan inspection, I agree to remove
Pe g
emit 1waNna air rontomimnu u defined by We Bay Area Air Quality Management
e
all new materials for ins ee[ion.
P
Obuin? /
❑Yu 0
1 Wvc real to huudous materials requimmcnu under Chapxr6.95 of dme Califon.
niafYalt9Safemycade, Savor 25.50.5, 25533 And 25534. I uede.und todtc Wiling
does not curmndy haw a anal Neth is my mspoaibiliry W notify use occupant of to
mquiremcots which pmysm W met prior W issuance of a Cc drica c of Occupu¢y.
Signature of Applicant Date.
Al!)69�/��
All roof coverings to be Class's or better
Ownerronho-rind