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08030005CITY OF CUPE �� � BUILDING DIVISION PERNIIT a r Y ^< BUILT6cffEsAPERMIT DRIANA NO. AVE DANIEL MACKEY CONSTRUCTION 08030005 OWNER' 2593 HEBRON AVE 04/01/2008 PHONE: SANrrARY NO. CONTROL NO. (408)274-6799 ARCHITEC IENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 Chapter 9 Job Description I hereby affirm that am licensed under provisions of (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is MV SMLLER WINDWO TO LRGER WINDOW &RMV SLIDR in full fora and off {p O Lice C! L- Lk &REPLC ' Dam ARCHITECTS D ter A ON W/WINDOW I understand my plans shall be used ss public records . Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 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, eller, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of am Contractor's License Law (Chapter 9 Sq. Ft. Floor AreaValuation (commencing with Section 7000) of Division 3 of the Business and Profusions Code) or $4500 that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 2 6 2 0 0 3 0 Number Occupancy ParaC y TyPe Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). ❑ 1, as owner of the property, or my employes with wages as they sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 70", Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thermn, and who does such work himself or through his own 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-). ❑ L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) TTre Contractor's U. cease Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant m the Contractor's L.lcense Law, ❑ 1 am exempt under Sec , B & P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations ❑ 1 hs.e and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation insurance, as required by Section of the Labor Cade, for the performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number are:/ Cartier. ACF USr1 Policy No.: C-T�603J� CAIS OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Phis section need not be completed if the permit is for one hundred dollars ($ 100) or less) 1 certify 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 WorkeW Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to Lite Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be darted revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lending agency for the performance of the work for which this permit Is issued (Ser. 3097, Civ. C) Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this City to enter upon the 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 in consequence of the granting of this permit APPLICANT UND STANDS AND WILL COMPLY WITH ALL NON -POINT / Issued by: Date Vv 4 SOURSE REG NS. Re -roofs Type of Roof Signature or ppliaraclor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 ❑Yes fioNo All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or device which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Dlsuict7 ❑ Yes No . 1 have road the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heal th & Safety Codc, Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant. that it is my responsibility to notify the occupant of the mqui whic� L prior to issuance of a Certificate o �r.� Signature of Applicant Date `� g assAll roof coverings to be Cl'r�}" or better /-i' Dam ' Owner or au arircd agent �