06060082 CITY OF CUPERTINO . ' ir*+� �^�^ s»e; ey'x"�"'+s -
BUILDINO DIVISION PERMIT .. 0 xCUR TrtFORMATIUN
x.F.a Pit., •4,"*w'e, :h'" d.ni1f.E•i. ?t ?*,.
BUILDING ADDRESS: ' NINA KLEPAC PERM"'O-06060082
20081 NORTHWOOD DR
OWNER'S NAME: PERMIT IS
SR
NINA KLEPAC 06/22/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT
PLUMB MECHO
uo�d LICENSED CONTRACTOR'S DECLARATIONm that Job Descn UOn
vd u� 1 hereby affirm I mm lie:osed under Provisions of Chapter 9(commenums P
with Section 7(1011)of Division 3 a(the Business and Professions Code.mod my license is
n, in full force and effect. KITCHEN REMODEL, MASTER BATH, 721 ATTIC SPACE
Lice.,.. L.ie.0
Date Contractor
ARCHITECTS DECIMATION
I undersand my plans Mall he teed As point.recru s
s Md� Licensed Professional
1,x21 OWNER.BUILDER DECLARATION
s� I hereby AfErm that 1 am exempt from the Contractor's License Law for the
i a o following reason.(Section 703 1.5,Business and Profusions Cade:Any city or county
$ which rtqulma a permit to eonuruct.Aw.improve.demolish,or repair any structure $75000
prior n its issuanm.also requires We applicant for such Pamir in rile a signed sutemem
IM,he is licensed pursuant to the provisions of the ConumtmSu
Lre law(Chapter9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 7000)or Division 3 of that Business and Profossiom Code)or
Q .. that he Is uempt therefrom and the basis fm the alleged asemptiam Any violation of
section 70313 by any Applicant for a permit mbiccts the applicant m a civil penalty of Occupancy Type
not more than five hundred dollen($500).
❑I.as owner Mf tits Propcny,m mY mpploym with wags a the'v sole cempensaaon,
will do the wors,and she avucont B not Intended croQered roraale(Sm.70/6,Business Required Inspections
and Profession,Code:The Crnhamara License Law ares not apply In an Manor or q P
property who builds or improves thermn,and who does such wort him W f ortiuough his
awn emplayem.provided use such impmvemanu are nes intended oro0'ered for Asia.If.
however.the building or improvement.Is mid within aro you of mmpkuon.the owar-
builder will have the buNen of proving dust he did rot build os Improve fm purpose of
sale.).
in 1,as owner of the property,am exclusively contracting with licensed mnuacmn to
construct the project(Sec.7044,Business and Profession Cade:)The Cootraroh U.
cave law does not apply m An owner of property who builds or improv Benson,and,
who concocts for aneh projects wish a can racnor(s)licensed purse m to the Corruamwf
License law.
❑Inns exempt un/A See B&PC for this
Owner Dam
L'lla�— Dau
WORKERVSC MPMP STLON
I hereby afflrm under pally of perjury arc of the fallowing declanalkhr
1 ham and will maintain a CeriOpteaf Caen m self-Wore forworker"Campen-
wian,As provided for by Session 3700 of the Labor Code,for the performance of the '
work for which this permit is issued.
Q 1 have and will maintain WorseYs Compensation Importance,As required by Section
3700 of she Labor Coda.for the performance of the work for which Nit permit is lssned
My Workee,Compensation Insurance wrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORK FRS'
COMPENSATION INSURANCE
(Thu section red oat be completed If the permit H(mane hundred dotter,(5100)
or lest)
1 terrify Wt In We pe fomucc of the work fm which Nis permit is Lured.I shall not
employ any person in my msapera�a a beeombjmt m the waders'Compensation
Laws of Caiiloncia.Dam OfT/7ri A G c�
Applicant - — -
NOTICE TO APPLICANT.If,After mmkint shit 'ricam of Exemption,you should
Assume subject m the workels Canpeasadan p kions of the labor Cade,you most
Oforthwith comply with such Provisions or this permit shall b.docmod mvmked.
z N CONSTRUCTION LENDING AGENCY
(.•v Ihemhy dRm that then tea couvucdm lending meney fur the performuae of
((.r7 tho wars for which this permit u saved(Sm.3097,Civ.CA
QUndoes Name
a z LemicesAddra,
U 1 cotify that I have read this appii..iAA and sure dost the be.Infamm0on is
D. come.I agree m comply with all city and county oNinances and me laws reining In
0 Wilding construction and hereby anhoriva mPmsc^utiv of this city to rner upon led
W mow..mentioned property for inspection ptu mas&
gy (We)agree to save,indemnify and keep hamlet We City of Cupenino against
in liabilities.judgmenu,costs and ape•..a,which may in my way amae against said City
U 2 In emaqucnce of she granting of this Permit. In
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2 L--�CJ
SOU ULATI 7 ,
�T Re-roofs
Signature of Applicart/Coillrictor °ins T e of Roof
NAZKRDOUS MATERIALS DISCLOSURE yP
Will am applicant or room building occupant shore ar handle haarda maLL+ial
a defined by the Cupertino Municipal Cade.Chaper 9.13.and tins Health and Safety
Casio.section 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea a
Will she applicant or furore building occupant ve equlpmml or dcvlm which If a roof is installed without first obtaining an inspection,I agree to remove
Will ft Applicant 2ulum building occupant moc cmulmum,or dc'Ims which
II hasrdoa air coouMosnu u defirmd by the Bay Area Air Quality Manag.mcnt all new materials for inspection.
District?
CYns r911"'
I have mad the hanrdousmaeruu requirements muter Chaper 6.95 of the Califor.
nia Huish&Safety Codc,Sce9a 25505,25533 And 25534.1 uedenued that tram building
dos not curianaly haw:A won.that it is my nu mnsiMlity m notify the occupmt of she
rcgai hmush rminummcaf,Cenrcama Signature of Applicant Date
All roof coverings to be Class"B" or better
Owner or autharvad agent Dam