08100186 CITY OF CUPERTINO x� �•+. z:.iim 9�' '
BUILDING DIVISION PE raCOITRAGTORI 'URMA.TI N
BUILDING ADDRESS: PERMIT NO.
10260 ORANGE AVE TBD - TO BE D
OWNER'S NAME: PERMIT ISSUE DATE
p ; S CONTROL N0.
ARCHIIECT/ GINEER: BUILDING PERMIT INFO
ELECT
REMODEL 60 SQ FT KITCHEN, 40 BO l� PLUMB O MECHO
Boa LICENSED CONTRACTOR'S DECLARATION SQ FP (2) BATHROOMS lob Descri tion
u I bereby"m NU lw Ilmoned maker pmvivw of Career 9(comrmaing ..-. p
with Sectun7010)of Di i on Softhe Burne Professlom Corea mylke u
nn n. in foil tome ark el[
j 9 Z Licence Class lie.e
n=
Date Con DIC
R HITECI-S DECLARAT ON
I undersand my plans Nall be used u public records
5�U
[G Licensed Pra nisei eal
Ols'NEB-BUILDER DECLARATION
i E i Wmby aRrm that 1 sue cacmpl from the Contrxto's Llccose Law for the
00 following mason.(Section 1931.5.Business and Prorendaos Code:My city or county
S ff which mcmrev a permit m nvslsun,slue Improve,demolish,lir repair any swclme
Za prior m its issuance.also mituiru the applicant forsuch Permit file a signed statement
this he is licensed pursuant to tiro provisions of the Contractor's Leen Law(Chapter 9 Sq.Ft. Floor Area Valuation
x�0 (commencing with Section 7000)a Division 7 of the Busiiw.0 aM Pmf.i...Conic)or
^ this W is eumpt thcrtrrom and Ila bleu for the alleged exemption.Any violation of
Section 7133M by any applicant for.Permit subjects the applicant m a civil paWry of APN Number Occupancy Type
cot come than frw hundred dollar($500).
I,.awnor of the propmY•mmy wployen with ngnuNeu role compedtsitirm,
and do the work and do he Com u not s Limedar Law
do far Wa(ger.TOas Buri r of
.ria property
soh W Can:The Contvaor's nd ere a Law don not apply lf an ownu or Required Inspections
com ertywW Wiprovidmpmvsuchm paremedwM douauclrwork himanlfor Waugh his
awnemployee,proMdodthatsuchimPsowm within
not our ccasoRemd for ralee-
however.meWildingiheimpmvmvinusold widiinarse year ormmpudomtheamr-
Wilder wild love th burden or Proving Wt he did cot 4dld or improv for purµam of
sale.).
❑1,u owner of the property.am Baden wly contracting with liecnmd mnuxlors to
construct the project(Sec 7Ws,Business am Psofecsloru Cade:)The Contractors U.
cense Law docs not apply to in owner of property who Wilds or improves thcoan,and,
who contracts for such projects with a conuactor(s)limned personal in the Cont.amr's
License Law.
❑lam esecoln under See ,BBPCfm Wismxxm
Owner, Dau
WORKER'S COMPENSATION DECLARATION
40 I hereby arilrm under pelWty or perjury ono athe foll wing declasad ase
Q 1 hew and will munWn a Cadamte ofComent io self-ieum far Wor ees Comwn-
.don.as provided for by ScNan 3700 a the labor Cade,for the Performanco of the
wort for which Nis Permit is issued
❑1 haw ark will maintain Worker's Compeommon Inwrancc,.rtqumd by Section
3M aft labor Code.for the performanco athe work forwhic,does permit is Wood.
My Worker's Campemation In rano a and Policy number ere:
Cartier. t�- Policy No.:
CERTIFlG OF IXEMMON FROM ORKERS'
COMPENSATION INSURANCE
(rhamcfen noel rttbeeompleted if doe It.I,is forerc hundred dollar($100)
or u.)
I owify dol in the performance er We work for which this permit is bound.I mall not
employ any person in any mmrcr so as in become subject t do Workers'Campatsadon
Laws of California.Dau -
Applicarm
NOTICE TO APPLICANT:If.after own,Nes Certificate or Exemption.you should
become subject b the Workeh Compensation provisions of the lilt,Cade you most
z forthwith comply with such provisions or this permit shall be tlssmrd rotted.
Z r CONSTRUCTION LENDING AGENCY
[-+rte- Ihereby affirm NU Nem u a m.tmction lending agrnry,for ftpuformarrm of '
iY. the woo for which lids permit is issued(Sc.e309'1,Civ.C)
W Q Uncles Name
A.:: z Landers Address
U 0 � 1 terrify Nod I haw mad this appliwion and sum Nu the abow information u
I2. F correct.1 agme in comply with all city and county a dinauea and sum lin muting to
'0(�
building construction,and hereby auNorim mprcimadws adds tidy to color upon Use
W abuse-mmtianed property fee inspection proposes.
6, (We)agree in save,indemnify and keep harmless the City of Cupertino again,
In liabilities.judgments,costs and cap•"•"•which may in any way acmne against said City
V 7 in co mm
Ong of Nu permld.
APPLI AANDg AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR FA
Ql(� Re-roofs �Z
Si um Applivnn Cantrictor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applient m imorc building eavpestuom orhandle ha.Nous mutual
as,krined by the Cupertino Mumd I Cade.Chapter 9.12,and Ne Hnith and Safety
Cade,seniors 235721.)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant or fume Wilding occupant use equipment or dcvices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haraknm air conumirwm as defrmd by the Bay Area All Quality Managemeet all new materials for inspection.
D trct7
0Ya IQ2ao
1 haw mad Ne hvamcus materials requiremcntsuMer Chapterb.95 of the Califor.
ria FinalthkSafctyCaM,Sccdw25303.25S7J and 25SX.l unMlsund dwif Nc Wilding
don tumy hyw a Wn.L WI it u my mepomibilidy m notify the aeupmt of Ne
mqui %ye_.nmLtsr�w-ine e
mishunmewt
ar.Ccr .morampaty Signature of Applicant Date
Pdarm
" ���29-0� All roof coverings to be Class'W'or better
or authonxed agent Dam