05010108 CITY OF CUPERTINO g �' r wmcs ,• s '-wspsa�' a ;� . g5 '
BUILDING DIVISION PERMIT 8 COL\UXCTjOR vNA'�tO!,�lYIA�IQN ,k
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMITNIO5010108
227 VISTA KNOLL BLVD
3 NAME: PERMIT ISSUE DATE
THOMAS DEFRANCO 10562 S DE ANZA BLV 02 2512005
PHONE: SANITARY NO. CONTROL NO.
(408) 257-4900
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION
I� 1 hereby affirm that I am limmed under provisions of Chapter 9(commencing Job Description
with Section 7")of Division 3.r on Basin.and Professions Cod.,and my license is
infull force and street. ADD 77 ' /REMODEL KITCHEN
R,? License Close Lie.0
p Dau Contractor
` 1 ARCHITECTS DECLARATION
`6
I understand my plam.hall he ties public records
Eyo Licensed Pmfcui...I
OWNER'BUILDER DECLARATION
j<x I hereby AM.that I am exempt from the Cantnctors License Lew for the ..
-OD following reuon.(Secuun 7(B1.5,Business and Profession Code:Any city m,mmy
S$� which requires¢Permit to construct,altar,Imprnw,dcmolLeh.in rep.i,my structure $107000
it' prior m its issuance.also mquiresthe applicant forsuch permit to file a signed statement
< that he is licemcd punuanuo the pmvisiomnfthe Connector.License Law(Chapter 9 Sq.Ft.Floor Area Valuation
22 (commencing with Section 7000)of Division Sof the Bmineseand Professions Code)or
` mat be is exempt therefrom and the Wis for the alleged exemption.Any violation of -
Section 7031.5 by any applicant for a permit subjects the applicant As a civil penalty of ;,., •,(„ a Occupancy Type
not more man five hundred dollars(9500). r
I,u owner of mem •� -'... ' ,�I_J,1
❑ p pent',structure
with wages; compensation,
will dome work,endur The Com i.nneot Licenstended e
Law offend rotten 704n,Boslous / Required Inspections
end property
wh obu Cade:The Contractors and
who Law does not apply fo an owner is ,/�` a ^ q P
own enywhob,provided that umemomandwho annotIdoessucIntended
oreffeor through Af. fr ala
owneer.ftWiprovidedmranchimprovementsarcnet year
of completion,
for owner.
builder the building a improvement i.anld within one)ear of cnprove fee
me owner
builder will have the burden of proving th¢I he did rot build or improve fm purpose of ^ I, 'I���' ,{f(1
1,as owner of me property,am exclusively contracting with licemerouanon
d nm
co loser the Dmkn(See'
TOaa,Business and Rafualom Code:)The Conwctori I.I.
came law docs noupply u anowmr o(pmpeny who Nlus or impmws thereon,and
W
contacts for such pmlecu with a contractor(s)licenxd puramnr to the ConB¢noM1
Liccme law.
❑lamµe mSee B&P C for this season
TION Dan-a•aa'-cs '
�"WORKE SS OMPENSATION DECLARATION '
1 hereby affirm under penally of perjury one or the following declarations:
❑I haw and will maintain a Certificate of Consent An selbinsum for Workers Compete
motion,As provided for by Section 3700 of the Lmor Code.for the Performance of the
work for which this permit is issu.d.
D 1 Iran and will maintain Wri Compensation Insuranu,As required by Sccuon
57M of the labor Code,for the performance or the work for which We permit Is Issued. '
My WmIne.Compensation Imvrana carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rails rection need not becomp osed if the Permit is furore hundred dollars(SIM)
fir less)
1 certify the,in the performance of the,work for which this Permit is Wood.l.hall raw
employ any person in anymanncran u u berome mbjut in the Worked Compi math m
Laws of Califom 'j0P �•
Applicant i/!R Crew► -�—�-
NOTICE TO APPLICANT:IL after ma this Certificate of Exemption,you should
become.ubject to the Woheri Compensation provisions of the Labor Code,you more
.�z fodhwim comply with such provision or this permit shall be deemed revoked.
.~� CONSTRUCTION LENDING AGENCY
. -
T hereby affirm that there its eonstrectinn lending agency for the performance of
,{ ft work for which this permit is Word(See.3891.Civ.C.)
la Q Lender's Name
z lender'.Addrms
J C I comfy mat 1 have reed this application and sok that the about information is '
F corner.I agrte to comply with all city and county ordinances and sou laws plating to
'YJ building Gonane,ion,and hereby Authenticreppssnutivu of thiseiry to color upon the
NU abovnmentioned property for inspection PurPnua .
(We)agree to use,indemnify and keep himeless the City of Cupertino against
ti v) liabilities,judgments.cents and expemu which may In any way accroe agaimt said City
J 7 in eomequ out,of the granting of this Permit.
L7 APPLICANT UNDERSTANDS AND WILV�PMPLY WITH ALL NON-POINT Issued by: Date
SOURC CATIONS, O U _
Re-roofs
Signature or Applic4m/Contudeffir Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicator or future building occupant store er handle hazardous material
defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
.Section 25532(a)7
❑Yu Ta Nu All roofs shall be inspected prior to any roofing material being installed.
'
Will the applicant or future building occupant use equipment or devices which If a roof is installed witbout first obtaining an inspection,I agree to remove
emit hanrdous air contaminanu as defined by the Bay Ame Air Quality Management all new materials for inspection.
Olivia?
❑Y.. NNu
1 have mad the haxaNnus materials requirements under Chapter 695 of tho Califon.
ria HealthA,SafotyCode,Sections 25505,35533 and 25514.1 umknund that If the building
door not cunendy have a A,Are,th I it is m pomihility m notify 1be oceupentor the
mqem�wllftch mast hemµprjDsro ��raCenineateofOrcapaaay. Signature of Applicant Date
�(�J -_os
owner or oumorued ages Dap Altroof coverings to be Class"B"or better G