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04030163 (2)
CITY OF CUPERTINO ` BUILDING DIVISION PERMIT hcom© ,R'ACT0V1NFO0iWATI10n,: BUILDING ADDRESS: PERMIT N0. CUPERTINO KITCHEN DESIGNS 04030163 ' OWNER'S NAME: PERMIT ISSUE DATE 12 •JE: SANITARY 4:7OL NO. ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ti0o LICENSED CONIRACTOWSDECLARATION Job Description C 1 Mmby affirm don I am licensed undcr provisions of Chapter 9(commcncing - b Ovid,Sau .70O0).f Divismn]ofihe Busines+W Prorusiu�Code.uMm licen a" inmBr eanderrcctJ ` REVISION- TRUSS CALCS S(�? Llce ,/ g tLl Dam con --NO—NEW— RMIT ISSUED/ ORIG. $ 03120081 QQ W ARCHITECTS RATION a �atnd mY NmC ahall W mmd ublte me.,& ic icdu LLo Lkcnsed Professional OWNER-BUILDER DECLARATION at I peachy from that 11. exempt from the Conuacmrac:Any for the i p o (Mowing mason.(Section 8131.3,Business'. and improve. dca al Cmlc:Any eiry at Counry $ which nm eresinsurance, a all a Uimacomithe tltec improve,h Permit t ser repair any structuned tmeme, hathei vaman,to ms thovisio so for mucCommCanit LUCnro file a aLaw(Chmmem S Ft. Floor Area Valuatio� (comma licensed Pursuant 70th)of Division of NC Conu mess ad Padf simil Com).1 9• 107 (commencing im is CowiNScnirn]Ondthe l;visioassis fr nfthe Bed!exmpton.Any n vi Cale)or _ n of Simon,70�5 bydsay applicant lots Permit subjects Nee appltroaanlm a civil'penalty of APN Number Occupancy Type not mom Nan five hundred dollars(SSW). Lathe work. ofInd themoc,mmy with wagess (Seele eompenuness 3561100 a-. 00 will dotheands: swcturtommeintended o Law dosted not-plytOaa.Bminrss Required Inspections and property which Code:The Comrcmrs IJame law uch not apply to an owar is 9 P property who Wilds i i d dovesch app.eracho sea oOchwmk oroffaorthrough his ownampl0,Wiprovidedopmewpim 11 sold has art not ear(ifdosoRertd for.le.lf, however.Ne building m improvement is sold within one year of.prove f r purpose mwmsf �J builder will have the burden of provinP Nn W did not build or improve for pugwe of ` �• \ at1eJ. ❑I.at Owner of de property am aschrewly contracting with liccascd conuac+ma to S convect the project(Sec.9044,Business and Prefessimns Cade:)The Contrac70ra U- -\ ttve law does not apply he an owner of property who builds or harrows theman,and. who contracts for such pmjecu with a contranor(s)licensed pursuant In the Conlsaetoes \ v Lice.Law. 1 sum exempt under Sec. .B&P C fur this rc.on uer Dam WORKER'S COMPENSATION DECLARATION 1 hereby arm under penalty of perjury mm of the following dColantiaru: ❑[haw and will munuln a Certifiam of Courant m self-insure for Workers Compcm .tion,as provided for by Salon 3700 of the Labm Code.for the arfarmaorm of dm work for which Nis permit is issued. 1 have and will maintain Waukee,Compewtion Insunna,as required by Section 3700 of Ne labor Cade.for the Performance of the wort for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arm' o 'cess 57Fl-rr f—`•tf�D Policy No.: CERTIFICA OE�F�Pf10N FRRS' COMPENSATION INSURANCE E ' (This section need not W camplemd Bthe permit b intone hundreddolhn($100) or It..) 1 certify that in Use performance of the work for which this permit Is issued,I mail oat Cot any Person in any manner a0.to become subject to the Wortera'Com icamdam Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:If,after making this Ccnificam of Esemption.you should became subject in ave Worker's Campanamon provisions of the Lalwf Coda.you must �Z forthwith Comply with such Provisions or this permit shall W deemed evoked. ZO CONSTRUCTION LENDING AGENCY [�. 1 bemhy.Rum Nat am.is a am om,ma homift agency Am the Performa..of a> on,work fur which this Mona is issued(Sea 31197,Civ.C.) fGl;� 1<ndcrs Name G Lender's Add. UVO I Octal dist 1 have mad thio appliation and cute that the move infmumahm is E•' cartca I agree 70 comply with all city and county pNiantts and sum laws rtlning m 0U building conswction,and w.indeyauNarice dkeephenwivaaf this eiry mcnmrn s ., above-m rmaned prepcny,for Inspection purposes. (We)agree to saw.indemnify and keep harm IW City of Capitation against _ F NOWIII .ju u.cosuand capctrses which may in any way accrue against and City Uzq eo etranting of this Perm=' Date ^ NT DERSTANDS AND WILL COMPLY WITN ALL NON- OINT Issued by: E R TI Re-roofs rt Ap mmVCmnmm1or D+m HAZARDOUS MATERIALS DISCLOSURE Type of Roof the applicant or future Wilding occupant amm or handle hamahm mamrial as dcfined by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety Code,Section 2553](ay? Allroofs shall be inspected prior to any roofing material being installed. ❑Ya �Nu Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove chat harmato air canmminanu donned by the Bay Area Air Quality Management all new materials for inspection. District? �1 ❑Ya T Ihawee ha.rtlaysmaterielsmqulmmenuunderChapter6.95ofthe CalifOp nice Hcaldt&$. ctyC M.Sccdom 25505.25513 and 2553a.l umkrsund thmifdm Wilding d note a((rpady ve a tenant Nat itis reaPo uhilay ed CodfY Occup. of the mq ; h mat tlemes dm 0art Cent ser gppmr Signature of Applicant Date Ow authorized agent < Dat) All roof coverings to be Class "B"or better