04030021 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT 0 C0NTRAC�TORSINFORMATION
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMIT No.04030021
a
OWNER'S NAME: PERMfy LSUE DATE
JUAN NE:
SANITARY,N0. ONIBOL NO.
(408) 257-4900
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0 0
tido LICENSEDCONTRACnOR'SDECLsorChar JobDescrip�����®
w I hereby affirm Net 1 em licensed under Provisions nT Chapter 9(commencing
,;z with Smtion 7000)of Division Jof Ne Business erM Professions Code,erW myliccnse is
in ren rare d , -so c&3 TEMP POWER
`s = MAR 0 4 2004
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ARCHITECTS C ATION
I ts r J m ns aM1e used is roc Ns
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BUILDING
if 1 hcrthy air,. I am excmpm nt IW Contractors Lima.Law for the
i 000 following reason.(Section 7031.5,Business and ProRssions Code:Any city or county
which requires a permit to construct.ager,improve,demolia b,or repair any al—mon
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now to its issuance.also requires Jt apPlieam for such permit W file a signed sutemem
< that he is licensed pursuant othe Povilmml.fineCmUrmtohLima.Law(Charter 9 Sq.Ft. Floor Area Valuation
�1- (commencing with Section 7000)of Division 3 ofthe Business and Professions Code)of
..
that he u ammpt thmefrom and Ne basis for Ne alleged camnption.Any violation of
Section 7031.5 by any appllesnt for a Permit subjects the applicauo a civil penalty of 3 M1113IC Me10 0 Occupancy Type
not mown Nan fin hundred dollars($300).
❑1,a net of the property,or my cmployco with wages as their sok compensation,
will do the work.and Nemumum is not intended of ofit for We(Sim.7044.Busireu Required Ins ections
and Pmfa.Wmu Cade:The Correctors Licensw e ladocs ret apply W owner,ownof q P
progeny who buildsor fro mma Nereo^,andwho doessuch work himselfaro through his
awn employoes.provided Nat such improvements see not intended oraRered for sae If.
however.the building or improvement is sold within one year of eompletion.the owners
builder will have the burden of Proving them W did nor Wild or improve for purpose of
sok.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
comwcl the projem(Sec.7044,Business and ion ProfessCode:)M Contractor's I.i-
cove law Coca not apply to an owner of property who Wilds or improves Norton.and,
who contracts;for such projects with a convsmr(s)licensed purcurand to the Contractors
License Law.
❑1 am exempt under Sec. .B A P C for Nis reason
Owner Dan
WORKER'S COMPENSATION DECLARATION
1 Mmby a0irm under penally of Perjury ren of the fallowing dmh000ko :
J Ihaveurd will maintain aCenifi<at of Consemtosdf-insure forWarkcfa Compere
L�k
.a provided fm by Section 3700 of the labor Code.for the pedormrce of tit
for which Nis permit is issued.have rd will maintain Wo lues Campenadon Insurance,a required by Some.
of the IaWr Code,for do,pcif....of Ne work far which Nis pmmit is Issued.
orkers Comoccnudon I�rmtt carrier and Policy n/opt/Wr�are�Oer:" ]Tgl mG ("'�/t/D Policy _(_(2�— IU
CERTIpIC OMPENK NFRAN WORKERS'�� /_ l
COMPENSATION INSURANCE �
(ITBsemion need online completed if Ne permit Is(mune hundred dollen(SIM)
or It.)
1 certify Nat in the performance of Ne work for which this Permit is issued,l shall not
employ any permn in any manner so a to become subject to the Workm!ComPeaadem
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become subject in the Worker's Compensation provisions of the lahm Code,you mum
.JO fhawilh comply with such Provisions or this permiishall be deemed revoked.
Z �" CONSTRUCTION LENDING AGENCY
(-.- I hereby aRnn that Nen is a mnsvutaim lending agency for mho Performance of
,7 Nc work for which this Permit is issued(Sex.3391,Civ.C.)
W Q fender's Name
6. Lenders Add.
L)z 1 certify Nn I have read this applicaion and stat them tit aWve information is
". correct 1 agree to comply with all city and county ordinances and mate laws relating W
C)- building maknommion.and hereby moomm mpresenulivos of this city to enter upon time
r W ahpve-mentioned property for inspection purposes
Q. (We)agree to save,indemnify and keep hamlcss the City of Cupenino Baia,
rtA liabilities.judgments costs and expenses which may in any way accrue against said City
f,z in cormxgnence P c ratingo Nis ftermik Date
APPLICANT ND S7A AND WILL COMPLY WITH NON�POINr Issued by:
SOURCE ON' _qC (
Re-roofs
51owDi na r Applicant mm"clor
am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or future Wilding occupant store or handle bvardo ,material
a defined by Ne Cupertino Municipal Code.Chapter 9.12 and the Hca1N and Safety
Ide.Seen.25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes HNo
Will Nc applicant or future building occupant uce equipment or devima which If a roof is installed without first obtaining an inspection,I agree to remove
it M1araokma air conumimmut a defined by tit Bay Arta Air Quality Management all new materials for inspection.
mrict7❑YesIhrveroil aomusmatrialirtquimmenuunderCluptrd.YSofNcGlifor
NSC ,Sodom 25505.]5573 end 255Jd.IumkrsNnd thai(the Wilding
es nam c y den atna LNatlll5myresp uibililyWnoUfythemcup t oI
uimmcn hk mbcmapdor iavanmaracedmam _ Signature of Applicant Date
some rr `� Da All roof coverings to be Class"B"or better
f�C CITY OF CUPERTINO �
TEMP POWER v
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ITY bF
UPRTINO PERMIT APPLICATION FORM
APN
Building Address:,90 CX
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f�/�/n/l f 0/'L I /1 l � U 2dY/✓� '
Owner's Name: Phone#:
Contr nor: ( w� I / S/Phonig yah X17 pa License#:
CtBuilding
tact, r�(�J /G � / Phone: O� /�� / Cupertino Business License#:
Permit Info:
Job Description:
C) 0yj
Residential Commercial ❑
6�
Cost of Project:
•
Ap
Qty
is le Fee ID Fee Descri tion Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
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