04050114 CITY OF CUPERTINOa " �^' '
BUILDING DIVISION PERMIT ACU,,^TRACTQRINFUR.MATION a
BUILDING ADDRESS: KIM KOBARA PMMUN004050114
21980 OAKNOLL CT
OWNER'S NAME: PERMIT MSUR DATE
IFKIM KOBARA 08/30/2004
IS: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION
I thereby sf irou Net I atm Ranted under provisions of chapter 9(commen<In{ Job Description
widt Section 7")of Division Sof the Business and Profusiuw Code,and my lice=is
in full force and cfreck ADD 138 SQ. FT. KITCHEN REMODEL
Llcenw Clan Lie.0
Dam Contractor
�e ARCHITECTS DECLARATION ARATION
y I understand my plans ahell he wed u public recorch
3 r
Z i�i Licensed Pmfca¢idnel
p OWNER-BUILDER DECLARATION
d 0 2 I hereby affirm that 1 1. exempt from the Convenors :A License law for the
p o following recon.(Suwon 71131.5, r.Business and Pmfusiaw Cada:Any city m county
$� which requires a permit to coruwct.alter.Improve,demallsh.or.,an any scut.¢ 840000
FZI'+ poor In its issumc,also require.the applicant for such permil to Jilt a signed statement
Fp that he is llaved pmmam w the proviso.of Ne Conucute.U. eraw(Chapter9 Sq.Ft.Floor Area Valuation
ds (commencing with Section 7")of Division 3 of Na Businem and Profealna.Cnde)01
Wt be s exempt Ihercfrom and Use bash for the alleged aremption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a cool roomy of or U Occupancy Type
sat mon N.Live thumbed dollars({500).
L.awneraf Nepmpeny,mmyempioymwiNwg uthe¢mlemmpeng0pn, '/
wmdothewok..dNemacwnlamtmmndedaranendrarwe(Sm.704+.BualaeP ea �iredIns cellons
and Profession,code:The commerce,ucenm Taw does not:pply.m'!b cote Of/ p
property who builds or improm theman,ant who dausuch weak himself Wthrou hhii
h.n.,.lthaWilwodedNmat, ntprowmemeannmmuaf6tended rofferedpledom th I IL1
however.the buildin{or improsvmant B mid within oro yew of iompkvu.Ne 9rirrcn
builder will have Ne human of proving that he did net build or(mprovafa{pts o
I,u ower reelect property.Business
and anewdng with Iianaed convennn w ,
U.
em
Inwl dte es noel(Sec.70sa,Business and Ry,who Profession ds Code:)The C.vm oo,and, I
,nae law ooea not a an amour of Property,who builds or Improves them.,and J
whonse U u for aoeh pmkcta wIN a conumtarts licensed pursuant to dte Conumnh
0 I ten Law.
❑ lamuemptu l�!Sm. .B dk PC f9r Ws n
Ow
'1 WORKER'S COMPENSATION DECLARA
f 1 by s tans under penalty of perjury one of the following dedeadona:
I have and will maintain aConlOam of consent w self-imun for Warhfa Compton.
saran,as provided for by Section 3700 of the labor Cade.for the perfmman a of the
work for which this permit is issued. /
❑1 have and will maintain Workers Compensation Issuance,.requirtd by Section
3700aftho lab¢Code,fea the pesore.oftheweak fmwhich ddspermitu issued.
My Worker's Compensation Insurance artier and Policy number an: �` '
Carrier. Policy No.: g'� V
CERTIFICATE OF E7(EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbb seniu need not bucomplewd If the permit is forowhundred dollars(SIM)
or leas)
1 anify that in the performan.of the work for which this permit B issued,I soli not
employ any permn in my manner an u m becomesubject w be Workcri Compensation
Laws of Califoods.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifiate of Exemption,You should
become subject to Ne Worker's Compensation provisans of dm Lahr Code,you mm
OfoMwiN amply with such proviso.or this pored mall he deemed mvoked.
z CONS RUCTION LENDING AGENCY
[-E2
•� Ihembyafnrm NU Nen 1.aconuucsnn lending at for the icsurmence of
C> Ne work for which this permit Is Issued(Sce.3097,Civ.C.)
Q Lenoaos Name
.7. z Lenders Address -
O Q I«nlfy that 1 have read Ni,applicidd.and one that the move isfmcom.n is
ly F
ants ants spa w amply with all city no county ordinances and stem lam mining m
C.) building construction,and hereby summon representatives or Nn city w enter upon the A
{i7 shove-(We)a rre propcny for inspection sell keep Int
(We)agree m ave,and expert and hep hay in m w City of against igs.l I
inconsequence fthet uandOf this pa which may in any way xecnc against mid City
t„)7 in consequence of the{ranting of this permit.
�7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POTNT Issued by: Date
SOUR EGUL TIO S.
K J d Re-roofs
y atunof Appl(andCommcmr n Dam
HAZARDOUS MATERIALS DISCLOISURE-f Type of Roof
Will me applicator futon building occupant mon m handle b.ardow material
u deRrmd by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
ale.Section 255334)? All roofs shall be inspected prior to any roofing material being installed.
Oyu No
Will the applicant m future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hamdnu air conmminanta as dented by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yu to
1 have mad the huardous materimsmquiremenm underC1mpmr Q95 ordm Califor.
ma Health S,Safety Cade,Sections 75505,35533 md2553e.l undersmM dosiftle building
does not cu ndy hast a tenant.that It u my mapo.l ffily m oddly the wnoup.t of the
myulremen wrehmu be IpriorminuanceofaCcnOc of a�mry. Signature of Applicant Date
T ,T V
Owner mNarind.,cut All roof coverings to be Class "B"or better