08080216 CITY OF CUPERTINO �a,�T 3 aa.s35-tiaaY` �F�'> +
BUILDING DIVISION PERMIT CQRA.CTRINFORMA.TION`"`
``{� {w4'd;t"}'mow "
BUIL?I DRESS: PERMIT NO.
S A g5 MORE= DR TBD - TO BE DETERMINED 08080216
NEWS NAME: PERMIT ISSUE DATE
JANE LOK 08/27/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHI'IECffENGINEEW BUILDING PERMITINFO
REMODEL KITCHEN (E,M, P) BLDG P.{PLT PLUMB MECH
O O O O
Sop LICENSED CONTRACTORS DECLARATION Ib Description
EF 1 bereby aabm that 1 am B¢necd under provisions,or Chapter 9(nmmemOe5Cr1p
ing
�Z1 ys wide Section 70(Ki)of Division ofdrc Business and Profculow Cade,and my licenses'
^ Pct in full torn and effect
Z License Class Lk.R
Dem Co.DEC
ARCNRECrDFLLSRATION
I understand my plana Nall W used as public raartls
t tad Licensed Pnsfessionel
bN
OWN ER-BURDaRDE DECLARATION
1 hereby.(Sero that 18M soman from the Cantrnctors License: nylaw for the
O O fallowing moon. uredact 70313,IS,Bueircsa and 9wfwsiaw Cade:Any can on county
9 which requires;•pcmit re enwwet,alter.Impmw,h Permit
e m t t or repair ed structure
�y
prior th.l iuwnc4ahuntto the theapplicantfor ewhpennitm tits uLaw(tamment
Nu hmenchi with
pursuant 71 the of Division
of the ConuanessainwelAw/C Code)
Sq.Ft. Floor Area Valuation
'at
Uexe pt Station1 and WDivissfr of the Budrvsa pion.dl Professions Cadet of
Nat he t exempt ., ppii and dee bub it the alleged tumpda.My violation of
Semlan 1031.3 by atry applicant fora pump nbjecu Ne applicant to a tivil penalty of _-ATN Number Occupancy Type
nm mom den Bw huMred da1Ws(SSW).
❑1,u owner oldie property.a my employes wide mgrs u the'vsek tampewtion,
aid Prdeework,and The
Obatmts Limede Law
doforum(See.7014,Buai»••
and Pmfwhou Code:The Ca tlemsm.License law don set apply lf rt owrcr is Required Inspections
property who st,prone lmpmvuch impo and who dougwh work h lutte edfoosgh his
ownu m,the
Wilding
or LNat gam improwmcou are not intended aroRao.fes tole If,
Wilder,the Wilding wimPmwmnt t anld Whin one gess of comPleef r the awrcr- ,
Wilder w01 haw the burden of pmNng Out k did set bWW a improv to purpose of ,
um.).
❑1,as owner of dee propertY•am uclusinlY comeacting with licensed contractors m
construct the project(Sec.load.Business and Profeuiou Cade)TK Coneacsers U.
a eta law does set apply to n Oa^er of Property who boll"or impnw derma and,
who contracts for such project with a conwner(s)licensed pursuant to the ConesmM1
License law.
❑I am tempt under Set ,B&P C for this rowan
rcr Dam
ORKEWS COMPENSATION DECLARATION or
1 .aim under penalty of perjury one of dee following decimations:
01k, ntain•Cerrifown of Consent to uIf-loom far Workers Comper,
Who.as provided fon by Section 7700 of tiro Labor Code.for the performance of the
wort for which this permit is issued. -
I haw and WII maintain Work es CompMathm IneuMn,as required by Section
71Wof W labor Cade,For the perfonmnn Of tk wart for which thv permit is issued. '
My Workers Compensation Weariness carrier and Policy number tae:
Canter. Policy No.:
CERTIFICATE OF MEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thi suction need an,be completed If the permit is formehundred all(SI W)
or ins)
1 entry that In the lerfomance of the work fon which this permit is Issued,l Nail net
employ any person in an rut bhecome subjecHa the Workers'Contractual. .
Laws of California.0
ApPlknt
NOTICE TO APPLI .IL sAct making this Cenificato of Esemption,you NOuld
become subjm b orkcts Compensation provisions of due labor Cole,you mut
.J O forthwith comply with sech provtbw or this permit Nall be dnmcd ore".
CONSTRUCTION LENDING AGENCY
y
E+ I hereby same that deem is a construction lending agency for dee Performance of -
C > the work for which this permit tissued(Sue.7037,Civ,C.) '
A Landers Name
O z lenders Address
V O 1 cudfy that I Mw nW this application and sem that the abow InfomNun Is
LU correct.I agree in comply with all city and county outnumber and mm laws retailing in
.O Wilding construction,and hereby authMm mplemnutivea of this city to enter upnn tie
W alawe-nu mtianed property for Wpection purywes
py (We)agree to taw,indemnify and kap hummer the City of Cupertino agaiut
y liabilities,Judgment,cwt and expenses which may In any way accrue against mid City
V Z in conaegwnce of dee granting of this permit. -
APPLICANT UNDERFMDS AND WILL COMPLY WITH ALL
d'NON-MINT Issued by: Date 1
SOURCE REGplispa e'�!L✓/ o// /�
Re-roofs /
Signature of Appl' ntrsem Dat
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will de applicant or In are mspuon building Od more handle Iwardow material
Itdented by the Cupertino Municipal Cade.Chapter 9.17,and the Health and Safety
role.Section 25572(s)?
❑Yrs No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fu ure buildiw ampant use equipment a dcvina which If a roof is installed without first obtaining an inspection,I agree to remove
emit hwatdnw air cmumiwnta u defined by dee Bay Amo Air Quality Management all new materials for inspection.
District? ����//
❑Yrs o
Ihaw read the malerialsrequiremcouumkr MPler&95aftheWifor-
nu Health&Safety Code.Satiaro25505.25533 nd25534.l understand!mhuifthe Wilding
does not currently haw a tenant.that It t my responsibility to ratify do Occupant of dee
regnlrementw be me armcadence of,certifeamof Occupancy. Signature of Applicant Date
Owner ora rima agent D,m All roof coverings to be Class rina,or better