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08050053 • • CITY OF CUPERTINO ��s,� 4 *� »� ,ex. A,N4 f �p '*' eve ',amAt ., BUILDING DIVISION • PERMIT i.RCONTRACTOR INFORMATION PERMIT NO. RuILpJIACJrDDR RAINBOW DR TBD — TO BE DETERMINED 08050053 OWNER'S NAME: ?EMT ISSUE DATE • 05/05/2008 — •NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O C C lC 000 LICENSED CONTRACTOR'S DECLARATION Job Description iu 1 hereby affirm wt 1 am licensed under provisions of Chapter 9(commencing escrP xZ s+ with Scnion70c )of Division 3 of the Business and Professions code,and my ken=is BATHRM RMMDL NON-STRUCTURALn?hin full force and effect. 4oro Danne� . .5 OJT Contractor A 1 53 n Date yy ARCHITECTS DECUB ON 12m Iundeandmyplans shall beused as public records DyV C ria Licensed Professional . OWNER-BUILDER DECLARATION i S I hereby affirm that I am exempt from d r Contractor's License Law for the -0 O following reason.(Section 703 1.5.Business and Professions Code:Any city or county 2 M which requires a permit tostrustructurealter,improve.demolish,nr repair any structure • -a;.0 prior to its issuance.alsosequires the he applicant for such permit tote a signed statement pp -e that heencin sed pursuant tathe)ofDisions fthe Contractor's LicenseLaw(Chapter 9 Sq.Ft. Floor Area Valuation yds (commencing with Section?DED)ofDivision3 fthe Business and oo.AnyonsCode)or $10000 e5- that he is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofper.Number Occupancy T e not more than five hundred dollars(SSW). 36210009 :Cl7' P Y YP 0 I,as owner of the property,or my employees with wages as their sole compensation. ' • will do the work,and theimmure is not Intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees.provided that such improvements are not intended or offered for sale.IL • however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that be did tat build or improve for purpose of sale.). ❑I.as owner of the property,am exclusively contracting with licensed contractors to ' construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply in an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant In the Contractor's License Law. o 1 am exempt under Sec. .B&P C for this reason Owner Date WORKERS COMPENSATION DECLARATION • I hereby affirm under penalty of perjury one of the following declarations: • I hive and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code.for the performance of the ' work for which this permit is issued. . ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. • . My Worker's Co-ryry psens[a/y'on Inssyance carrier and Policy number are: Carrier SfarAt/ TLAT Policy No.:Jt 30027'11$ CFAt7FlGTE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE • ((hisseNon ned not becompleted if the permit Is Ito one hundred dollen($Lal) nr less.) I certify that in the performance of the work for which this pemnit is issued.I shall not employ any person in any manner so as N become subject o the Workers'Compensation Laws of California.Due Applicant NOTICE TO APPLICANT:If.after making this Cenificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you muss .J Z forthwith comply with such provisions or this permit shall be deemed revoked. - .' RUCTION LENDING AGENCY - CONST FI hereby affirm that there is a construction lending agency for the performance of Ir', > the work fur which this permit is issued(See.3097.Civ.C.) CUA Lender's Name noz Lender's Address - fJ 0 I certify that I have read this application and stale that the above information is ,E correct I agree to comply with all city and county ordinances and stale laws relating to .O building consuunian and hereby authorize representatives of this city to anter upon the i" LU above-mentioned property for inspection purposes (Wc)agree to save,indemnify and ,r i!(/1 liabilities,judgmcnu.cosu and expenses which maap ry in any way amless the yccene agof ainst sanino id City �� SOURCE REGU Y . a Date •S f'^tiq. �► �� _ ce,5,0g Re-roofs PP s HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof Will the applicant or future building occupant mom or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code.Section 25532(0P ❑Yex 0No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, g I agree to remove Will the applicant or future building occupant use equipment or devices which .t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. 'strict? (3 Yes 0 N I have read the Wardens s maleriau requirements under Duper 6.95 of the Cabled. nice Health&Safety Code,Sections 25505,25533 and 25534.1 undersand that if the building does not currently haw a levant that it is my responsibility In notify the occupant of the • a Certificate of Occupancy. Signature of Applicant Date Sir • All roof coverings to be Class't'or better Owner or agent Damm'"