06030038 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONSRA.CTURINFOItMA,TWb1V
Bu1LDING ADDRESS: INTERNATIONAL KITCHEN EXCH CVO06030038
10359 HENEY CREEK PL
' OWNER'S NAME: PERMIT ISSUE DATE
FRED & MICHELLE LACCABUE 1175 E HOMESTEAD RD 03/06/2006
E: SANITARY NO. CONTROL NO.
(408) 296-3055
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION Ipb Descriptionrd 1 hereby An.that 1 am licenced under provisionsof m
Chapter 9(comencing
with Section 7")ofDivinon 3 of the Busineuand Professuru Code.and my liceme is
n infuRto=And CCL REMODEL MASTER BATHROOM
Z License Lk.N
Dae Cam'EC T^aP C
ARCHITECTS DECLARATION
I understand my plans Mall W used u public records
76
g Licensed Professional
OWNER-BUILDER DECLARATION
I hereby maso affirm that 1 1. exempt(sum d r C"ohe o License law for he
p O which
mann.(Section 7(D 1.4 Business and vee demolish.
Cad,:Any city or county
4 3 tai which mqus u a permit re cnwruc4 aloe.improve,farau de ermit t ore a sig any hwctum
jna tprior hat
its issuance.cauorequires Limaapplicantof he CohpemitmfMeaaigwdhntemenl
F�F< thld heulic,nscd punuanlmthu pmWalonsmNc Conlraetoel inserts law(Chapter 9 Sq.Ft.Floor Area Valuation
3$ (commencing with Smlon70D0)ofDivision 3ofNeBusineuandProuaaiomCoda)or $56988
3
than he u exempt therefrom and die basis for Me alleged efempdon.My violation of
t�eR N�nw nmappMmnt per allars permit subjects the applicant m a civil penalty of APN Number Occupancy Type
❑1,as owearof the property,Army employees with wagesu Mxirmlecompentadnn,
will do Mu work.end Ne swnurt u rot intended Ar o(fcrttl(orsale(Sec.7044,Buunm
and professions Code:The Conuamo's License Law don not apply Is an awws of Require fGITCyTe(clllgonns
man enywyees,ida provided that
thereon.and who are
Mmcelforthmugh his
however.meuilding provided provemlmDmvenw hale ne year of completion,
m,Rema(Ar We1L I®g®m s9C5g7114{/J�p[611 T[}+/)ave yVgjl,.waTT°rk
however,Nebue Me Arder of mAnasold n did oroWeldofhap.I.theowwr-
builtlu will have Me buNert of pmvinu Mut h,did rot hdltl w improve for purpose of
tale.)
.
❑1,an cower of the property am exelesively cWersel ng with licensed mnuacmrs an 711Hconstruct the pmjmt(Sec.7044,Business and Professionsu
Code:)The Comura LI-
m m
mean Law does am apply an awr of propenYand
who builds or improves themem, , /f
who La ufonmh projects wlNaconucemr(s)Mcenud pursumtmNc Contravenes a� ✓�1 ����I { �es, ;a
who co tact Y✓� fLlq'FjlFyl�`J'' r�(pl\\"tn�i
❑I am exempt under Sec. .B @ P C for this moan Q
Owner Dau
WORKER'S COMPENSATION DECLARATION UY/
I hereby Arm under penally of perjury,one of Me following declarations: LI
I haw and will maintain•CeNficons of Couent to self-insure fm Worker's Cmtpco-
wpm.u provided for by Section 3 RX)of the labor Code,for the performance of Ne
work for which this permit is issued.
(ql Mw and will maintain WmkeYs CompensationIrmuance.u required by Section
3700af the labor CWc,for Me performanm of Ne work forwhiM Nis p,mit a iuwd.
My Workeee,compensation Was arae carrier and Policy number am:
Carver.1-(,l[„'fCJ("'D SY�g• Policy No.: 6` '253 I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu whom wed net he Completed Iftbe permlt is froom hundreddolters($10(y
air less.)
I certify that In the pufmmance of the wank for which this permit is issued,I shall not
employ any person in any Mannar an As At became subject to the Woreari ConpewMm
Laws of Califomin.Dae
Applicant
NOTICE TO APPLICANT.If,AMr making this CeniRoou of Exemption,you should
become subject un the Worke s CompereadW provi,lons of the tabor Code.you muse
z forthwith Comply with such prtrvislons Ar this Furthers]W decmal revolted.
a~�i CONSTRUCTION LENDING AGENCY '
[—i Ihereby affirat Mut Nem lea conswetim lending agency for the performance of
a 9 the work for which Nis permit Is issued(Sec 3097,Civ.C.) '
LQ Lattices Nurse y
z Lenders Mdmas -
U Q I certify Nat 1 have mad this application and hue that the above Information is
W P Comm 1 agrce u Comply MN all city end county ordinances and sue laws relating An
0 V building construction.and hereby auNarine representatives of this city to enter upon the
Dd aMw-me liawd pmpcny for inspection purposes
(We)ism.to save.Indemnify and keep harmless de City of Cupertino against
,,n liabilides,judgmms,tours end expenses which may in any way accrue against Wd City
U In eoniey c of the grouting of Nle permi
APPL UNDEg�rANDS AND COMPLY WITH ALL NOr-POINT Issued by: - Date
ygy915_ �d��1p� / J� Re-roofs
S�i' n m of AppplliesnxMJCeo—n�or 'DDue
N US MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or sutura building occupant am or handle hoallous maedal
As defined by the Cupen]no Muni" 1 Code.Chapter 9.13.and the Health and Safety
Cale,Section 35532(¢)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant or future building occupant use cyuipmml at devices which If a roof is installed without first obtaining an inspection,I agree to remove
f. ,hazardous air contaminants u fined by the Bay Ama Air Quality Management all new materials for inspection.
Mulct?
❑Yes Nu
I have mad de huardma material,requirements underCha ecr6.95oftheCalifon-
.inHealth B S fctyCm1c.Sued.25505,25533 and 25534.1 understand that lithe building
does to ndy have un Am.Nu it' y hility a roti Me upenl of @e
mituwhich met prior cc ACcu Signature of Applicant Date
rte authorimcl agent Date All roof coverings to be Class "B"or better