04120079 (3) F'U
TY OF CUPERTINO r'
BUILDING DIVISION T PERMIT CONTRAC"TQR INFORMATION
. ,.�,�. �.
DING ADDRESS: CUSTOM KITCHENS & BATHS PEfA11TNO04120079
408 KRZICH PL
PER'S NAME: PERMIT ISSUE DATE
BABU NOTT 581 CALPELLA DR 12 /13 /2004
NE: -" - "—^' SANITARY NO.-�-- - CONTROL NO. " '*
(408) 829-0078
ARCHMIC'17ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
aOo mi LICENSED CONTRA(=41 S DECLARATION
WF
relay 000).f Met l,mlihazwunder
ckan .R.Mmemin,Chapter v(commencing - Job Description _
Z�y wt ticemilefnf =viaionlof Ne Businrs��rofcssians1� myliccnm is tete tete •tete. .__.
'^Wit Lic,.mmeanderlec ' BATHRM REMODEL "
�{? Liccnx Clus Tic.g
�Fci Dow - Conlncwr "
ARC DECLAR N
d u puhlic rtcnrhs
;ay Lleen u �
.� g OWNER-exempt RDEWe Com ION
i I Wag aRrrn that 1 1. exempt from We Comns Co Liccnx Law co the
Kp o following massa.(Section 7 o su Business and wc.de tau Code:Any city as county
$ which¢yuit=a permit m cnnswct,elaq improve.OcmnlivM1,at repair any structure ---- -
' w-'^ prions its issuance.also requires the Applicant for such permit to rile a signed statement
<< that be is rccaxd pumant to the pmvuiou n(We Comncari Urn.Law(Chapter 9 Sq.Ft. Floor Area _ Valuation
0~a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
._ Nat he u exempt therefrom and We basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a Permit subjects the applicant.a civil Penalty of5QNR;;TFJet00 _ Occupancy.Type
not mom Nan fin hundred dollan(SSW). - _
Q I.uowms of Ne pmpcny,mmy cmploycu wiN wages=their sole cmnpenudon,
will do ducwork and thestmcture isnot inumbad moffcnd for sale(Sec.7014.Business
And Professions Code:The Connors License law doer not apply in an owner of --_ Required Inspections _ .__.Uq_x: __
property who buildaor improve thereon,and who daessuch work himseuor through his .
Man employees.pnvidcd that such impmwm=u are notinanded oro@red image.if.
however.Nc Wilding or improvement is mid wiNin one year of completion,the sworn
builder will have Ne burden of proving Net he did not Wild orimprove for purpose of
sale.).
01.u owner of me progeny,am=elusively contrmting with limnxd conmcmm to te te
connmet to project(Sec.7044,Businw and Pmfrsgook Code)The Contractor's Li.
cense Lawdm not apply m m owner of proPeny who Wilds or improves t a goon.And. - - - - -
whoconmets,for such projecss with a contncmr(s)licensed pursuant to the ComsxaYs "
case OW..:
I Am exit d c B&P C for this reason
cr CO ENS DECLARATION
1 hereby afford under penally of perjury one of the following declvations:
I have and will maintain a Cenificam of Conant to self-mage for Worker's Compcn- - -- -
anon,u provided for by Section 37W of Ne IaWr Code,for Ne performance of tW
work for which Nis permit isissmd.
❑1 have and will maintain WmIce,,Compensation Insurance,.required by Seedim
371 ofthc laWr Code.for Ne performanmofthe work forwhich this pognitis issued.
My Werke/s Campensadon Inanmx carrier and Policy number art:
Carrion Policy No.:
CE]MWATEOFEXE MON FROM WORKERS' -
k COMPENSATION INSURANCE
(This union Aced not W complctcd if the Permit is for one hundred dollan(SEEM)
or Is..)
1 eighty Nat in the pe(atm9npP a the work for which this permit is issued.I shall not te te
employ any portion az uuth
on in asyydu a xo OZ$ jeco e Workers' Orepcneation
haws of Cnifor i . Tit -- - -
Appii sat
N E T a g this Cenifieac of Exemption,you should
:come Ion an Ne Workers Compact ration previsions of Ne Lamer Corte.you mug
.,z foo ' Comply with such provisions or this Permit hall he decmc l revoked.
Z O CONSTRUQION LENDING AGENCY
(_, .N. I Wreby ARM,Nm f.is A Construction lending agony(or the erfgnorrme of
X > the work fur which this pcmtit is tamed(Site.3097,Ci,C.)
W in Leneces Name
z Lendcls Address
V Q 1 cagily Nn I have mad WE.application end sign WE Nit about information is
(•' cogeck 1 agree ha Comply with all city and county oodimmtcee and sate laws mladng to
O V building construction.and hereby auNann repreAntatit<s of Nis ciry u enter upon tW
Ch1 above-mcmioncd propeny for impaction purposes. L!
6. (Wit)agree to save,indemnify and keep huminss the City of Cupertino against ,
S4�� —
F'fD
liabilities,judgments,costs and expenses which may in any way accrue against said City
of the
C.)Z APPLICANT UNDERSTA Startingof
ats Permit.
NO WILL COMPLY WITH A L NO T Issued by: Date
SOURC G S.
Re-roofs
Signor AP a nVConW n '- Data
HAZARDOUS MATERIAfS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant share or handle hvmdous material
az defined by Ne Cu,,morm Municipal Code.Chapter 9.12.and Nc Health and Safety
C.Seaton ss3z('17 All roofs shall be inspected prior to an roofing material being Installed.
C]Y. Na P P Y g g
Will she applicant or town building mapnm esu equipment or dcvicu which
If a roof is installed without first obtaining an inspection,I agree to remove
it hanAnme air C.n.inana u dey'tncd by the Bay Area Air Quality Management all new materials for inspection.
District' (�P,!v/
❑Yes
I have rtul the buard�msma.rials rtquiremcnu under Chapter 695 of the Califag
nice Hcsldt&SafetyCodc,SCNuns 25505,25533 anJ 25514.1 undersand suit the Wilding
da=not curtcntlanent,tbatit i reapouihilitY nndfY tW u:cupanl n[IW
myuiremc n t 'tar anmofa 'fin f "Arcyv Signature of Applicant Date'
ow t esti b,a All roof coverings to be Class"B"or better