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04070026 (2) CITjADDRESS: ERTINO BISION PERMIT rL©k�i".CRtyiCTQ .t"I1VT+C1ItM�t1.�.`IUl . ' ,a o ..�,ti•,a r BUILDIPERMIT NO. ASCO CONST 04070026. PERMIT ISSUE DATE E: SANITARYOL NO. ARCHITECDENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 40 0 LICENSED CONTRACTOR'S DECLARATION U 1ion7 affirmthat 1amftheBuunder ndPo,ossorChapter 9(commencing Job Description n� with Section 7IXNfecDivision 3of NC Business and Pmfcasinv Cade,and mylicense is o. in full force and effect. i Um..CIm¢ Lic.M Dam Comletor DEMO (E) HOUSE ?q ARCHITECTS DECLARATION 33 1 understand my plans shall be used n public meads caua G Licensed Profes¢(omal OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the i 02 following mason.(Section 7031.5,Business and Professions Code:Any city or county +�$ which¢quires a permit to construct,elect improve,demolish,or repair any sternum , pdor to its issuance,also squires the applicant forcuch permit m file a signed statement FFxx< chat he is licensed p...nL m the provisimasof the Contractor's Lima.U.(Chaim.9 Sq.Ft. Floor Area Val t gF$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt ehandrom and the brill for On alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects to applicant in a civil Penalty of 7�� 1, /fsyer not mom Nan five hundred dollars($=. 3' .f Hr00 Occupancy Type [1 1,as owner althe property,or my employees with wages uthelr sale compensation, zvv � willdo the work,and the structure is na intended aaffeted forsak,(Sec.7044,Business And Professions Code:The Centimeter's License Law does oat apply 0 an owner of Required Inspections property who builds or improves theroon.and who does each work Maunder through his own employes,provided Nat such improvements arc not intended aroRem l forsale.If. however.the building or improvement is sold within one year of completion.the owner. \ builder will have the battle.of proving Nat he did not Wild An improve for purpose of 1,As owner of the property,am exclusively contracting with licensed comp cum;to consumer the project(Sec.7044.Business and Profesnians Code:)The Convectors LI- ceme law does not apply to an owner of property who Wilds or improves thereon.and �J who contracts for such projects with a contra tors)licensed puuusnt to the Comractor s License law. ❑lam exempt yndm Se I� ,B&PC far Nis mason Owner COMPENSATION Due WORKER'S sPENSATION DECLAR""AFR1tJ 1 beshy affirm under p.try of perjury one of the following declarations: have and will maintain ACamIlimm of Consent to self-insum for Worker'sCompm- Man,as provided for by Section 37W of On labor Code.for to pafommmce of the work for which this permit is issued. ❑I have and will maintain Workers 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 Insomnce cavi.,end Polity number am: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed Rune permit is furans,hundred dmWA($1 00) nr Ical.) 1 minify that in the performance of the work for which this Permit is issued.I shell not employ any person in any manneran as to Wcomosubject to the Workers''Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Ccrtiacata of Exemption,you should Wcome subject to the Worker's Comperuainn provisions of the labor Code,you must QQ forthwith comply with such provisions or Nil permit shall W deemed ranked. E. Affirmzr " CONSTRUCTION LENDING AGENCY (Y. 4 I hereby arm Out there is a cunsvuctinn lending agency for the lerfarmana of > the work fur which this Permit Is issued(Sec.3M,Civ.C.) W�Q Lender's Name U z Lcntler'I Address minify U Q 1 certify that 1 have read this city And county and sure Nat the shove information muting is Igo U .ending I agree m comply with all city and coumy oNinaruo and cute laws r upon to D V Wilding construction.timInandhembysedim,pn... ativoa of this city reenter upon Ne y W ahova-menuuned propertyest fard oris se,purposes. (We)agree to save,indemnify and keep harmless the City of Cupordno against 7 �a w Z liabilities,cnajndgmen6,costs and expmueewhich may in any way accrw egalnsLmid City V z Aconsequence of the gunning of this permit APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC�REGU ONS. ©fy nO OO -J 4 Re-roofs igneam of Applicor for Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dre applicant or(atom W Riding acupmlamm orhendlc hamrdous material as derined by tine Cupertino Municipal Cade,Chapter 9.13,and de,Health and Safely ce Code, Ej es 35533(an All roofs shall be inspected prior to any roofing material being installed. Yes .�J No r If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or(.tore building occupom use equipment or devices which _ g sv n1 mous air conmminants as defused by the Bay Area Air Quality Management all new materials for Inspection. ❑Ycs IYJ Nu , Ihave&Safet NehwSnd.ectio mamriats,2553 and255ments under Chapter erstan Chat if the Calding nia Haiti,&acrulyhave A meant, eLL iii MYrespd35534.1 understand Natitthc building SUC dans not cum which have a tenant,dyer it is my responsibility to nouly the ak t of rhe reyuiremcn which Wmctpriorwi ceofaCwOca¢of apmcy. Signature of Applicant Date ©$ . All roof coverings to be Class"B"or better Ownc r authomed agent Dote g