08100035 CITY OF CUPERTINO � ��
BUILDING DIVISION PERMIT okCONTRAGTORANFORMA'TION :
BUILDING ADDRESS: PERMIT NO.
22638 OAKCREST CT INTERNATIONAL KITCHEN & '
WNER'S NAME: BATH CORP. PF3tMTI IBSTrEDATE
ONE: 5AKl1A19MO7CONTROL NO.
(408) 296-3055
ARCHTTECTYENGINEER: BUIL[)ING PERMITINFO
BLDG ELECT PLUMB MECH
900 LICENSED CONTRACTOR'S DECLARATION
F 1 W.by air-that,am licvcd under prodsimut of CMpur 9 from ntommg Job Description
withSecuon]pKl)af Division3ofdu Budxuan Prafecrinm Code.ana myfieenQu
%+ h in run tamaM0rf✓1RMDL KTCHN,CHNG EXT LNDRYRMTO NEW HALLBTH, CHNG
�,�i License Iw °' otta
ontrssmr � '.r.. EXT PANTRY TO TO NEW LANDRY RM,MINR CONST INCLD
C
ee ARCHITECTS DECLARATION+
Mu
torluenndmyplatashallWusedupublicmcoms M/E/P 182SQ
JyU
k C N Licensed Pmfudonal
5 OWNER-BUILDER'Isontomplut DECLARATION
vZ C O I Wmby aRrm Net 11. exempt from the Contractors c:Any
Law for the
p O following won-(Sation]Ol IS,Busimss and Professions Cade:AnY my at county
iei which its..
ts a permit m rima an plus. such
crura i fie a sig ny ummem
primmiuissuarwe,alsomuita lhcapplisof for such permit m License
Law(Chpw9
FSC Nuhec.cmi; alputsuammNepmNiamofNthnBoa aicnselaw(CWPur9 Sq. Ft,Floor Area Valuation
at- datIm isrouwithsection?ODD)of&bandsn3 ofthent"Acvanaon'MY vi Cade)of 55253
y�$ that be u esmpt tivse(rore and Ik Essim for the aimgea enmptim My violation of
Sation 70313 by acy applicant for a permit mbjcu dre aPPIXZrt to a civil pctulty of APN Number Occupancy Type
an,seam don EK hunamd dollen(Isom. 34248004 . 00
❑I,uowms of the ptoperry.car mY wplaycet with mgn uNe'vmm campewtion.
win do the work,and can stsunam is mtimendea or offered fornk(Scc.7W,Business
and Professions Cade The Conucmfs License Law does nal apply m n owner of Required Inspections
P-Pany who builds or imposes 0v+nn,and who doea such work himself or through his
ownsmployees,provided thatsuch imprommonu w not ino:Med oroffemd for PI&It.
however,the Wilding or impnommont unld within one yeas of nmpletion,the owner
Wilder will haw the Emden of punning that he did not build or improve for"rpm of
sale.).
0 T.u owner of the property.sum acluanly convening with licmed contntnun in
construct this Project(Sec.7014,Bmimsi aad Profesdom Code:)The Consomme.U.
cue Law dors not apply in an norms of prapenY who Wilds or imposes memo.and.
who contracts for such pmjccu with a commmor(U liccued pursuant in the Convactars Lice.Law.
0 lam exempt undm See .BRP fdr this mann
was Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm undcr penalty of perjury one or the following dalwtions:
❑1 ham and will maintain a Ceniftou ofComent in wlblosum for Workds Compcn-
smion,as provided for by S lion 37M of the Labor Code,for the performance of the
art f wNcIt mrs pmmiI is issued.
w haw asW will maintain Workces Compensation Insmanc,an muired by Suction
my orme Labor Code.far the ==carcof the wort(m which mis permitu issued. '
My Warkwer-m Campeualuon Ionone artier W Policy n�ryb�rlare'.
Cartier. 1 (U GV LU\S Polity No.: 11
CERTI CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This renin need not W compleud it the permit is froom hundred dol us(SIM)
or Mas)
I certify that in the perfomarce of ma work for which this permit is issued.I shall not
.mPlayany penin in any mnnern as us ecoma subject a tluwod.es'Cnmpewdnn
Laws car Califamia.Date
Applicant
NOTICE TO APPLICANT:If,aiur making this C.niricam of Eaemptian,you should
became subject in the Workch Compensation provisions of the Labor Cook,you most
�Z forthwith comply with such provisions or this permit shall W decreed rewkcd.
?O CONSTRUCTION LENDING AGENCY
(" iWd,byifarm that them isaconnuutin Icndingagency for the prfurmancof
C> du work for which this permit Is issued(Sc.3097,Civ.C.)
Q Landers Nun. ,
z Lmukes Add.
U Q I citify that T ham mad this application and main that me aWm information Is
Ig,P corms.l agm to comply with all city rad county ordintrucea and sum laws mining to
�U Wilding comvuction,and hereby authodm rep.nutims of this city In comr upon me
abow-mon orMl propny for inspection purposes
Fy (Wc)Mm no mow,indcmnify and keep harmlw the City of Cupertino against
CA liabiliti.a,judgmenu,cmu ndespenmawhichmay in nywayaccmeagonsunid City
U Z in consequence of the gmung of this parmiL
^ APPLICANT DMDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUr ATIONS.
I4!:� V 1 J - L t d , Re-roofs
Signaturd,ofAMlicatsUCOntractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will on,applicants found,WlMiug aavpurt no.or handle huardous nuor al
as dcrimd by the Colo n car,Municipal Code.Chapmr 9.13.and tW Halth and Safety
title.Suction 255324)?
0y. �GN. All roofs shall be inspected prior to any roofing material being installed.
Will the.,]I.,alfumm Waning.,.OL nm wnipmnt car mama whichIf a.roof is installed without first obtaining an inspection,I agree to remove
.mit hmaadou at,cnumimnu u ncd by the Bay Ara Air Quality Management all new materials for inspection.
District?
0Yns No
1 haw mal due hs>abous mamaab requirettuw under Chamcr6.95 afore Caiifor.
nu Hralm&SafetyCode,Savou 25505,25533 and 25534.1 undenund thatifthe Wflidutg
dans set cunen ly haw a meant,mat it h my responsibility m notify the ocuupans or the
rcgaue hichmanxmtprior in issuance ofaCOmfic.mofanpancy Signature of Applicant Date
own t aamnrivcd ascot Dam. . All roof coverings to be Class /?. or better