06030082 CITY OF CUPERTINO �' �'' '`
BUILDING DIVISION PERMIT cow—RAG nd,NNFORMA ON r
BUILDING ADDRESS: PERMITNO.
CUPERTINO KITCHEN DESIGNS 06030082
0*04"E:AINSWORTH DR PERhff SUE DATE
qW: DE ANZA BLV SANITARY 1,103 15 LNo.
A0.CHI7ECr/PNGINEER: (40TY257-4900 BUILDING PERMIT INPO
BLDG ELECT PLUMB MECH
0 0
io LICENSEDCON7RACTOWS DECLARATION
j v 1 bvcby.rr.dm,l.con licenced under Provldmd Orcharm r 9(am rz Job Description
• NN Ssuo 7")dDmrloe Sof Ne BuarcuW Pmfauom Code^,Wmyli is
u f amM flot
^•," � f0. f) -. KITCHEN REMODEL, MINOR STRUCTURAL REMODEL EXIST
t ARCHr1ECT5 DECLARATION "
M wMmyPb=l kwdapuldiertrcd. (M) BATH SHOWER, REPLACE ALL INTERIOR DOORS
LiceueI ruby Mnal ��p . ��®
5 OWNER-BUILDER DECLARATION N!■��,4Y■e
1 heresy.Item that 1 em Hemp from Ibe Conlaaetol.Lkeme Law for th
iro immIal Trion.(Sectio t 7(n15,BudavO;and Rufeadom Cone:Any dry Or county ,
3 which rcgdra.rcrmll to comuucL a1W.hor mce.domoli .«apmlr any vmuclvm
prior Isla lssuaµc,alu raquha the apoiew for.ucb ranmil no 0b..igmd uuemwl
;< thuk4u«nQapu.m.nlminepm,;.;«Rmurcnmr.elnrtuansl,w(cn,r�v Sq.Ft. Floor Area q p Valuation
'° (aommeMntwimScauenToomaawbn3urlbeeu»ne«wPbre.anmcnde)« wt"' Cf {o0p $100000
$ aul h 4 earspt t rmn ad Ibe baab for tl,a sifted......ptoo.Any vlWtion of
Sa11mt 70313 by M Mlic m fm.pmme mbjcM we.ppllunt In a dace Pemny of APN Number upancy Type
am Or.auo the hundrtd dabs(5500).
❑1,a awoar of the pawwy.«my emd Na With w.F+a lho-role mmpmaton.
Iriu dot wort amM ae muaam b not orfo fmaak(Stx.7BN,Buurca. Re Uli
W Ppd ximu Codc The emmamurt Liam Law dou.[apply b u owev a q
proparty wbobulld,ar Imprma thereaa,aM wm daa.W work h"unxlf«Wootb his
aur mopby ,provMd WumW hnpro.emava art ea.inlanded ao0md f«tale.H,
howew.Nc bulMint m impxovemeµ4.oM within arc roti ac«epktim,the owrcr�
bwldm.;B n,ea ux Iavdee a wa.;nt IhY Ix ma w colla«imPmae r«pvryo¢a
-
1.u owttc a Ne PmIpr y,am eadu.iw:ly canuanint wilh Itsaacd
coµlmcl tie projtxl apply
to aa•Bin.Of rry r tna Cade)The,as th h IU. V
cure Law dm 001 apply loan owmm of Protons wEo build.«'unpo.a Cmrtb.amq. OOGL(�f /
who mmncu for and projen.wlN.contmorta)lianrea pamW atlxeonu.nora
L air.
❑Iwewnpt undo Sec .B&PCf«this
Owoc Due
WORKERS WMPENSADON DECLARATION
•I herthy.frmo under pemlp'of perjury oa of One fdawMt dIM,.11me
[t.ba.c and wulm uin.carlletma of Crnau io ads-Imam I.work,,'.compm- V(/`�/( J/Uv/,may//✓k f(p/�I,
inion,u pro idd for by Se 37W of dx I- Code,f«the mform.of dx .
wmk I.w b thb permit Is laced.
❑1 ha a:tna will maintain Worker's Companuaon Inwranm,u eequlnk by Section a s✓ ✓ /�'
3700 aaa Mbar Cod,for tb,parfartrana a Ne work for whkb Nis Pmnit i.,,._n
My Wocle.compeoutia/a'1 .�rcs arra ami PWicy wbcr tic
nn ��y�l
hnkr.'�r�t: YET.(/1�11 Polly Not:``//76-7 _W 00`/ 0. ..
`-"- CEIMFICATEOFEXENPTIONFROM WORKERS
COMPENSATION INSURANCE -
(fidt.mlm need not b eampinea If Ih permh It for cox hunted tloll.n(SIM) ,.
ork )
1 certify WI in ae pmfm m.ma of ft wmk I.which al,&permit b ivad,l.hall govt
empby.ny per.on In any.,ea u n became.ubja<t la tK Worken'Coop mdalioo
U.of"ifi ma.D.0
Apphoant
NOTICE TO APPLICANT:If.Ow making lhl.CcaiOaa of& imirtn•you dauld
baame tubjat to We Worker's Compenndon provisions a th,bnor COda,you mus
Z forthwith amply Will,nxh p.ovlalom or Ni.pormit.bl be deemd avokca.
0
CONSTRUCnON LENDING AGENCY
1 beahy all'.that thea b.connauNmi bndint•FncY f«tk perfmmana of
> tis w for which this permit b laud(Srs.3097.Civ.C.)
Q4dmt Name
z 1<rder'.Ada,cu
p 1 an;fy thal 1 have rad this grrl"tion.mW sate Nat the above Inramuaon 4
tamer.l atme a comply wIN all dry and county mdimmxa.tint.aa 4wa m Wing to
WiMint couwumion..M b Ivy.othoam tcp tsa aarcs Of Ni.city to ova upon Nc
above-mandond property for uupcn;on P.P.
G (We)agta to art.IMrmNfy and keep bama a the City of Cuporono alai
to 14bilhimfudgmonmcmu ud a,, m which may In uy way ascot agaiul said city
APPLICA ERSTANDS AND WILL COMPLY Wrnl ALL NON-POINT Issued by: Date .I
souRj� ��„/ 3�5��. Re-roofs
Sltn dfApphcvuCan dw
HALk S MATERIALS DISCLOSURE Type of Roof
Will tlx applicant m futomc bu0diog«etgam awe an,handle hazvdma maarW
u dcrimed by the CupeNw Munidpvi Coda.Cup=9.12.and the rlaltb and!Safuy
Cud,.SUYsoa 2.5532(.)7/ All roofs shall be inspected prior to any roofing material being installed.
�
Will
l �Ao I$.pPlkw«
Diarim7 om !ware wilding Occupantequipment mm.d�wnmb If a roof is installed without first obtaining an inspection,I agree to remove
r,d .ir onn twu lnanu dc0ad by Ilse Bay Ara cm Air Quality Martaga all new materials for inspection.
❑Ya ' &*- .
I hive eW 0.hamdaa tnucrlal; girt mtx un dorCbpu 693 ame CVifor.
nmllh& Uy Cad:.Sadma2Y4.25533ad2553..Iu�"Jlh WiM
doe.nd 0y ha.e a amuµthat It 4 my rtrymWb;llty to notify the areutamr of dx
ravel hnnpro mi onctiru or Signature of Applicant Date
lJG All roof coverings to be Class "B"or better
r .gem Dole
4-1