05010126 I
;—CITY OF CUPERTINO 7_T,77 r%, 7-7�'�,�Ao
BUILDING DIVISION PERMIT
C F
"BOILDTNO ADDRESS: STEVE KIRTLEY PERMITNO05010126
".1516 MONROVIA ST
I;VNER'S NAME: PERM"ISSUE DATE
STEVE KIRTLEY 01/21/2005
'ONE SANITARY NO. CONTROL NO.
ARCHITECTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0, LICENSED CONTRACTOR'S DECLARATION
�dc I hereby affirm that I am licensed undler provisions of Chapter 9(commencing Job Description
fflwith Section 70(y)of Division 3 ordhe Businesses ad Prodfiessions Code,and my license Is
1.f.11frousturdCRicel. KITCHEN REMODEL
License Class—Lt..X
Diaz�Contractor
ARCHITE-CTS DECLARATION
W I undarmind my plans insall ts,used as public records
U
MLicensed Professional
0 OWNER-BUILDER DECLARATION
I herch,tiffiren that I am exempt from Me Contractor's License Low to,the
ng moon.(Soc on 7031.5,Business and Prafeessions Code:Any city or county
which requires a Permit to construct,attar,improve,Mansolish.no repair any structure
prior is its issuance.also reptimes,he applicam For such Permit to file a signed evicurnern
that the is licensed pursuant to the provisions of the Contractor's License Law Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 or the Businces and Prorcesiona Centel or
Met he 13 exempt Motorman and Me basis for Me alleged exemption.Any violation of $25000
Section 703 1.5 by any applicant for.permit a.bjcU Me applicant to.civil penalty of APN Number Occupancy Type
not mom Man five hundred d.11...(S300).
0 1.as owner of Me property,or my emplo,oss with wages as hoir sele compensation.
will do Me.,I,and Me sunicture is not intanded or ffiered r...1.soc.7044.Business .5 5 6 2-5 U 2 L 0
and Prodficadim,Code:The Contractors License Law does.1 apply to an owner of Required nspections
property who builds orimprom thercont.and whodoces;such work himself ordbrough his
own employces,provided Mai such improverectio;us not intended orofferecl forsale.If.
however.the building or impromment is sold within one year of Completion.Me owner.
bulkier will have Me burden of proving Met he did not Wild or Improve for porpoise of
sale.).
E]1.&a owner of Me property,am exclusively contracting with licensed contractors to
construct ft prinect(Sec.70",Business and Professions Code:)The Contracuer's U.
ceew Law it=not apply to in owner of property who Wilds or Improves Memon.and,
whocan c lonsuch J1, WI�l,con�,c��,llion�dpu,l�Inl��Coo�Icloe.
License Law.
0-1 ansiomimptimes, x B&P C f.1 Mi.posim.
Dam 1AZ//0
'TI
WbRKFR 9!0 PENSATION ECLARA IN
I handby offlose under Penalty of pedury one of Me following clawbuniflonse
C]I have and will maintain a Certificate ofConsount to self-insure forWorkor'sCompam-
.line.as powid.d for by Section 37M of Me L&1W,Code.for Me perfirmou.of Me
wo*for which this permit is issued.
0 1 haw and will maintain Woriver's Compensation Intrundim,as enquired by Section
37W of ft Labor Cases,For Me iscifornearace of um:were for which this Permit is intend.
My Worker's Compensation Insurance carrier rund Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus suction ncout I tic,mriplined lithe Finish is i.e.hundred d.H.Bilf)(1)
or IcsQ
Icerfilythotinthopicrimpris our the work For which this permit is humid,I sludlion
croployanypersounin y ran as to become so�t t to the 7 lec".C.,orene.tor
Appfl Iler) ,. 4� 4A�hq —
NOTICE TO APPLICAW W'.11ter sisal ng(R9,15itillown or ption,you should
become subject in Me worices compensation previsions of r,r Code,you in"
:l z fixodswith cmipl,with soch provisions to Box pennit halt k decoundl nonflutd.
z 0
CONSTRUCTION LENDING AGENCY
I Weebysuffinus Met Marc hist.mouroi looding agency for one pcohmeminax,or
the.,it for which this permit is Wool(Sec.3M.Civ.C.)
umicr a con.
34 Undoes Address
Z) z
0 1 mfy Met I have read box application.4 We that Me W.Information
correct.I alles,to comply with all city and county ordlimucts and auto,Jews misting W
building consurectiom.and hereby auffionne nopicasonatim or his City to enter upon Me
U alsove-mentioned property for inspection purposes.
(We)itgom to save,indemnify and i harmless Me,City of Curcrfiro against
litibilm.,judgments,costs ands .,.which may I.any way accom l sald City
incomunticerecoffluegrantindisfiN N it.
SOUPLAP ANT SNTSANDS D'WI COMPLY WITH ALL NON-POINT Issued by: Date
U
El
ICCIE no
M! I , Re-roofs G7
LT Signwd'rt drApplicionfCodusector I Dim
HM�ARDOUS MATERVLS DISCLO/RE Type of Roof
Will the 4pplicaut or future building occupantsione or handle bluounkrus unittrial
as deflned by the Cupertino Municipal Code.Charter 9.12.and the Herd,lo and Safety
Coal"seems.....("? A All roofs shall be inspected prior to any roofing material being installed.
0y. _T No
4 D Will Me tippli'an,or future building occupart use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
orni,hammous air contaminator as defined by has Bay Am Air Quality Management all new materials for inspection.
District?
0y.
I ho. ad the houndous materials nequiremouss;undaurChamer6,95oftlem Califor.
ni.W.Milks 'y -=reat V,5,25533 and 25534.1 understand thatiriho building
om,
'.9
, ve
does mol'. , .. iiinny mobility in sooty da,..P.,or Me
de
requirements I usits, I r.ccourcuthe�' ."P`ml` Signature of Applicant Date
MW 1 1/0
Ownerlerrauthornmed agent D /Date All roof coverings to be Class"B"or better