08040097CITY OF CUPERTINO
BUILDING DIVISIONPERMIT
�-CONTRACTOR INFO RMA.TI()N -
BUI�.gING ADgKESS:
.L 0480 N BLANEY AVE
INTERNATIONAL KITCHEN &
PERMIT NO.
08040097
OWNER'S NAME:
BAIM .
PERMIT ISSUE DATE
1175 E HOMESTEAD RD
06/03/2008
ONE:
SANITARY NO. CONTROL NO.
(408) 296-3055
ARC HITECffENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMBE MECH
LICENSED CONTRACT'OR'S DECLARATION
Job Description
I Wmby affirm Thal l son liconmd under provisions of Chapmr 9 (commencing
with Sation]IXXO of Dividon 3afdb Busm. and Professions Cade, dory liccmu is
ADD 147 SQ FT. ADDITION ON MASTER BATH & BED,
in full forte an for o '
- n
or
REMODL KITCHEN AND BATH
Dammclw,
C
Dam _c> Gmn
ATIO
ARCHITECT-S DECLARATION
1 undenunJ my plan mail W umd as public memrda
Lkc road Professional
OWNER-BUILDER DECLARATION
1 be¢hy s fflon that 1 am eacmpl from Ne Contranors License Law for the
following moon. (Section 703I.S, Busincu and PmftWons Ccdc: Any city Or county
which hold. a pmmil to conswq a1w.. impmw, demolish, mr mpair any amnum
poor In its isuame, ilsu rugs ima the applicant for Such permit to film a hignad atskmcnl
• b On f db Can.Wf'o Ucenm law(Chapmr 9
Rceucd
- Sq.Ft. Floor Area
Valuation
that he is pu..at movishoo
Section 7000) of Division 3 of that Business and Pmfcsions Coda) or
$104000
(commencing with
that he is eaempl therefrom and the hub for the allotted eaempuan. Any violation of
Occupancy P Y Type
Section ]OTI.S by any applicant for a permit subjects the applicant to a civil porosity ofNumber
not man ftw roaNlandmd dollars(1300).
31630002.E
0 I,uo mrofthepmpmty,mmymaployeeswtNwarnutheirsoleeampeuaunn,
Required Inspections
Newmk. and the u fm sale (Sec. ]016, Bmer
au Cook: The License Law don not apply b rt of
and Pr he Coo om's Lacon , Law rid
and
orty wh and who rimssuchwork himself rough is
propertywhohuIlaorimprawch
icap alNroaghb.
awoemployees,pmvidnddotsohimprowmnts tie nal innendndmplaesed for ask,
r-
hoilclar Ne Wilding errimpmmnanlahold within am yea ofcompletion,Nemwner-
builder will haw 0m WNan of proving Net ho did not Wild err Improve fm purpom of
sok.).
0 1, as manner of the property, am exclusively contracting with Ilarued comomfors ut
construct the pmlen (Sec. 7044, Bilines and Professions CaO:) The Coustomm s Li-
emus, law don not apply to an owner of property who builds or improv theran. and.
who contracts for such pmjccu with a cmvttamor(s) licensed pursuant to the ConuacmYs
Lisawas law.
❑ lanexcmptundor Sec ,B&PCforthisrtamn
nv Date
WORKER'S COMPENSATION DECLARATION
1 Wrtby alrmn trader penalty of perjury oro of the following dalanWttc
❑ 1 ha¢ and will milnuin a Cmufimb ofGnum to self-msum far Warkefs Compen-
sation, as provided for by Section 3700 of the labor Cade, fm the perfannanco of the
wort for which this tenni, is wood.
0 1 have and will maimdn Wo lean, Compematimn Ins., u required by Section
37Ooaf the labor Coda, fm the part... of the work for which Nis permit is iutmd.
'
Mywar'
Polity No.:1T 9 ��JY
RTIFlGTE OF (EMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This senlmt reed act ccompleted ifthe permit Is for. hundred dollars($IW)
r
ar kis)
1 arch Nat in the performance of the wort fm which this pcoult is issued. l shill not
employ, anyperaon in any manor m u b baomc mbjnlb the Workers'Compensalw
.
Laws of California. Data
.,
Applicant
NOTICE TO APPLICANT: If. afmr making this Ceniftcam of Exemption. you should
become subjcn b the Worker'sCompensation provisions of the LIhor Code, you moa
forthwith comply wit such provisions or Nb permit shall W account mvoked,
I
CONSTRUCTION LENDING AGENCY
I homby affirm that thcrt is a cmmrmd m lending sgency, for Nor perfurch. of
"
Nor wart for which this permit is insad (Sec. 30Tf, Civ. C.)
landcrf Nano
IandeYs Address
I cattily that I haw mad this application and sum that Ne show information is
Canmct. 1 agree to comply with all City and coldly mNiaMCn and slam laws misting la
Wilding mnswcumt, and hemby ammumna tepmmnuuwa of Our city to comm upon the
show-mcntimmd for inspection purpowhich
(We) agree to saw. indemnify and tap harmless the City of Cataluna against
m.
ts.co and npuunrmit. may in anyway acme agilnst aid City
inchritinajWgmcnhe swung
in eonsequcna of the dranun6 of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOU GU ONS.
Issued by: Date j�OI
�
O; .O
Ole
Re-roofs
Signature of AppliaMCuac
onmr Dak
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
We
Will dm applicant m future Wilding aaupanlaem or handle haaNau mamdil
u dcfinmd io do 32(a)? no Munki al Code. Chap. 9.11. and sire Hnith and Safety
Cade, Section 15331(a)T
❑Yrs Ne
All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or fbtrm building Occupant um egaipmem Of devices which
If a roof is installed without first obtaining an inspection, I agree to remove
colt havardau air canuminanu u dcftnc l by the Bay Arca Air Quality Maugcmcnt
all new materials for inspection.
uin
DisT
0 Yes
Ihawmad rile Aar mamdilsmqu udm
5un4rCWpmrd.95Ndm Wilding ilia HallsurSafety COM, Seeuoruoad
29333and13534.1 undcrsundthacup Wilding
it I,
dam out currently how • manL that it u my rnpouibility b wufy Ne acoupanl of Ne
calms c� nuwhich mna be met prior b lavas of a Cmulic5 Ofa �pu�Cy. 0 p
Signature of Applicant Date
g! spam 6
All roof coverings to be Class'n:s' or better
OrnaarrK7ornaualthodsd agent