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07050263 CITY OF CUPERTINO BUILDING DIVISION PERMIT Cd) ,CTQR IqwM ���i: PERMIT NO. BUILDING ADDRESS: 7598 KIRWIN LN CUPERTINO KITCHEN DESIGNS 07050263 PERMIT ISSUE DATE OWNER'S NAME: KNIPE RUTH C AND GARRY D 10562 S DE ANZA BLVD 06/15/2007 SANITARY NO. CONTROL NO. )NE: (408) 257-4900 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ZLICENSED CONTRACTOR'S DECLARATION Job Description w P, I hereby affirm that I am licensed under provisions of Chapter 9(commencing ZuVi with Section 7000)of D"ion3oftheBusinessandProfessions p }mylicenseis REMODEL—MASTER BATH,HALL,LIVING RMS NEW WINDOWS & a a in full force and effec U(� i Z License C1 s Lic.u DOORS FURNACE RELOCATION. t o DareEkm Contractor I ARCHITECTS DECLARATION i a< I understand my plans shall he used as public records tyV U.H Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the :00 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 structure i Z y prior to its issuance,also requires the applicant for such permit to file a signed statement q.Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $150000 [_- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or ? that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 35922021 :U( Number Occupancy Type not more than five hundred dollars(5500). 0 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 or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does 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.If, 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.). 0 I,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 Contractor's License Law. 0 I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1-1 1 have and will maintain a Certificate of Conscnt to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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's Compensation Insurance carrier and Policy(nuher arc:� �r�,) Cartier. F= 1 �`'� Policy No.: •�- __ ( � 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 Workcrs'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 1 hereby affirm that there is a construction lending agency for the performance of fYi> the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is Ll, " 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 W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Cel liabilities,judgcosts and expenses which may in any way accrue against said City U Z in conseque of the ranting of this permit. Dale �� �—+ APPLIC U RSTANDS AND COMPLY WITH AL NON OINT Issued by: SOU Re-roofs Si urc 1`451-icant/ContKtor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP 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 Cote,Section 25532(a)? � All roofs ;hall be inspected prior to any roofing material being installed. 0 Yes �° If a roof i;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 Arca Air Quality Management all new materials for inspection. District? 0 Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&S Sections 255()5.25533 and 25534.1 understand that if the building docs not c ntly h a tc L.that i ism responsibility m notify the pant n c reyuirc tswh' usl metp' r a Cepiliecit ofosanp Signature of Applicant Date �j All roof coverings to be Class"B"or better Ow uthonzed agent Date