07090101 CIT�' OF CUPERTINO y^r ` `
BUILDWG DIYISION PERMIT w'�������� ����������� `
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PERMIT NO.
aui � 4 ��� R P R TLJSCANY PL KITCHENS BY MEYER 07090101 .
pERMIT LSSUE DATE
`ER'S NAME:
ALAN ZAPALA 278 CASI'RO ST 10/17/2007
SANITARY NO. CONTROL NO.
PHONE:
(415)968-8318
BUILDING PERMITINFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
� p � LICENSED CON'I'RACTOR'S DECLARATION IOU DeSCilpt101]
� v� I hcrcby aCfirm �hat I am liccnxd mufcr prnvisions oC CMaptcr 9(commcncing
: z� wiih Sccuon 700U) of Di�ision 3 of thc Busincss and Profcssiuns Code, and my liccnsc is REV I S I ON - F I ELD CHANGE TO RELOCATE DOOR AND
�� y in lull torec and effec4 �' L ! SHEARWAL L( OR I G # 0 7 0 5 0 216 )
j v� z Liccnsc Clats L�. �
: F, � Datc �
A CHtTECI'S DECLARATION
j a Q I undcrstand my plans shall bc uscd as pu6lic �ccords
JyU
' a � I,iccnsed Pmfcssional
: � a OW NER-BUILDER DECLARATION
� a� i hcrcby alTirm that 1 am excmpt Crom thc Contractofs Liccnsc Law [or thc
p O following icason. (SccUan 7031.5, Busincss and Profcesio� Codc: Any ci�y or county
�,°, � which 2quires a pemiit to conswct, al�ct improve. demolish, or repair any swcture
prior u� ils issuancc, also rzquircs �hc applicant for such permit to filc a signed sta�emcnt . s Ft. Floor Area Valuation
-� a �hat hc is licenscd pursuant to thc provisions o( thc Conuxwr's liccnsc Law (ChaPtcr 9 q• h O
r t �(commencing wi�h Scction 7000) of Division 3 of �c Businessand Profcssions Codc) or '�
i�� that he is exempt thc�efrom and Ihe basis for the allcgcd exemptioa Any viotation ot
Secuon 7031.5 by arry applicant tor a peimit subjecu ihe applicant to a civit penalty ot 3 5 9 2 9 0 3 2�(� Number Oeeupaney Type
not more �han five hundred dollars (5500).
❑ I, u owncr af ttie pcoperty. ar my employces witN wages az the'v sok compensaGon,
willdothewo�ic,andthestrucwreisnotintendedoroffecedfocsale(Sec. Required Inspections
end Professions Cade: The Conuactor's License Law docs no[ apply to an owner af
property who builds or improves �hercon, and who daes such wort himsel[ or Uwugh hia
own emplayces, providcd that such improvements are not inlended or otTered (or sala lt,
however, the building or improvement is sold within one yesc oC completion, tlrc owner-
builder will have the burden of proving Uwt he did not build w improvc Cor pmpose at
salc.)•
❑ I, as owner of the propcny. am uclusively contracting wiW licensed conuxtors w
conswct the projea (Sec. 7044. Busincu and ProCessions Code:) The Cootncwr's Li-
ccnse Iaw dacs aot apply w an owner of propeny who builds or improves the�r.on, and ,
who convacts Cor such projects with a conuactor(s) Iicensed pursuant to the Contnctors
License Law.
❑ 1 am ezempt under Sec . B& P C for this rcason
.� Da�e _.. _
WORKER'S COMPENSAT70N DECLARATION
I hercby aftirtn under penalry of pe�jury anc oC the folbwing declaralions:
❑ I h:re nnd will maintain a Cenif cate ot Consent to self-insum (or Worker's Compen-
sation, u provided for 6y Section 3700 of the Labor Code. (or �he performance ot thc
work [or which Wis permit is issued.
❑[ have and will maintain Worker's Compensaaon Insunnce. u �equired 6y Section .
3700 0( tAc Labor Cade. Cor the pedortnance of �he work for w6ich �his p¢rmh is iuued.
My Workets Campensa[ion Insurance artier and �cy numbcr arc:
�:T��-x/��r.nn�� �� �t�091ysY�3�s�
CERTIFt ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
. (This section necd no[ be completed i( the pertnit is for onc hundred dollazs (S1U0)
nr Icss.)
1 certify �hxt in �hc performancc of thc work [or which Wis permit is issucd, l shafl not
employ any person in any manncr so as to bccomc subjcct w �he Workcrs' Compensation
Laws oC Califomia. Datc
Applicant
NOTICE TO APPLICAM: If, aftcr making ihis Ccrtiticatc of ExcmpGon, you shauld
become subject to ihe Worker's Compensation provisions of �he Lsba' Codc, you muu
� O fonhwi�h comply with such provisions or this permil shall hc dccmcd m'akcd.
z ""' CONSfRUCTION LENDING AGENCY
[.~.� ► I hcreby aff rtn Wat there is a consuuctian Iending agcncy for thc per[ortnancc o( �
a, . ihe work for which this pertnit is issucd (Sec. 3097. Civ. C.) ,
W Q Lendcr's Narnc
a z Lender's Address
(� � 1 certify tha� 1 have rcad this application and state tlut thc above infofmatiun is
w �--� cortcct. 1 agree to comply with all ciry and county oniinances and sute laws rclating w
� U 6uilding conswction, and hereby authori�e representatives of �his city to rnter u{�c�n thc
� W abovc-mcnuoncd properly (or inspccuon purposes.
� a (Wc) agrce to save, indcmnify and kecp harmless the City of Cupcnino against
H � liabilidu, judgmen�t, cos�s and expenscs which may in any way ucruc agains� said City
V z in conxquencc o[ thc granting of this permit. Date
�+ APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-PQINT Issued by:
SOURk�, REf,iULAT10 S. .
� / / y � 1����f�7 Re-roofs
s�arreyorbeat�u�� l� T of R�of
HAZARDOUS MATER[ALS DISCLASURE YP
Will thc applicant or futurc building occupantstore or handle hanrdous matcrial
as dcfincd by thc Cupertino Municipal Codc. Chapicr 9.12. md the Health and Safety
��. Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
� y� �No ,
Will the applicant or fuwrc building occupant use equipmem or dcvices whic6
If a roof i: installed without first obtaining an inspection, I agree to remove
cmit harardnus air contaminan�s az dcfincd by thc Bay Area Air Quality Managcmcnt all new m�terials for inspection.
�u����
❑ Ycs �Q Nu
I havc rcad the hasardcws maicrials reyuircments undcr Chaprcr 6.95 o(ihe Califor-
nia Hcal�h & Safcty Codc. Sccdons 25505, 25533 and 25534.1 w�dctuar�d Owt iCtl�c buildinB
docs rro� cumently havc a tcna�x, �hat it is my respantib7ity io ndify thc oecuPant oC Uic
myuire en�s hich must • el prior to issu�ce of a Certificve af •� 7 Signature of Applieant Date
/n /'� All roaf coverings to be Class "B" or better
Owncr or authori . agcm Datc