00020165 CITY OF CUPERTINO � �; VIE,n BUILDING DIVISION PERMIT CONTRAC"TOW NEORMATIONBUILDING ADDRESS: PERMIT N201694 GARDEN CRRST CT XOWNER'S NAME: PERMIT ISSUESMITH RODNEY E 0ONE: SANITARY NO
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
4Oo LICENSED CONTRACTOR'S DECLARATION Job Description
O O O
ee F I hereby affirm that I am licensed under provisions of Chapter 9(commencing -
,� with Section 90)(0)of Division 3 ofthe Business and Professions Code,and my license is
in full force and effect.
License Close Lic.p
REMOVE WALL
r Date Ca.racmr
QQ ARCHITECTS DECLARATION
I W U 1 untlersund my plans shall be used as public rccoNs
a
a H Lsonacd Pnsfcsamnal
Cg OWNER-BUILDER DECLARATION
i X 1 hereby of Ofen that 1 am exempt from the Contractor's License Law for the -
o O following Yemen.(Section 7031.5,Business and Professions Code:Any city or county -
5 m which mulches a permit to construct,atter.improve,demolish,or repair any structure 6 O 0 0
-Za poor of its issuance,also rcyuires the applicant for such permitmflcaxigneJ summem
ESC Nal he is licensed)Urso.2atheProvisions ofthe ContracmriLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
Ct- (commencing with Section 7000)Of Division 3nfthe Businessand Professions Coucd.,
that he is exempt Ncmfrom and the basis for Ne alleged exemption.Any violation of 36230051 . 00
Section 7031.5 by anyapplicanl fora permit subjects Ne applicant to a civil penalty o
f
not more Nan Five hundred dollars($500), - APN Number Occupancy Type
❑1,m owner of the property,or my employees with wages as their sole compensation,
will do Ne work.and the swctum is nm intended or offered for sale(Sec.76th,Business 10 1 —
.it Professions Code:The Contractor's License Law does not apply men owner of Inspections
pmpertywho builds or improves comma,and who does such work himselforthrough his 305 — FRAME
own employees.Provided that such improvements e...I intended mattered postal.,If. 516 — FINAL BUILDING
however,the building or improvement is sold within one yew of complwion.the owner.
builder will have she 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 be project(See.7OW,Business and Pmfessinns Cede:)The ComoselorS Li-
whocLawdoesnotapplyto eanownerofproper(whobuildsorimprovesNeon,and �� �n �y
Lu,,mx tecta for such projects with a eonnamor(s)licensed pursuant m the Contractor's T.E u
License Law.
❑l sm exempt under Sec. ,B&PC for this lesson '
Owner Date OCT 2 4 200'
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne fallowing declarations: p�
—/
I ban and will maintain a Certificate of Consent a self in fSM1 ll,�r sum for Workman Compose - V,,, hip
wosatrk on.
r provided for by Ss issued.3]00 of one Labor Code,for the performance of the a`- d G
work for which Nis permit is issued.
❑1 have end will maintain Worker's Compensation Insurance,w required by Section
3700 of the labor Carlo.far the peRoures.Of the work for which Nis permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or less.)(Thu section need not becomplcmd if the permil is for one hundred dollars IS 100)
I certify Net in the peff.manec of the work for which this permit isissued,I shall nut
employ any person m any mannerso u m subject become subjeco the Workers'Compenvtimt
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,atter making this Certs ricam of EumPtum you should
become subject to the Worker's Cmet enswton previsions of the Labor Code,you must
=O forthwith comply with such pfnvisions or this permit shall he deemed revoked.
y CONSTRUCTION LENDING AGENCY
1 WMhy alRrm that Nem is a cons(mninn lending agency mr the performance of
Y. ti Ne work for which this permit is issued(Sec.3097,Civ.C.)
3 Q Landau Nam.
z Lenders Addross
J Q 1 ttnify Nal l have read this application and sum that the above infmmwlun is
Hcones.1 agree to comply with all city and county ordinances and sum laws rotating to
J V buildingconswmionand here by suthroar mpresematives of Nis city to enter upon the
shove-mc judgment.
udg dproper(for inspection purposes.
y a (We)8gme to So .indemnify and mCP haTdeso the City Of Clients.against
y incoed nsactjnco Of the
expenses which may in any way accrue Against said City
Jz in consequence of Ne granting of this permit.
t" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApphcanVConuacmr Dem Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or four.building occupant score or handle hazardous award
u defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Inilmquireencris,
de.Section 25532(a)?
-1 Y. ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous air contaminants so defined by the Bay Area Air Quality Management all new materials for inspection.
atrieL?
❑Yes ON.
I have read the m ardous materials requirements under Chapter 6.95 of the Cxlifor.
Health&Safety Code,Secduns 255)5.25533 and 25534.1 ma ersund thw if the building
es not currently hove a tenant,Nal it u my responsibility m noufy the ommuent of Ne
which must us met poor to issuance of a Cenlficam of Occupancy.
Signature of Applicant Date
Owner or au thorized agent Di1e All roof coverings to be Class "B" or better