07090039 77777777777777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ��1 TRS` TC1R NF
PERMIT NO.
BUIL]IyG�QII sSWEET OAK ST SEARS HC ME IMPROVEMENT 07090039
T UU UU PERMrr ISSUE DATE
OWNER'S NAME:
'DOUGLAS & MONICA BULLARD 1024 FLORIDA CENTRAL PKWY 09/10/2007
SANITARY NO. CONTROL NO.
-.,NE: (925) 24_ —2000
BUILDING PERMIT INFO
ARCH1TEC IENGTNEER: BLDG ELECT PLUMB MECH
{p zo LICENSED CONTRACTOR'S DECLARATION fob Description
W
p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;Z�d with Section 7000)of Division 3ofthe BusinessandProfcssionsCode,a dmylicenxis INSTL NEW KITCH CAB, NEW CNTR TOP, RECONNCT NW
t 0 H in full force and ctfecs Q
Licen Class_tl1--�•g SNK
D. Contractor
ARCHITEC7'SDEC Tl N & FAWCT, UPGRD 3 .OUTLTS TO GFI INSTL ICE MKR W
i z< 1 understand my plans shall be used as public records LINE, NC)NN-STRUCTRL. (REMODEL KITCHEN)
iyU
LL
Licensed Professional
•O
< OWNER-BUILDER DECLARATION
3 e I hereby affirm that I am exempt from the Contractors Liccnsc Law for the
in o following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any stnrcture
"cn prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $26711
21- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
- that he is exempt therefrom and do basis for the alleged exemption.Any violation of �p�Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32651043 .`l7V'
not more than five hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.ff.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a contractor(s)licensed pursuant to the ContracWfs
License Law.
❑I am exempt under Sec. B&P C for this reason
r lwner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker' Compensation Insurance cam and icy num be O'
Carrier. Cr AAMI to N WW',.No.7 7 {O
37
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify,that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
F-c 1 hereby affirm that there is a construction lending agency for the performance of
p:> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Name
z Lender's Address
I certify that I have Head this application and state that the above information it
".0" correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
shove-mentioned properly for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments.costs and expenses which may in any way accrue against said City
V z in consequence of the granting of this permit
�4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: Date
SOU RC GUT ATION I o—w11
Re-roofs �_-
Signature of Applicant/Comractor Dore T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
rode,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
❑Yes If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all newt materials for inspection.
District? V0
❑Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the Date
require a is which m e e met 'or to is ancc of a Certificate ofOccupancy.
c w47 Signatur:of Applicant
f V All roof coverings to be Class"B"or better
Owner or authorized agent Bate