05060018 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT WOLvt IUMT�ORTIVTN't�RMATf
BUILDING ADDRESS: ROYAL KITCHEN AND BATH PEHMITNO'05060018
1034n TAR QNI)A�q WY
OWNER'S NAME: PERMIT ISSUE DATE
CHRIS & ANDREN STACK 5383 WOODSTOCK WAY '199'1
' SANITARY N0. CONTROL NO.
408) 265-0161
ARCHIT ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
job LICENSED CONTRACTORS DECLARATION lob Description
1 Wmby afErm Wt 1 am licensed under provisions of Chap ar 9(cemmencin{ p
With Sea&.7013))of Division 3.f the Business and Pro(cuians Cade,ab my lieenw k
nCall
m.Cl(am anaertea // ADD 516 ' (FAMILY RM/KITCHEN)
tj� Licen�se Cl/ass/_��94 Lk.N (t�z��CS�$ /
' °Tor era AliCHITECCBD�ECLrAMnoQAfe.t;4TUµ hCONTRACTOR: ROYAL KITCHEN & BET (#01000013534)
u 1 understand my plans shall be wed u public recmds
go.J–, Licensed Pmfassumal
b0� OWNER-BUILDER DECLARATION '
1 hereby..Tom
that I am exempt rrem the Convectors UccMe Law far Na
p o following mann.(Section esun
1071.5.Business and Professions Cole:My City ar Comfy
$9! which rcquvu a permit to connmct.Alam.Win—.deawftm.ar reput,any stramure
_2m prior In its issuance.also requires Ne applicant forsuch permit in file a signed statement
< low heIslicammdparantMteprovisionsOftheCon"acmeslaemelaw(Chapmr9 Sq.Ft.Floor Area Valua�9TD400
w
(commencing with Section 7000)of Division 7 of the Business Was Professions Cade)un
that he is comfort therefrom and the basis for the alleged esempdon.My violation a(
Section 7031.5 by any applicytt far a permit abjeeu the applicant m a civil penalty of APN Number Occupancy Type
nat roam sen five hundred dolim(SIDB). 36932024 . 00
0 1,u ow"s of the Fop",of my employes with"gas u their mlecnmpeewdon,
will do the work,and theawmure is mawwnded aroRemd formic(Sec.7061,Budws Re aired Inspections
and Profession Cade:The ves trecmrs and
who
Law does rot apply if an awter is ������� .
property who buildsr or impmvea thereon,and who m dem,such work hwndi(m through his
awe emplayen.provided that reach improwmmu tae roc inwndd"oRered(m axle If.
however,the building or impmwmem is mid within aro year or campkdw,the manna. FINALE'D
waidear
a na-
waida will have the burden of proving that M did om build or improve far purpose of
ark.). � np
0 I.u ownstmr of the property,am exclusively contracting with liswed mnusewn w p�.11,) q III!^
coruct Ne Probes(See.7044,Bowan And pcefessow Cotler)The Contractors U.
came:law dor not apply in an owns ofpmpertyvho builds ar impmwsn thereon,and,
whence Law.
[3
such projects wiNacoovumr(i)Ikemed pursuant to BSContracmrs �& vs tj�g�6f u. aa,�
License law. BUILDING
eA�tatPal f��`YR■A`�V�'°`
0 lamexemptunder Sea .B&PC(m thlo reawo
Due
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of we following daluWorec
0 1 hon and w01 maintain s CeNOaw ofcoexent w mlf-Inwm fa Wwwgcompen-
amm,an provided for by Section 7700 of the Inbar Cade,for the performance of he
work for which this permit is Issued.
0 1 haw and will maintain Workers Compensation woomme.as rcgHred by Secdon
3700 of the Iabm Cade.for aha perfarmance of Ne wart fm which this prmR is issued.
My Workers Compnsatim[rsonna artier and Policy number rm:
Carrier. �.✓�idl Policy No.:
CERn OFEKEMFDON F7tOM WORKERS'
COMPENSATION INSURANCE
Missectim need not W cmnpkwd Ulhe permit is froom hundred active($100)
or want)
I roily that in Na performance of the wart for which this permit 13 Wood.I shall not
employ ,any prmn m any mmrcrso u w became mbialta be Worked'Compensation
Laws arCAlbfamis Dara
—s �Lry–GS_T�� -
Nctrue TOaLi acorn matln{Nb Cesi naw of LAW Code,
you should
became subjan y the Worker.Compensation pmMumu or the labor Code,you mus
�O faMwith comply with such provisions or this permit Nall be dermetl revoked.
z rr�. CONSTRUCTION LENDING AGENCY
5I hereby affirm tow Nem Is a eenslruNon lending agency for dor performance of
7 tie work rue which this Permit is issued(Sen.7097,Civ.C.)
ap lendces Nome
a Z Lender.Address
U O 1 cMify that 1 haw read W.application and mor this don maw information Is
Dr U cons-n.I agree w comply with sit city and county annnuwa and slow Iowa miming w
bulldin{conwuctian,and hereby amhodse represmudsa of this city to mwrupna the
LLIaMw-mmtiamd prepeny fm inspection purposes 117
a (We)agree to taw,indemnify and keep harmless the Cly of Cupertino against
cn liabilities,judgments,casts and expoams which may in my my sccmc against said City
U Z in consequence or the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REO LATIONS.
aege &-A Re-roofs
SiolmodorA.pplicanUCmisectar Dew of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will de mpliant or fuuue Willful mtupm Yam"handle haallow mawrial
u defined by the Cupnim Municipal Cade,Chapter 9.12.and the Health and Safety
section 25522(.)7 All roofs shall be inspected prior to any roofing material being installed.
0Yin 4dNo
Will the applicant or(alum building mcvpant use cyuipment or devlaa which If a roof is installed without first obtaining an inspection,I agree to remove
craft hacamus air co uminants u de0ned by the Bay Area Air Oddity Mmageewnt all new materials for inspection.
District?
0Ybs
[have cud the haurdimsmaterials mquimmenuunder Chapter 6.95 of the Collier.
nut lwsiN&Safety Cada.Sections 25505.25573 uW 25534.1 undersand than if the building
do"not commonly haw.wnan4 Nat It is my responsibility w nobly we occupant of the
mluimmenu which mora be at prior in Issuance or.Ceruncaw of Occupancy. Signature Of Applicant Date
Tza/�� All roof coverings to be Class"B"or better
Ow .mhacimd agent Dow