08050239 •
CITY OF CUPERTINOu•k;:% s.sawAi x a i:3r +""e` '
BUILDING DIVISION PERMIT • CONTRACTQR.INFORMATION
*W'7Ffr: Y A x;,,s;.,2^ -'74., .»,'M 6 !A•-ab•` `. 3
BUILDING ADDRESS: PERMIT NO.
21881 COLUMBUS AVE BAY AREA ENTERPRISE 08050239
OWNER'S NAME: PERMIT ISSUE DATE
•
2110 MANGIN WAY 05/29/2008
IlleNE: SANITARY NO. CONTROL NO. '
(408) 238-5043
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
.BLDG ELECT PLUMB MECH
C 0 0 . o
a 00 LICENSED CONTRACTOR'S DECLARATION Job Description
ption
5,p I hereby affirm Nat I am licensed under provisions of Chapter 9(commencing
`D`uj withSection 7000)ofDivision3ofthe Business andprlfesdansCodeeand myliicenseis RMDL BTHRM NON—STRCTRL RMV SHWR&RMV8 ' NON—BRNGWL
2;F in full forte and effec /7413 ry11 !g
;qi License Class Lie.II MV WSHR,DRYELCTRCL ADD4 RCSD LTS,RMV PATIO& ADD
Dam m Contractor 3'M .tY4C brit•
2' g1ill'" IARCHITECTSDECLARATION GSLINE TOKTCHN NORE—RFOR STRCTRL(70SQ)
I understand my plans shall he used as public records _
JdV • '
k▪C Licensed Professional ,
OWNER-BUILDER DECLARATION
<f II hereby affirm that I am exempt from the Contractor's License Law for the -
p o following reason.(Section 7031.5.Business and Professions Code:Any city or county
g M which requires a permit to construct,alcor,improve,demolish,or repair any sanctum
-ii prior to its issuance,also requires the applicant for such permit to file a signed statement
-
pp G that he is licensed pursuant to the provisions of the Contractor's License Law(Chaser9 Sq.Ft. Floor Area Valuation
€ (commencing with Seefroma )ofDiviisfthe Business and
on.An Professions $25000
e c..-9 that he u 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 ofNumber - ' Occupancy Type
not mom than foe hundred dollars($509). 35614031 .'V 0'
in 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 offend for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through hu
own employees,provided that such improvements are not intended or offered for sale U, •
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.).
❑I.as owner of the property am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Conuacor's Li-
cense Law does not apply m an owner of property who builds or improves thereon.and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law.
lam exempt under Sec .Bit PC for this mason
•
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
I have and will maintain a Certifsese of Consent to self-insure for Worker's Compen. ' •
mien,as provided for by Section 3700 of the Labor Code,for the performance of the ,
• wort for which this permit is issued.
o I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the wont for which this permit 4 issued. • '
My
:
CERTIFICATE OF EXEMPTI FROM WORKERS' '
COMPENSATION INSURANCE
(Thu section iced not be completed if the permit is for one hundred dollars(8100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner no as to become subject to the Workers'Compensation '
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become objet to the Worker's Compensation provisions of the Labor Code,you must •
wJ Z Forthwith comply with such provisions or this permit shall be deemed revoked.
'Z O CONSTRUCTION LENDING AGENCY
f" I hereby affirm that there
is a construction lending agency for the performance of
D,> the work for which this permit is issued(See 3097.Civ.C.) -
LG 0 Lender's Name
z Lender's Address •
fJ C) I certify that I have read this application and state that the above information is '
I5, F correct I agree to comply with all city and county ordinances and sum laws relating to
•O u building construction,and hereby authorize representatives of this city to enter upon the
›"[A shove-mentioned property for inspection purposes
t„i L4 (We)agree to save,indemnify and keep harmless the City of Cupertino against
Date S-
'-4f.--/_
SOURCE REGU NS. cc/ n
�-- 5 sap, Re-roofs ^/
Sign m pp resp onRD r ,loam /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof •
Will applicant or future building occupantstoreor handle hazardous material •
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Cmm,section 2ss32(a)+ vet/
❑Yes All roofs shall be inspected prior to any roofing material being installed.
th
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant in future building b¢ueaBt use equipment u or which p g
it hazardous air contaminants u defimtl by the Bay Area Air Quality Management all new materials for inspection.
Disuics7
❑Yes
I have read the'wardens maeriau mquimments under Chapter 6.95 of the Califor-
nia Health dt Safety Code,Sections 25505.25533 and 25534.1 undcntand Waif the building
does not currently haw a mmol It is my responsibility to notify the occupant of the
requirements which must be or to issuance of a ca fOccupancy. Signature of Applicant Date
Owner or sum '
` /" Dams."All roof coverings to be Class' or better
C