08080117BUILDING DIVISION PERMIT
10061 PHAR LAP DR
OWNER'S NAME:
CHART_rES MA
ARCHITECTIENGINEER:
c u o '
u 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is
�< y in full force and effect
Z License Class Lic• N
F Date Contractor
gg ARCHITECTS DECLARATION
pQ I understand my plans shah be used as public records
0.0 -
O y Licensed Pruf=ionai
y S OWNER -BUILDER DECLARATION
1 hcrchy alTitm that i am exempt from the Contractors License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
t m which requires a permit to construct alter, improve, demolish, or repair any structure
.0 Z y prior to its issuance, also requires the applicant for such permit to file a signed statement
f 2 that he is licensed pursuant to rite provisions of the Contractor's License Law (Chapter 9
2 F. s (commencing with Section 7000) of Division 3 of the Business and Profession Code) or
y 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 of
not more than five hundred dollars (S501n.
❑ L 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 forsale (Sec. 7044. Business
and Professions Code: The*Conuactors License Law does not apply to an owner of
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 forsale. 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.).
as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractors) licensed pursuant in the Contractors
License Law.
❑ 1 am exempt under See. B & P C for this rc n
Owner j ' r Date
Y' WORK 'S I PENSATION DECLARATION
I hereby airum under ty of pedury t of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self insure for WorkeesCompen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of rhe
work for which this permit is issued.
❑ 1 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 numberare:
rrxmt t nU.
D & D CONSTRUCTION 08080117
PERMIT'iSSSUE DATE
1447 HAMPTON DR 08/26/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
REV, ADD 4'X6" SHRWL ON S BLDG PLUMS
9±13E OF HS -E. BET
„ ,. - , , ,. , „ ,Job Description
Sq. Ft. Floor
Required Inspections
Carrier. Policy No.:
CERTIFICATE OP EXEMPRON PROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the wofk for whic tis permit is issued, l shall not
employ any person in any manner 'o to c m sub •c tor(e Work=s' Compensadon
Laws of California. Date 1 0(W
Applicant
NOTICE TO APPLICAN s is C=tifi affi+reiirption, you should
become subject to the Werke Co nsatian p the Labor Code you must
Oforthwith comply with such provisions or th' k shall be deemed revoked.
z " CONSTRUCTION LENDING AGENCY
E -i I hereby affirm that there is a construction lending agency for the performance of
i the work for which this permit is issued (Sec. 3097, Civ. C.)
WCLr A Lenders Name — — -
Z Lenders Address
U I certify that I have tad this application and state that the above information is
(y cortccL I agree to comply with all city and county ordinances and state laws relating to
H building construction, and hereby authorize representatives of this city to enter upon the
U
above-mcntioncd property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
&n liabilities, judgmcats, costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of chis permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL rN-POINT Issued by:
44OZAIMOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municip ode, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ res o
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants asred by the Bay Area Air Quality Management
District?
❑yes No
1 have read the hazardaus materials requirements under Chapter 6.95 of the Califor-
nia ficalth & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant that itis my responsibility to na it'y the occupant of the
requirements whjch must be met prior to issuarige of a Certirmate df Occdpanty.
Owner
Re -roofs
Type of Roof
Occupancy
Date
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
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class'n" or better