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