04060227 CITY OF CUPERTINO '" '
BUILDING DIVISION PERMIT 7 CONTRACTORMORMATI,ON Ua
BUILDING ADDRESS: CUPERTINO KITCHEN DESIGNS PERA"""04060227
1577 ASTER LN
OWNER'S NAME: PERMIT ISSUE DATE
MARY & JONATHAN SAUER 10562 S DE ANZA BLV 06/25/2004
NE: SANITARY NO. CONTROL NO.
(408) 257-4900
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ti00 LICENSED CONTRACTOR'S DECLARATION
u C I hereby affirm that 1 not licensed under provisions of Chapter 9(commencing Job Description
U with Section 700l of Division 3 of de Busineu nb esaiana Cmm,m my license is
'a�a i�((uuuroaamer a 3 KITCHEN & REPLACE SKYLIGHT/ WINDOWS
j i LiAo�Chis IJc.N
n DaaCr D/I,72c TSDIECL RA3yN'Z/I+O KIrtHc
RCHITECTS DECLARA N D2S/[+N
l w l underwr�l mYT s ahall ¢std as puhli cords
3 c Licensed Pmfcoionel
5
OWNER-BUILDER DECLARATION
<2 1 hereby.Sect Nal 1 1. exempt from Ur Casions o License Law for the
my
O O following mason.(Section Non LA Consumer. les. and wn.do soh Coda:Any city or rounry
$(Li which its inu a permit ro .thOalar,Impmw,demolish. file
repair any swaum $50000
Tai primmiuiensed .amenttoima Novismaeant for such Cmurarmit mecrom aw(Chuctl ¢mcm
C that me Licensed pmction m Ne of Division
err Nc eBusi tors Liaroclaw(Chepmr9 Sq.Ft. Floor Area Valuation
¢t`O (commencing with Section Division3nf he Businrssand Professions GndC)or
y�S that he is exempt therefrom and the herb for the alleged eremption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
oat mom Nan Eve hundred dollars($500). a Occupancy Type
❑I.as owner ofthe properly,or my employees with wages as their sole compensation,
will do the work.and Ne.mutt..is natimended oroQemd forade(Sec.7044,Business
and Professions Code:The Contractor's Liam Law dors not apply to in owner or Required Inspections
property who Wildsor improv thereon,and whodoessuchwmk himself orNrough his
own a
however,
the building
uiNn such improwmenu are not inmslded moOcrW the owner.�uilder the Isuil the ru improwmenl is hold within one yen of c prove for
the awe of r�
builder will haw dm burden of proving Nn he did not build or improve for puryom of L f�
eale.). Y It 'v{1�1ak Sh
❑Lint owner of project
properly,,Business d contracting with li Theed contractors i.
ceras La the es not (Sec.7044,werofand Profusions ds or i poo Cs thereon.tai- SEP
P�
nse law coca not apply je an owner of property who builds or improv thereon.and, J t 200
who'm Lacca for such projects with a cunPursuantm the
or(a)licensed Pursuant ContracmrS 4
`F
Liar¢Law. ,
i am eaempt unaen Sce. .B g:P C for Nis¢awn
Owner Dae IlD�1Ll4$�gy�UJ
WORKER'S COMPENSATION DECLARATION
1 hereby arm under penalty of perjury one of the following declarations:
0 I haw and will maintain aCcnificam of Consent to self-home far WOrkersCompon-
sation.as Provided for by Section 3700 of the Labor Code,for the performance of 1M
works for which this permit is issued.
La�1 have and will maintain Workers Compensation Insurance,as mqumed by Section
3700 of the Labor Coes,for the perfomuna of the work,for which his permit is isamd.
My Workers Compensation Insunnce artier and Policy number ase
Per,ryrt :
Ca r.S A �UWD P o.: /7t1'3�T70.03 ,
CERTIFCATEOFE%EMPfItlrngPPfFRR0 WORKERS'
COMPENSATION INSURANCE
('Ihb section need nutheeompleu l if dr Permit is forms,hundred dollars(SIM)
less.)
I certify Nat in to periu manes of the work for which this Permit It issued.I shall not
employ,any person in any manner an as to become subject to ltm Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,aper making this Cenifcau of Exemption,you should
become subject to the Worker's Compensation provisions of the lalmr Code,you most
.,z foMwitt comply with such provisions or this Permit shall be domed revoked.
'EO worCONSrRUCf10N LENDING AGENCY -
[-+� - Ithereby affirm cut them is a construction lading agency far the performance of
Ci de k fur which Nis permit u insued(Sec.3097.Civ.C.)
Uj A tender's Name
Q z Lender's Address
C)Q I comfy Nat I have read this application and sum Nat the above information is
Fcorrect 1 agree to comply with all city and county ordinances and sum laws mining be
Q V building construction.and hereby amhalire reinnuenutiv of this city to enter upon the
{Sl about-memioncd property(ter inspection purposes.
(We)agree to sage,indemnify and keep harmless the City of Cupertino against
fin consequence
ents,cmaang of listumit. .mayinany way attmc againstsaid City
C)z A APPLICANT
of the UNDERSTANDS
til Nis permit ,
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU TIONS.
-0
Signazum of ApplttadVContractor Dam I Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ter future building occupant store or handle haruduus mautlal
freed by 0m Cupenino Municipal Code.Chapter 9.12,and Oe Health and Safety
ode,Section 25332(x)7
❑Yu All roofs shall be inspected prior to any roofing material being installed.
�ao
Will the applicant or future building Occupant tar equipment or deviah which If a roof is installed without first obtaining an inspection,I agree to remove
emit bmardnus it conuminanu n defined by de Bay Arca Air Quality Management all new materials for inspection.
Diavicp
❑YCS y�{rvV
I have eat de hararelmomaufials requirement under Clummr 6.95 o(the Califor-
nia Hcall Safmy Code,Sections 25505,25533 and 25534.1 understand hatuthe building
dues not currently have a mount that it IS my msponsibility to notify Ile occurs,of the
regnvc ntawhmhmtrn mctpt.o ivuAll oraCmficamOfGee coney. Signature of Applicant Date
Ow
12tnZr ormthodredege, Mul All roof coverings to be Class"B" or better