061201680
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
19628 STEVENS CREEK BLVD
KCR DEVELOPMENT
06120168
DATE
PERMIT ISSUE
OWNER'S NAME:
KCR DEVELOPMENT
19770 STEVENS CREEK BL
7
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
,lob Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division3oftheBusinessandProfessionsCode,andmylicenseis
PATIO LANDSCAPING AND SCULPTURE INSTALLATION
L eneClassull force dcftec� Lie.#
License Class
DESIGN FOR RESTAURANT
Date Contractor
ARCHITECTS DECLARATION
! I understand my plans shall be used as public records
i
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
> following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
9
Sq. Ft. Floor Area Valuation
tthat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
$10000
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number Occupancy Type
not more than five hundred dollars (5500).
36906009
0 I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
dwn employees, provided that such improvements are not intended or offered for sale. 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.)*
as owner of the property, am exclusively contracting with licensed contractors to
eons ct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
Law does apply to an owner of property who builds or improves thereon, and.
cense not
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
0 1 am exempt under
DECLARATIOK
I hereby affirm u d penalty o perjury one of the following declarations:
J I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen-
cation, as provided for by Section 3700 of the Labor Code. for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workces Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the wor for which tit' it is issued, I shall not
employ any person in any mae asp me ju t to Workcrs' Compensation
n
Laws of Califo f D tc
Applicant
NOTICE TO A PLICANT: If, after making this Certificate O(Fxcmption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
,Z forthwith comply with such provisions or this permit shall be deemed revoked.
O
CONSTRUCTION LENDING AGENCY
.�-. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
Q Lender's Name
Z Lender's Address
1 certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
U building construction, and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (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
Z in consequence of the granting of this permit. Date
►-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by:
SOURCE REGULTIONS.
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Re -roofs
Signature of
as deftncd by the Cupe mo Municipal Code, Chapter 9.12, and the Health and Safety
25532(a)? All )fs shall be inspected prior to any roofing material being installed.
Code, Section
ro
0 Yes °
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
for inspection.
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all nes v materials
District?
Yes f—�LN\o
1 have read the hazardous materials requirements under Chapter 6.95 of Ne Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does
Date