05050148 (2) CITY OF CUPERTINO '
BUILDING DIVISION PERMIT t.�CON VITOR INF TtMATIUN n
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMIT Nib 5050148
10427 VISTA KNOLL BLVD
OWNER'S NAME: PERMD'ISSUE DATE
THOMAS DEFRANCO 10562 S DE ANZA B 07/13/2005
E: SANITARY NO, CONTROL NO.
(408) 257-4900
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BO EO PLUQMB MOECH
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
1 bcmby affirm that 1 un Ikermil under provitiau of Chapter 9(mmencncing p
with Secdon]IXIU)ef Div an 3efthe Budneuand pmfeWu a Code,and my license is
:a mmnmwattaeHat REVISION--ADD GIRDER. TRUSS
5 uamse 9 Z tx.r
Dem — Cont r • gT0 NEW PERMIT ISSUED/ORIG. #05010108
B
' � ARCHmiLTSD RATION N
? l unargyattemy en W used MIR records
5 p Licensed lifinfesellufFAIP
^ OWNE ILDER DEQLARATION
i 0 0 I adreno .(Sero o n 1 em attempt from the Contns Ox License law for the
OD which noon. emit ](131.5,Business and ProfeWhns Ca lc:Any city orroomy
$ which rits issuance.
su•e.aim to<atsuuca alter,improve,dcwllN,ri repair any tmenw t
Pdornits iuumcedtlant Wme the applicant(hoochp lees ceps,rile a Law(Cnement 0
(commencing that the
with
pursuant 711 )of Disions vision of that
hnd Proelaw(C Com)or
Sq.Ft. Floor Area Valuation $
65a (wmmrming with Scctien 711K)of Division3rf the Business and Professions Cak)or
tial he is exempt therefrom and me Wale fn the alleged a.emptim.Any violWon of
enc
Section 7031.5 by any applicant for a permit subjects um applicant he a dvil penalty of APN Number eccu
rot men than Ova hundred dollen n5Bo). 32613034 . 00
C p y Ty�
❑I,u ownv of de property,a my employees with raga u dteit vele eompenndrn,
w it l do the work.and me suuclum ts not intended m o@red fm me(Sa.7044,B ted.
and ProfeWou Code:The Contractne.Lions Law does not apply or an owwr of. Required Inspections
property who builds orlmproW thrown.and whadmaauchwmkhimselfortluough his �ry
own employees,pmvided that such Improvements arc notimencied orr0eted forsam.If. V
how...the building or Improvement is sold within oro year of completion,the ovacer-
bulldm will he.the burden of proving that he did not build or Improve for purpose of
ole.).
❑1,u owmr of me property,am eaelusively contracting with licensed contwton to
construct the project(Sec.7044.Busmen and Profesdens Cade:)The Contractm's Lt.
came Law dm not apply to an owner of property who builds or Improves mature,and
who contracts for such projects with a conuutm(q licensed pursuant to do Contractor's
License Law.
❑IemenmptundoeSx ,BAPCforthtsmamp
Dwwr Data
WORKER'S COMPENSATION DECLARATION
I hereby afrirm under Penalty of perjury om of the following declarations:
1 have and will maintain a Certificate of Consent to selfAnsure for Workers Corepc .
urian,
as provided for by Sedan 3700 of the labor Code,for me perfmme.of the
work for which this permit is Issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37M of 1W labor Codo,for the performance of me were forwhich this permit u issued.
My Worker.Compensation insurance carrier and Policy number am:
Cartier. Polley No: _
CERTIFICATE OF EKEMFTION FROM WORKERS'
COMPENSATION INSURANCE
(Mix wime wed not becompleml](the permit 4 foronc hundred dutlan($la)
or less)
I unify mat in that perfum usce of the work for which this permit Is broad,I.WII not
employ any person In any msne�r u)o ecome subject to the Workers'Compenution
pF of C.Rfo� `
A Iiunl
WomnesTO APPLICANT.Worl es.furmakingrola vidMcate of Exemption,you
uam
become comp m me Worker'.Compewuon providrns of theLbor Code.you mute
wJ O foMwath amply with such pmvidnu or this permit shall he dcemcd revoked. v
T► CONSTRUCTION LENDING AGENCY
Ihembyalllrm that then is a comuuction lendingagenry,for ton performance of
ori> the work for which m4 permit is Issued(Sm.3097.Civ.C.)
!V QLattices Name
0.z Undoes Address
()Q I certify that 1 have mad this application and sum that the above Information is
;-! caro 1 egw to comply with all city and county onflammeund sure laws relating to
0 building censuucllon,and hereby aumoam repnxammm of this city in enter upon 0te -
ahove-mentioned property for inspection purposao
eL (We)agree to save,indemnify and keep h.rmlesa tui City of Cupertino agaimt 'I
IA liabilities,Judgments,cuts and expenses which may in my my accrue,against said City
C)7 in cm emseem of the grumng of this it
Fl APPLIC DERSTANDS WILL COMPLY WITH ALL NOWPOINf Issued by:9 Date
SOUR S.. 7/�
�iJ Re-roofs
Sign ore of pplieu aARDO hate -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t applicant or future building s.Chapter
nom or haMle Health and
u defimd by the Cupertino Municipal Cadc,Chapter 9.13.and We Health and Safety
i0cm. 0y.3ss33(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu No
Will the applicant or tun building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
I
weardeu air corurnmanu o defined by me Bay Acca Air Quality Management all new materials for inspection.
istrict?
❑Yea w.
I have read the hu adnus materials require=.under Chapter 695 of de Calif..
.is Heal" Tet Co4.Smtims35505 5533wd25534.1undcmwdthatifd tmilding
dm.mi c Y • 4 ren my responsibility to ratify me wuP t of the
M
uimm � uawco(aCcniOuuofOc Signature of Applicant Date
q "• p �' Do All roof coverings to be Class"B"or better
Owmr ter nthorizcd a� Dom