04030260 CITY OF CUPERTINO � ^' ' "' `
BUILDING DIVISION PERMIT 0ONTA,-cTOWINFOA A ' 'I"
BUILDING ADDRESS: - INTERNATIONAL KITCHEN EXCHANGE D 04030260
W NER'S NAME: PERMIT ISSUE DATE
E:MORD I HUE T40MR2TRAP Rn
SANITARYN 2 0 AOL NO.
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=3 (� Q
app LICENSED CONTRACTOR'S DECLARATION "' - -- '"" -"— Job Descrl tion -
u 1 hereby affirm Thal I am lwo"W u��der��,,PPmvisions of Chapmr 9(commencing P
`+ with S.MB10 i.fDiv Ion7of Nc BusinLS(p10 fu io Co ,gpp licenmu
tMnj- Uwl ad.Trees. 6.1 Lic
n / BATHRM REMODEL (MS . & HALL)
^F D Com
C ITECI'S D R O
1 undersand my plans.hall W seed as public..,us
�yU
Be
Gt Licensed Professional y/
OWNER-BUILDER DECLARATION /
0I I hereby.(Sinn slam 1 1. [Bumps from the Camas,Co License Law for the
pO followingreason. ermit, ]fH1.5,Bums and improve.
Morons Calc:Any city orcounty
$ which requires a pemit n .sensed,pWr,improve,demolish,or repair any stannum
t-ZNprior m its issuance,also(equine the applicant for Permit to Ne a signed summem
Nat be is licensed pursuant to the provisions of to Coamcwrs License law(Chapter9 Sq.F[.Floor Area Valu On
as (commencing with Section 7")of Division 3 of the Business and Profusinns Cods)or
a
3.. Net he u exempt deuterium and Ne basis for Ne alleged exemption.Any violation or �A wT--AASSSs.. s1�.�
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 3 MS NDS bl r 0 0 Occupancy Ty
net more than Rve hundred dollars(1500).
❑1,as owner of the property,or my employ..with wages.their to eorepenasslan,
will de the work,and the sconjuse isnot intended Marietta Waste(See 7W,Business Required Inspections
and Pmfeenons Code:The Convector's Licertse Law does not apply m e an owner of q P
propeny who buildsorimproves thereon,and whodeusuch work himselror through his
own employees.provided Nal such improvements am not intended reoffered forsain.If,
however,Ne building or improvement is sold within ane year of.mpletian,the career-
builder will have tial burden of proving that he did am Wild or improve for purpose of
sale.).
❑1.as owner of the property,am exclusively contracting with licensed contractors in
wmlmcl the project(Sec.7614.Business and Professions Code:)The Conuacmr's Li-
ve Law does not apply in an owner of property who Wilds or improv thereon,and
who contracts for such projects with amnuacter(s)licensed pursuant to the Co^maser's
License law.
1 am exempt under Sao .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
410 1 haroby affirm under penalty of perjury One of Ne following dedidauuns:
l have and will maintain a CeNOum of Consent o sslf-insum for WarkersCompen-
smon,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compemauon Insurmce,as required by Section
3700 of Ne labor Coale,for Ne performance of Ne work for which Nis perolil is booed.
My o kcl nsauon In.l urer¢c tarsier and Poli (ucj' Q
e� 1 1 I (J
CER
COMPENSATION
M WORKERS'
COMPENSATION MMMS RANCE
(Thu section need not W completed if da permit is faronehundeed dollam(Slop)
ksa)
L certify Nat in the pertmorence of the work for which Nis perm¢is bound,l shall not
employ any person in any man.rm u W become subject to the Worker'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If.after making thio Ccnificaa of Exemption,you should
become sobjeel in the Worker's Compensation provisions of the tabor Code,you must
O forthwith comply wit such provisions in this permit shall W deemed rewokcd.
ti yCONSTRUCTION LENDING AGENCY
1 hereby affirm Net there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097.Civ.C.)
i Q lender's Name
z, Lander's Address
V Q 1 certify Nal 1 have read this application and seam that the above information is
W H cmnecL 1 agree m comply with all city and county ordinances and stale laws relating m
pU building construction,and hereby authorise mpeasenouncs or this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep homless the City of Cupertino against
Sap Ilabilitins,judgments,costs and expenses which may in my way accrue against aid City
U 7 in...cetron.of the greasing of Ibis permit.
G APPLICANT UNOL'RSTA AND LL COMPLY WITH ALL NON-POINT Issued by: Date
yfvrT
S U EREGU TIO
Re-roofs
awns of Applican ontrscmrwDam
HAZARDOU ATERIALS DISCLOS E Type of Roof
Will the applicant or future building eccupmtiame or handle haasrdous material
as defined by the Cupenino Man al Code.Chapter 9.12.and the Health and Safety
Cade,Section a5533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will Ne 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 ha.aranus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
[3 yes M4.
I have mad the basardeds materials requirements under Chapter 6.95 of he Califor-
nieHcolth&Safety Code,Sections 8505.35533 and 8534.1 undersand Naz ifthe building
*d 'curretlyhoYc a W Nvs it ix reaprecom sty m natiljdre.cupan�t rnr Nc
entswhichmust melp I an.arice Rua of Oce ey51 Signature ofApplieant Date
r.,soh .sent Data All roof coverings to be Class"B"or better