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08080235oz 7U :zw .may' ?aa 7yU C w t0 rye .apo i ^ter :Za FQ CTT' OF CUPERTINO BUILDING DIVISION PERMIT �JkR�'''�: 17— BUILf G RE TTV tANSDALE AVE EDWARD CONSTRUCTION PERMITNO. 08080235 OWNER' 2533 AMETHYST DR 08/29/2008 PHONE: (408) 985-0731 SANITARY NO. CONTROL NO. ARCHT112C UENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under previsions of Chapter 9 (commencing Job Description With Section 7000) of Division3oflhcBusinessandProfessionsCode,andmylicenseis FOUNDTN REPR@ LFT CRNR GARG& HSE in full force and effect.- License Class Lic. # Date _2 9 4a Contractor�M D C-96) ARCH CTs DECLARATION 1 understand my plans shall be used as 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 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to is issuance, also requires the applicant for such permit to file a signed statement that he is licensed purivant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 70D0) of Division 3 of the Business and Professinns Code) or $5500 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 ofNb 3 6 9110 0 5 Number Occupancy Type net more than fire hundred dorllars ($50M. .All Y ❑ 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 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 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:) The Contractor's Li. cense Law dors not apply to an owner of property who builds or improves thereon, and ,. who contracts for such pmjecs with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: have 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 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy numberam: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (E'his section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, E shall not employ any person in any m 4 r so as Io beco c su 'c t to the Workcrs' Compensadon Laws of Califomia. lf, after making this Certifieatc of Exemption, you should become subject to orkees Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lenders Name Lender's Address I 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 authorise representatives of this city to enter upon the ahove-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 UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE Issued by: Date �— REGULATIONS. �� Re -roofs —"— —479"-2 1 °y SignaturcofApplicam n r Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hasardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑Yes No 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter6.95 of the Califor- nia Health& Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the mquimmens prior to issuance of a Certificate of Occupancy. Signature ofApplicant Date e— -q9 All roof coverings to be Class In" or better. � t Owner orized agent Date "