06110140 (2) CITY OF CUPERTINOsea
BUILDING DIVISION PERMIT "C®NTRACTO,RiINFaORMATION
BUILDINGADDRESS: CUPERTINO KITCHEN DESIGNS PERMIT No.06110140
OWNER'S NAME: PERMIT ISSUE DATE
BEEBE BARBARA E ANZA RIM
SANITARY NO, CONTROL N0.
W. 408) 257-4900
ARCHITEC (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pp LICENSED CONTRACTOR'S DECLARATION lob Description
1 Manby air,.that 1 and limagg!under provisions of Chapter 9(cammeoci.g 13
with Section 7")of Division 3 of de,Business and Preload'.,Code.and liccnseu
Icy inmRfdreeanderma o�/G KITCHEN ENTRY HALLWAY NON-STRUCTURAL
n'A? License Claes Lk.g a s
Contractor
AACHITER'S DEC ION
i < 1 understand my plans shall he used as;public meets
dyV
0 vhi Licensed Pvfessional
OWNER-BUILDER mDECLARATION
nC 1 Masa alum on 1 am exempt from dm Contractor's License Law for the ,
o O following yuan.Permit
i 713 1.5.Business and Improve.
denav Colo:Any city or county
$ which requires a permit re construct,the aper,improve,h Permit
t at repair any ewaum
.sea that hor e its ceased e.Shunt in to the applicant o far SucContractor's
Lic me,Law stawmem
< thahcisdingwid pursuant 70th)pmvisions of of eBuaauhdd Preflaw(Chapmr9 Sq.Ft. Floor Area Valuation
ir0 (commencingwidt5ccuon7000)of?iasis for
so WeBusinesseuamd...A.,avi Chain)at
`t$
that M u eumpt therefrom and tM bust(or Ude alleged eaemptian.Any violation of
Section 7031.5 by arty applicant far a permit subjects to.,Ilc.1 w a civil penalty of r 0 0 Occupancy Type
not mart Nan five hundred dollars(5500).
❑I.an matter of the property,or my employees with wages u Wir role compmandon,
will do the wort and than structure u..Ihanded or offered for sok(Sec.7014,Busircss
and Professions Cade:The ConuacmrY License Law does not apply an in owner of Required Inspections
property who builds or important thereon,and who duessuch wok himx If or through hu
own employees.provided that such improvements and trot intended aroffered forsale_IL
however,the building or improvement is sold within one year of completion.then owner-
builder will have be buten of proving that he did not build or improve for purpose of
sak I.
❑1.an owner of the property,am exclusively contracting with licensed contrazmrs in
construct the project(Sec.7(0t44.Business and Professions Code:)The Conmemr's U.
antic Law docs not apply in an owner of property who Wilds or impmm daemon.and.
who contracts for such projens with acomrac ur(s)licensed pursvzm an IM Contra em's
License law.
❑1 am exempt under Sec .B&P C for this nodded
Ow a Date
WORKERS COMPENSATION DECLARATION ,
1 hereby affirm under pcnalsy of perjury one of the following dcclamdons:
haK and will maintain a Cersifinseor Covens m self-imure for Workers Compcn-
satian,as provided for by Section 3700 of the Labor Code,for the performance of IW
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Ivwarta,as squired by Second
3700 of he labor Code,for than perform.of the work for which this permit his issued.
My Worker ComApqensation Insurance carrier and Policy numbcra7: '�nn �/O
Cartier 3 1I A f UAI 1 Policy No.:_ -/ V
CERTIFTCA OTE F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
,This section..d nos W ix mplmed if the permit is forams hundred dollars(SIM)
or less)
1 certify Ida in the performance of the work for which this permit is issued,l shall but
employ,any perm.in any manic,so u te become subject to the Workers'Campemsadan
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenifleme of Exemption,you should
become subject in the Workers Compensa0an provisions of he Labor Code,you maw
.Jz foMwiub comply with Such provisinv o,Nu permit shall W dcemed revoked.
Z O CONSfRUC ION LENDING AGENCY
I hereby allure that them is a conswcti.n loading agency for the performance of
0: > the work far whim do$Permit to issued(See 3097,Civ,C.)
Tat Q Lenders Name,
ILz lenders Address
U O 1 catty that I have mad this application and saw this the above information is
I,, F^ correct.1 as=to comply with all city and county otionam and ame laws relating to
O U building consuuction,and hereby authorim apreaenutives of this city to enter upon the
4
above memiunedF propersfur peedon purposes.
(We,)ag¢e to save.indemnify and keep harmless the City of Cupertmo againstCgI liabilidu,judgments,costs and eapenseswhich may in any trey accrue against said City
U z inean ICA'mea eg begot Nis permit. ��
'—' APPLICA Np RSTANOS AND WILL COMPLY WITH ALL N N-POI Issued by: Date 'L/- z
SOURC EGU TIONS.
? Re-roofs
HAZARDOUS
Dam
Si fApplica .A2AADOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(owe Wilding e.Chapter
Sart m handle Health
material
C defined n the Cupertino M al Code.Chapkr 9.II.and the Health anti Safety
Conic.Section 2553I(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
t h.vardov air contaminants u defincel by the Bay Area Air Quality Management all new materials for inspection.
iatric?
❑Yv
I have Mad4hehaatnus materials requirements unser Chapter 6.95ofthe Califor-
nlnHcalth afci ode.Scamem 5U5. 533and2553d.1avaS:rstandthaif the Wilding
does rte mroml have a¢nand IIIc y rosponsihility w and dm occuy ant of
redid cora as met or f.Ce am ofo5aupapty� Dt Signature of Applicant Date
err atuhmocd ovens /�D,w All roof coverings to be Class "B"or better