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04080139 (3)Luiz 00 YUEj �zw 0 n i -a �re< CaU yLLOr YOO ym�s FZs £FC i 0C CITY OF CUPERTINO,a a[1g�+r-i:''Aa-'+�, �.rs' ^sat' .a NTRACT,ORj,NFORM BUILDING DIVISION PER ,$s° P_ ON: BUILDING ADDRESS: 2202B 1 TNIDY IN KITCHENS BY MEYER PERMITNO.04080139 OWNER'S NAME: PERMITLSSUEDATE TONE: SANITARY OL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 o LICENSED CONTRACTOR'S DECLARATION isions Chapmr 9 Job Description p I am It mf (commencing I Wmby affirm that 1 am liauxd under Senion ]IXIU).f Division Jof the Btninusa Profesviuns Code,and my license is �is nmPrc^i ftWsnaerr .� Lie.a 323Oei'� L KITCHEN REMODEL Dam Contract., ARCHITE-cTsDECLARkMN I understand my plans shall W used as pubic records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm than 11. exempt from me License Law for the maso sionsCContractor's which r g arson. (Section 703 1.5, Business and Professions Code: Any tiny lir county which alter, improve. demolishh fie any structure requires a permit illre COMIvires the Perlia asig pith m its issuance, also squires the applicaOf for such Permit to rile a signed statement its hemenicenwit Liccnx Law (Chapter OurContractor'sBusiness Sq. Ft. Floor Area Valu two thatpursuant pro visions of fl tion 7to 0W the Business and Professionshouon of (cat xempt Section 7001) of Dlvlsiofr Code) that he is exempt tMmfrom and dm buffs for Ne allegetl exemption. Any violation o! Ibis m Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of j 3 rak blas daT..U*J7 p p Occupancy Type FTPJ iC YV' 4 not more than five hundred dollars ($500). I, ex owner or the pmpeny, or my employees with wages as their sole compensation. will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Code: The Contractor's License Law does not apply to an ownef of property who builds or improves thereon, and who does such walk himself or thmugh his own employees, provided Out such improvements as nil immrided OroRertd for sale. If. however, one building or improvement is sold within one year of completion. the owner. builds' will have the burden of proving Nat he did not Wild or improve for purpose of nam.). ❑ 1, as Owner of Inc property, am (CILliNely contacting with liecnsed convectors to construct the project (Sec. 7W. Business and Pm(essions Code:) the Contractors Li. . crave Law does not apply to an owner of propcny who Wilds or improves motion, and who contracts for such pmjccu with a einuactm(s) licensed pursuant to the Comnctor's License Law. ❑ 1 am exempt under Sec. . B & P C for this reason Own Date WORKER'S COMPENSATION DECLARATION 1 hereby affied under penalty of perjury one of the following dceleratiom: ❑ 1 have and will maintain a Certificate of Consent to self insure for Worker's Compere nation, as provided for by Section 37M of dm tabor Codc, far the p,opmo Ona of the work for which this permit is issued. ❑ 1 have and will maintain Workc''s Compensation Intal., as required by Section 3700 oFA Labor Code, for the performance ofthe work for which this permit is issued. I,W kers nsadon Insula carrier and Pol� be, er.nmpe Policy CERTIFICATE OF EXEMPTB3NFROM WORKERS' COMPENSATION INSURANCE , (This section need not he completed if the pc mil is fOriie hundred dollars ($100) - ,it loss.) 1 certify Nat in the pmfmname of the work for which this permit is issued, I shall not employ any person in any manner x ss to become subject to the Workers' Compennadon Laws of Califomia. Do¢ Applicant NOTICE TO APPLICANT: If. after making this Csnifcate of Exemption, you should become subject to Ne Worker's Compensation provisions of me Labor Crate. you muv forthwith ce reply with such provisions or this permit shall W deemed invoked. CONSTRUCTION LENDING AGENCY 1 hereby that seri is construction 30 lending agency lar the performance of which s the work for which this pertnit is issued (Sec. Jf0], Civ. CJ Lender's Name Under s Address 1 I certify sat 1 have read this application and seams that the above infommniun is correct. I agree to Comply wish all city and County ordinances and sure laws relating to Wilding construction, and hereby sumodae mprexnuthes Of mix city to enter upon the ( shove-mcntimed property Tor iesperom purlmses (We) agme m save, indcmm fy and keep harmless the City of Cupertino against i liabilities,judgments. costs and expenses which may in any way stento against said City in emse,... ce.(me gmnling of this permit. ' APPLICANT UNDE TAN S A WILL COMPLY WI LL NON -POINT Issued by: Date SOUR EGUL d Re -roofs Typo Of ROOF _ Milliliters of Appliclinvebritmewr am HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant snore or handle hazardous maadal as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Scedon 25532(d' Ycs All roofs shall be inspected prior to any roofing material being installed. Ku If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wilding Occupant use equipment ordcvices which emit hanormus air conumin toes ar dcfncd by the Bay Area Air Quality Management all new materials for inspection. District? Xv. ❑ Ycs I have sad sc hazardous materials requirements under Chapter 6.95 of me Califor- nia Health & Safcry Colo Sccd.ns 25515, 25533 and 25534.1 undersand mat if the holding doer I currently have a en . mm it i y re slbdity m omit,'he .ecupanl of me rectoomeet, menta mlr. eOfaCeaiBea� eapanerzZ4l Signature of Applicant Date All roof coverings to be Class "B" or better ow aim.d..ea ager D CITY OF CUPEkTINO tkTY OF CUPERTINO • PERMIT APPLICATION FORM / 7uNi Fee Deseri tion Date: lding Address: ther A liances MECHANICAL n onstruction Tax Lune in d/Off/COmm/ uasi Owner's Name: on. Tax for B Zone Phone #: Hd Y) 'F45-- ! 7 y Contra tor- BUILDING BCONSTAXR License #: BUILDING e� en e'C7 ELECTRICAL BELEC1001 Elec 600V > 1000A Contact:/ BELEC200 Elec Svcs 600V <= 200A Phone #: BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING Applicant/Contractor: investigation fee BUILDING Fax #: Comm. Housing Mit. Fee Building Permit Info: Bldg & Elect Plumb 4 Mech `Job Description: New Multi -Family Res MECHANICAL BNEWMULTI Residential: e/Y/ t Commercial: I New Comm Electric Sq.Ft. Floor Area: BNUCOMMM New Comm Mechanical $/Sq.Ft.: BNUCOMMP New Comm Plumb PLUMBING ArchitecEpgineer: aluation: 7_r5 t Type of Construction: r i L 1 of 3 7i(J�/o Fee Deseri tion Fee Group ther A liances MECHANICAL n onstruction Tax BUILDING in d/Off/COmm/ uasi BUILDING on. Tax for B Zone BUILDING otel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME I New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 7i(J�/o