06060043 CITY OF CUPERTINO r �7r gr.�Iy^ra+� A>y3du+>d "%''• a
BUILDING DIVISION PERMITQ31'J..l[L5. �'`^ "' T ^': �.
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERMITNo.06060043
970 MARIA ROSA
S NAME: PERMIT LESLIE DATE
A
' WILSON WILLIAM M AND LINDA L10562 S DE ANZA B 2006
PHONE: SANITARY NO. CONTROL NO.
(408) 257-4900
ARCHITECTIENGINEER: BURRING PERMIT INFO
BLDG 1
O ELECTO PLUMB MECHO
LICENSED CONTRACTOR'S DECLARATION lob Description
i 1 hereby'That,that 1 am licensed under provisions of Cbapur 9(commencing P
With Sudor 7000)of Divlaon 3 of dm Business and Profeadoo Code,arta my Irene it
in full farce and effae I<dw Og1Ga� KITCHEN REMODEL- NON STRUCTURAL REPLACE WINDOWS
a LkanmI a CLk.S
8' Dam Can roue LIKE FOR LIKE
n F�g ARCHrIELTS DECLARATION
I g I understand my plans shall Ise used u public records
IN
:u t; Licensed Professional
ty3 OWNER-BUILDER DECLARATION
i I hereby sfrom that I am exempt from me Contractor's License Low for tie
3 a o fallowing mason.(Sentient 703 1.5,Business and Prorwhono Code:Any city or county
t$ which requima a permit to con oro rime,improve,demolish.or repair my summum
prior m its issuance.aim mqulros the Applicant for such Permit to file A signed statementVaIU
Nat he is licensed pursuant m the provisions of the Counselor's License Law(ChapM 9 Sq.Ft. Floor Area
1� (commencing with SeNan 7000)of Division 3 of the Business and Professions,Code)or
59 9 mat he Is emmpt thamfmm and tie basis fm me alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit objects the applicant m a civil penalty of 3 er 0 0 Occupancy T�pe
rat more than five hundred dollen(5300). O.l.a tl U
C 1,u awe of de voputy,m my aoploym wim wpm u men mlecampanudon,
wBlmmewanmde:The oalenarmmnmdorawdoes;r 1-ply.7B u.eatima Required Inspections
proand Etonian CaaG The canuacta .Licence law don rot apply m rt owner of 9
own em wholouIhtssiimpvs su Ih Onpr andwho rimasub work himselfthrough bas
owe a er.thea.poWar I Woe such impovemmu are not,Intended mplatior offered for ales,
bowcw,me building ar den ovement d old Within oen you or mproe forn.dump=of
ado.l. NB have rix burden of proving that h did not bulb m improve(o puryom of
sau.L
C 1.u owner a the property,w exclusively communing wise licensed conuactms to
construct ma project(See.7B44.Gasman and ROfeSYOn CP'IG)Th C®VmmrA LI-
rowan law does nm apply m an owner of property who dims or Meow dem on,and.
who connotes;for such pojeeu with a ormamer(s)Iicenmd pursuant m me Commences
Licenm law.
no uempt under Sec. .B A P C for dda resume
Data
WORKERS COMPENSATION DECLARATION
I hereby sBirm under penalty of perjury one of de following mlarstions:
C I hamond will mainuina Cartifeamaf Cammutmself-InmrefarWormesCampen-
salon,u provided for by Sudan 3700 of the labor Code.for me performance of the
work ser which this permit Is Issued.
❑1 have and will maintain Workees Compensation Insurance,an required by Section
3700 of the labor Cede,for the performance of dae work for which this parent is Issued.
My Worker's Compensation IrmRance order and Policy number art:
Cartier. ' Policy No.: y(P7—pvoo lis
CERTIFICATEOF F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This motion mxd not N completed If tie permit is faaenhundrea 011MIS100)
or less)
I certify thm In the parformence of me work fon which this Permit is flood.I shall not
employ anyperson in my mmenrm u In become subject to de Warkus'Compensdeo
law of Ctlifamia.Data
Applicant
NOTICE TO APPLICANT:If,unor naming this Qmncam of Euampdon.you should
baame mbjcn m the Workees Compmadam.povisiou of tie labor Code,you mm
Ofortamih comPly with such imnwia u or oust permit Nall M daunted revoked.
Z CONSTRUCTION LENDING AGENCY
P Iaffront mu
hy affront mem sanm is a eoninn lending agency for the performance of
o4 2: me wick fm which th s permit is issued(Sec.3097.Civ,C.)
G.Q m
Lender's Name '
0. z Lender's Addr
U Q 1«nify that I has read Ids application sed sum the me above information d
U.E'^ cortcar.I agree to comply with all city and county ordinances and some law mhting in
0V building construction,and herebyaumom<mprcsomedve.ofthis city to enter upon the
Uabove-mentioned property for inspection purposes.
Qy (We)agree to save,indemnify and keep ha hien me City of Cupertino ageiast
rA Iiabiliticajudgments.coms and expense which may in any coy accrue against said City
U z m conmque a of the granting of this Permit.
^e APPLI UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sou a cu
GUCS Re-roofs
agwuura of AppllunUCan Dam
H US MATERIALSDISCLOSURE Type of Roof
OWill me app tame olldingaceupanlMm uluMle hemdoas maurid
Dred by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
,Section 75531(4)7 All roofs shall be inspected prior to any roofing material being installed.
CYas Awl
Will the applicant or fu um Wilding occupant use equipment or devise whsch If a roof is installed without first obtaining an inspection,I agree to remove
emit Incurious air canumimuts a defend by dm Bay Amo Air Quality Management all new materials for inspection.
District?
�C
QYn �C
I have mad the baaardommaMats raquimmenounderChapmr695 ofthe Califor.
nu Hnith85afc Smiw 25505.25533 ad 25534.l mwemad theorise diking
dm
.Lee by M a mum It� tespoadbility m ratify de of
require whc uabe u of Cerdlkae Occas Signature of Applicant Date
Ov0dFITanthwized agent I Do. All roof coverings to be Class "B"or better