07050045 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ' ' A..
PERMIT NO.
BUILTT6T SAOSARI0 AVE KITCHENS BY MEYER 07050045
PERM17 ISSUE DATE
OWNER'S NAME:
YAMAMOTO RANDALL K AND KAREN 278 CASTRO ST 06/12/2007
SANITARY NO. CONTROL NO.
NEK (415) 966-8318
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION Job Description
M1
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:z�d with Section 7000)ofDivision 3 offfic Business and Professions Code.and my license is REMODEL-KITCHEN, DINIING & MASTER SHOWER FURNACE
I a ain full force and ect4-2 i�? License ass Lic.ff TO BE MC1VED TO ATTIC.
- c pare Contractor
:E A CHITECTS DECLA A N
1,< 1 understand my plans shall be used as public records
0.0
'n,y Licensed Professional
: a OWNER-BUILDER DECLARATION
3 a I hereby affirm that 1 am exempt from the Contractors License Law for the
:
00 following reason.(Section 7031.5,Business and Professions Cale:Any city or county
a�, which requires a permit to construct,alter,improve,demolish,or repair any structure
1' w priorto its issuance,also requires the applicant Cor such permit to file a signed statement c q.Ft.Floor Area Valuation
-^� that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
F (commencing with Sect1. aion 7000)of Division 3 of the Business and Professions Cade)Or
2 5 E that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 619 0 3 ;t7 f Number
not more than five hundred dollars(5500).
0 1,as owner of the property.or my employees with wages as their sole compensation,
will do the work.and the structure is not intended oroffered for sale(Sec.70",Business Required Inspections
and Professions Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sate-if,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale').
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U-
cense Law does not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a contractors)licensed pursuant to the Conuactoes
License Law.
0 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations.
Q I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are: f
Carrier: I I �C- r I Policy No.: ✓�`�' -
CERTIFICATE O EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(flus section need not be completed if the permit is for one hundred dollars($100)
or less.)
I cenify,that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(�rte-. I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Name
Z Lender's Address
U 0 I cenify that I have read this application and state that the above information is
LL correct.I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City /^
U Z in consequence or the g ung of this permit. Date
�, APPLICANT UND DSA ILL COMPLY WITH ALL-NON-POINT Issued by: '
SOU C N O
Re-roofs
tgtra—turc pplicanUContractor T of Roof
HAZARDOUS ATERIALS DISCLOSURE Type
Will the applicant or future building Occupant store orhandle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed.
fi
0 Yes
If a roof i;installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safety c,Sections 25505,25533 and 25534.1 understand thatif ft building
does not curie h a ten t it is my responsibility to notif tic occupant of the
rcqu no toissu ccofacen;f ate oe Signature of Applicant Date
dZ All roof coverings to be Class"B"or better
Owner or authorircd agent to