08110047 CITY OF CUPERTINO /t pi - T(,�' t "'
BUILDING DIVISION PERMIT -aA+�A\yI.�VTQ4�jF� Q41 -1�1y�.
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BUILDING ADDRESS: PERMIT NO.
7647 NEWCA T PINNA
R'S NAME: PERMIT ISSUE DATE
PHO : SA CONTROL NO.
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
REMODEL: 400 SQ FT TO
3w^ LICENSED CONTRACTOR'S DECLARATION KITCHEN, 150 SQ FT BAMbIDescri tion
et0 tt��= 1 hereby,+from that I am limnscd under pmvisima ar CMpm,9(commencing p
n�
with Section 7glU)af Divi'on Saf to Butinw and Prof ons Code nd mylmmseis
H in full forte and a'.
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3pzmc cntarnI-q a MCI-
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ARCHITECTS DECLARATION
f�� l undeound my pbrns shill bu umd as public rceorN
yc G Licwed Pmrnmional
5OWNER-BUILDER DECLARATION
1 herohY Afrrm
that 1 am exempt form the Contractors Lice^¢Law for the
O O following Ta. ..(Section 7031.5.Business and Profnsdons Cade:Any city or county
e m which requires a permit in construct,alter.improve.dcmalhh,Or¢pair my stmctum
?z y prior to its issuance,a so mquires the applicant format permit in rile asigned summem
xxetas he is llccnmJ purnunl to the provisions of dm Conisseux's license Law(Chapmr 9 Sq.Ft. Floor Area Valuation
yF$ (commcndng wit section 7000)of Division 3 of to Businessmd Prol.inos Code).1
y tat he is exempt thmefrom and to basis for to alleged exempdme Any violaum of 1
Section 7031.5 by airy applicant for a panmit subjects to Applicant CO A civil penalty of APN Number Occupancy Type
nut more tan firs hundod dollars(ism).
1,as owner of tbu properry.army employees wit wage u tolr sok compenssdon,
willda thework,and dmswctureunotinmMW maRerte forsaw(sce.]M4,Budtmu -
w Professions Core:Tim Conmacurs License Law dors WE Apply to an oven¢or _ Required Inspections
pmpeny who builds orimpmwa mmuca,sed who doessntch wont himselfortluough his
awn employees,provided natant impmwmmu arc nut uncurled+ramrod forsaic.If.
however.the holding or imWo`m'en.undid within are Isar ofcomPImOm-the awncr-
builder whB low the hurdm of proving thus he did rot brow or Impww ran pugose or
saw.).
❑1.as owrer of Jon propmty,a h evJusivaly Cushioning with Iiansed cvnmactao an
Constrom to project(Sec.7044.Business and Profcsdoas Code:)The Communes Li-
come law dna not apply man owrer of property who buiwA or improves th mon.and
who contracts for such projects with a conhanar(s)licmund protons tote Contractors
Lkense Law.
am eaemps under sec .B&P C for tis mason
x
Data
WORKER'S COMPENSATION DECLARATION
L hem"amort under pertly of perjury nth of Can following doda dims
❑I ham end will mdnuin a Cendfium of Came¢roself-insure far Warkds Compen-
sation.u provided for by Suction 3700 of to Labor Code,for the performance of the
work for which this pQmlt is aAYe1
❑1 haw and will mdnuln Workers Compensation InsWana.u toqubud by Scntn
37m of Jon Labor Code.for On pcdommmo of to wort fm which this Pemtit u iuuee.
My Worker pomation wmrarcs orrim andPatty ¢bur a¢:
timer: /
WORKERS '
CO SATION INSURANCE
CDsuametlon rend mtbecsnplemd if to pcsnit Is for.hundred dollars(5100)
or ins.)
1 cenify tar in to performance of than work for which tis pconit w Issued,l shall not
employ any person in my manner m as an become mbjecs to the Workets'CompeMadon
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,afmr making this CcniCsesm of Exemption,you shsuw
become subject to to Wmimrs Compcasadon provisions of to Lubar Code,you most
0 0 fortwit comply with such prrm
provisions or this permit mall be doomed rooked.
Z y CONSTRUCTION LENDING AGENCY
[•;.. I hemby,dorm ton tem is n Commuctim wndlsg agency for dm pedonmatum or
C> dm work far with dos permit w wood(Sm 3M.Civ.C.)
vas p Landers N.
Z Lenders Ademas
U 0 1 certify tat 1 have read tis application not mm than to Above information is
Is,F cor it-I agms to Comply with all city and county ordin of and sum haws misting w
0 building construction,and hemby muorias mpro¢moves of this city in mor upon to
W drove-mentioned property for inspection purposes.
a f W Agree to saw,indemnify and keep harthas to City of Cupertino against
ti(n livbito gmcnu.casu end ex sea which may in mywq mane agdasssdd City
fJ,'� ¢come cc0 cg tingof ih�
r APPLIC
Dem
US MATERIALS DISCLOSURE Type of Roof
Will Phi mfr building occupant mon or Nnrllc hamsNoas mamrial
red Coleco. ni a ads.Chapter 9.13,and dm Hedth and Safery
.,Soeti M533(')7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will the Ppli. ar rmrm Wild asupam use cyuipmml ar us".which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmANous Air cmuminunts as J by the Bay Area Air Quality Management all new materials for inspection.
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lawquiterpeCut undcr�hmucrb.95 ofte Califor.
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