04070048. CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
K & M DEVELOPMENT INC
PERMITNO .
04070048
OWNER'S NAME:
PERMIT MUM DATE
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SANITARYO. N0.
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RCHITECf/ENGINEER:
BUILDING PERMITINFO
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 bereby affirm Ws 1 her licensed umler provisions of Chapter 9 (commencing
with mlan ]gIU)ofDivision3 orthe Buai arW Professions Code, end..ylicense is
mI Itccc.
REVISION--FRONTAGE CURB DETAILS
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Licanac. Lk
Dom Contractor-
NO NEW PERMIT ISSUED/ ORIG. #02060187
ARCHITECT'S DEChAdBATION
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1 un m rad my plans shall he used u public mantra
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Licensed Professional
OWNER-BUILDER DECLARATION
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License Law for the
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om en
Comment's
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I hereby erfmm the 1 em exempt from the Cosign,
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7(D L5, Business and Professions Code: Any city or county
following mason. C
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which requires a permit m
Permit alter, improv, demolish, or repair my'ah'IMm
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prior to its issuance. elm require Ibe applicant for ouchpermitaice
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othat
ssignedammment
he is licensed pursuant to theprovisiomn(theConummrsLiccnulaw(Chapmr9
with Section 7")of Division 3 of the Business and Professions Cede)or
. ;$(commencing
that he is exempt thnrefmm and the basis for the alleged caemptlen. Any violation of
.
APN Number
Occupancy Type
Section 7031.5 by my applicant fon permit Objects the applicant to a civil penally Of
not mom than five hundred dellen ($500).
34216034.00
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❑ 1, a owner of Ne property, or my employees with wages as their Ole compenudon,
Required Inspections
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willdolhewne,.nd NcavuctumisnotimmndedoroBendforsam(SM.704d,Bnafnea
and Professions Code: The Contractor's License law donot apply to an owner of
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property who builds or improves Oemon, and who does such work him W f or through his
Own employees. provided Nat such improvements arc not intended meaered for We. If,
however, On building or improvement is sold within one year of completion, the owner.
builder will have dm burden of proving that he did out build or Improve for purpose of
ale.).
1. as owner of the property, am exclusively contracting with licensed eonVOemn to
construct the project (Sec. 70", Business and Profusions Code) The Convector's Li-
cence Law door not apply to an owner of property who Wilds or improve thereon, and
who contracts for such projects with a conuucmr(s) licensed pursuant to the Convenor's
License Law.
I am exempt under See. .B&PCfar{hj a
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Own e
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4ed
7 hereby eRnn send en lire( rjury one of the following duations:
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have and will maintain a CefdRCBm alloself. rWorkee.compen-
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tion, as provided for by Section 3700 of the labor Code. for the performance of the
work for which this permit is issued.
1 have and will maintain Workeh Compensation Iasunnce, as requited by Section
3]00 of the labor Code, for lie performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
,
COMPENSATION INSURANCE
(This section need not be completed if the Permit is forone, hundred dollars ($100)
or less.)
1 certify, that in the performance of the work for which this permit is issued, l shall nut
employ any person In any mmerso as to become subject to the Workerd Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this ceniricalc or Exemption, you should
become subject to the WmkeM1 C...... too provisions of the labor Code, you men
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forthwith comply with such provisions or this Permit shall W deemed revoked.
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iCONSTRUCTION
LENDING AGENCY
1 hereby affirm Nat then is a construction lending agency far the performance of
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the work for which this permit is issued (Sec. 3097. Civ. C.)
QLendn',
Name
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Under's Address
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I ccnry Nat I have read this application and slam that Ne above infmmation is
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I agree to comply with all city and county enhances and sum laws miming to
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building censwclma, and hereby authorise mprosenutivu of this city to enter upon the
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above-mentioned property for iosp COM Puryoses.
(We) ague to save, indemnify and keep hafnlleu Ne City of Cupertino against
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Ilabilitie.judgmens.costs andexpemes which may to anywayaccmeag.balaid City
in consequence or the of this permit.
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gmnling
APPLICANT ERSTANDS ANP..WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE RE U//
DNS
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Re-roofs
aura ofA UContnc
H US MATERIA DISCLOSURE
Type of Roof
Will thcapplic or future building ce calcium or handle hazardous material
,
az derived by the Cu nine Municipal . Chapter 9.12. and the Health and Safety
Code, SeeMm 25532(a
All roofs shall be inspected prior to any roofing material being installed.
Dy. No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or (alar building occupant use cyuipment or devices which
I, hazardous air contaminants az depend by the Bay Area Air Quality Management
all new materials for inspection.
suic"
❑ Yes
Ihavereadthchazardnum rials mquimments under Chapter 6.95ofthe Celifm-
ma Health &Safety Code, Seeman 25505, 25533 and 25534.1 unticmmcd that if the building
docs not currently haw a comm, that it is my responsibility m notify the oecupant of the
requirements whit mel prior tui asccn6emer Occup y.
Signature of Applicant Date
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All roof coverings to be Class "B" or better
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