00080099 (2) CITY BUILDING
oFN DIVISIONN°
IPERMIT CONTRACTOR INFORMATION: -
RDamrvc ADDRESS
FT BAKER DR BRAND KITCHENS & DE NiNM1O 00080099
OW'RER'SAME: APPLICATIO S B T'
A u' Z.AKI 13715 QUITO RD r4/2000
PHONE: SANITARY NO. CONTROL NO.
J (408)871-8190.
G C ARCHITEC(ENGINEER: _ BUILDING PERMIT INFO
g m 6 BLDG ELECT PLUME MECH
�a -
Z z 4 n I h...b 6m I an I a CO c sed under possums Rol'Ch pier 9(commencing s Job Description
pz—❑ Ynlinn ra g
rNcw whnse=doeditlI)arnmismn3anneBuainessandrmressiamcode,yndmrfiam KITCHEN REMODEL
isc mR threes freer.
s e5 Lieeasa cws . Li=,a �'�y�
' r ,Dam �,i_mp p_ cmnmcmr 7L— l_
DEC
Sa 1 undersmnJ my plans shall M used m pudic recoils
de ceased Pmtbssional _ 0
= OWNER exemptBUILDER DECLARATION
1 hereby allirm that I am, had .an .be Profession.
License Law for,he -
Zj following reamer formiint Il131 5,liusiter.nail ve,de oli Gds:Any city ora structure -
au It O which requires u e.also re ronmmct,aper,improve,demolish, file
repair ed swaare
at pat heor isscensecta6o requires the the pookilicant for Conarauch rminnices Lariv(mamme,n
— thathe700) 1Divisisof,he 0theBusines andPele"ma,Code) S Ft. Floor Area - V'lI i
orChapter 9
that he is c with Sodom an anoI n,basis 9.f e alleged Iss and ien.Any i Cnion q'
nr that he 7 31.5 b rang ti and a, .psis fnnbe ctsthexemption.Any inflation
of pol r o mons nr any deed m rar a pcmrir gubJme me appy=ant to a a.a ponmty Occupancy Type
ornu..rrom nra..r nnnnredm,Ilnrs csstga APN Number .
01,mrnmee fthe"openy,or myemplayccs with wages m nheirsole compensation, 35611.030. 00
will do the wad,and,he structure is not intended or offered for sale(Sec.7f ,
Bnsinass and Pndessians Cnde:'I'It'Cantm=la,'a Lmenm Law day it...apply to a. Required Inspections
caner of property who builds or improves thereon.and who doer such work himself 1.01 — FOUNUAT I ONp
or through his awn employees.pmthinvided such impmvemennre anot intended or '
offered for sale.It,hood.er. be handi^g a,imp sound,I,sold within alae year if 1.02 — PIERS
completion,the insi uiWcr will have the burden of proving that he did no,build nr -
impmvefcattorsaeufwlc.). 103 — Ul
❑Las uwaer onhe propar,y.am esdasmely connnoin,wise licensed eanha=mrs,a 1.04 — REBA R
erosional the project(See.7W4,Business and Pmfes,sm,Crdep The Cannucho's
License Law does not apply to an owner of pmxrty who wilds or improves theater. 1.05 — ANCHOR BOLTS
and who contracts for such projects with a contmchoad licensed prmaant to the 1.0Fs — SEWER R WATER
Comndon''s l.iccasc Luw.
❑l nor exempt under Sec. 11&PC for this mason 202 — UNDERFLOOR PLUMBING '
Owner.Date 203 — UNDERFLOOR MECHANICAL
WORKER'S CfIMYD;NSAI'ION DIiCLARATION
I hereby affnm made,penmryof porary ane athe!mowing declamdons: 204 — UNDERFLOOR FRAME
10 ❑ 1 base and will mainmin a ConfLe 1.of consent to self-iamn, for Warke,', 205 — UNDERFLOOR INSULATION
Compensation, as pmvided for by Section 37W of the Labor Code. far the
perroma^cenrthewed.far.hirntbispermdi,issued. 301 — ROUGH PLUMBING
111 nave and will maintain workers compensation Insurance,as required by section 302 — TUB IF OR SHOWER
3700 of the Labor Cale,far the performance of the work for which this permit is
issued.My Wart Comlrcnsaron l^mmmee carrier and Policy number are: 303 — ROUGH MECHANICAL
Carie,: Policy Na.: �'g'�-\Q 304 — ROUGH ELECTRICAL
CIiR11FICATIONOp EXEMvriONFROMWORKERS' :')e
COMPENSATION INSURANCE 30t5 — FRAME
sc
(This olio.need not be completed if the permit is(a,are hundred dollars 306 — HOLDOWNS
(alwl"rless.l 307 — INSULATION
I lumay,that in the pernm role of.he work lin which this pendh is issued,l 306 — .SHEETROCK
shall nth employ any perm in any manner ser as to hecame sob ed,m the R'mkns'
-Compensation Laws of Califomia.Date 309 — EXTERIOR LATH
Al pllcunt
NOTICE TO APPLICANT:if,nine,making this CeHlficme of Exemption,you should 31.0 — INTERIOR LATH
Z beaamesednea lathe Wud.ce,Crnnpctimoon previsions arms,Labor Mo.you must
ZO mnhwi.ncomply wansuch provisions orthis Permit shall beabroad revoked, 311 — SCRATCH COAT
CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL
ai1 herehy affirm that he.is a eumhudic n lending agency for the performance
err are work lbr wbiab mispemd,1,!,,and(Sc..3091,Cc.Cd
header's Name 501. — FINRL ELECTRICRL ENERGY
y p
.7 Z
Lender's 502 — FINAL PLUMBING ENERGY ,
OI certify that Ihave vedlis appficaronand s.memattire move inmonadaun 503 — FINAL MECHANICAL ENERGY.
E.. cancel 1 agree m comply wiih all ony and county mdureace,and Stam laws relow,
O U to building consimarrion.and hereby ammonite representatives ofthis city to enter upon 504 — FINAL BUILDING ENERGY
a+ W me.tna(We) a gree 1.pmparty far impectn,n purposes' 505 — FINAL ELECT R I CAL
[r L (We)agree m.cost and expenses
and Ire,hamay in the way s'Ctincoem,against
said
C.7 z City in co judgments.Costs and engemi which may in any way aecme against said 506 — GAS TEST -
APPLICANT
she granting of this permit.
APPLICANT UNDER STANDS AN LCOMPLY WITH ALL ON-P INT
souREsu�.Anorvs. / B�Jti Issued by: 507 — FINAL PLUMBING Date
sign. of pp actual aced r 1 Date Re-roofs —
HranorDD nAUApantcoLI or handle
YP 509 — FINAL GRADE
Will ft app!HAoDO building occupantmarca,.:mill(harmNnuS material T sof Roof
as defined by the Cupertino Municipal Cale,Chapter 9.12,and the Health and Safety 51.0 — FINAL PLANNING
Crdu,Section 25532(a)? _
❑Yes t 0N All roofs shall b5IjApeeted-FIlMAtn aIi�JBbl3t,ntlffaffrxing installed.
Wilt the applicant or future building occupant use equipment car devices which If a roof is installed without first obtainingan inspection, I agree to remove
mit hmwdausair cunta.rinums mdnfincd by the nay Area An Quality Managcman, P �'
' ipUG? all new materials for inspection.'Applicant understands and will comply with
°Ye5 ON. all non-point source regulations.
1 base read mo haeard I,materials equiremmns under Chapter 6.95 of the -
C.lifome.Health A Safety Code,Sections 25505,25533 and 25534.1 understand that
ifthe building does at currently haves t t.ohm it is my responsibility to..it(y she _
cupan,of the reyuiren,ants av or a and prior to.ssmume of it Certificate of _
Occupant
8 � Signature of Applicant Date
own uamonzed agean ate All roof coverings to be,Class"B" or better
OFFICE