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08090153CITY OF CUPERTINO BUILDING DIVISION PERMIT �CONTI BUILryryO<1UOjtES SAICH WAY lR'S TBD — TO BE DETERMINED P08090153 NAME; PERMIT ISSUE OATE THE 1989 MESSINA LIVING TRUST 09/23/2008 PHO. SANITARY NO. - CONTROL N0. ARCHITECTIENGINEElt: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Chaptero 9 Job Description I hereby affirm that 1 am licensed under under provisions of (commencing with Section ]000)ofDivision3 of Ne Rosiness and ProPossfum Code.and my license is DEMO — FLR TILE DRYWL EXTNG FIRE DEBRI force at, 13$ 19 ucallsand L..N PLATINUM BLDRS INC PD FOR BUS LIC 92408 Data :Las Cmoommr J y ARCHITECTS DECLARATION I understand my pans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby aRrm Nat 1 am esempt from 0m Comravo's License Law for the following moon. (Section a(D1.5, Business and pronounce, Cmk: Any city or county which mguires a perenino crm on et, abet. improve, demditah, or minor any Iwcture prior to its issuance, also requires the applicant for such Permit to rile a signed statement he is licensed to the of the Contractor's Umcmc Law (Chapter 9 Sq. Ft. Floor Area Valuation that pursuant provisions . 6000 m (comencing with Section ]000) of Division 3 of the Business and Prolosions Code) lir that he is aaempt therefrom and Ne thou for the alleged exemption. Any violation of 32632042�737qumber Occupancy Type Section 7031.5 by any applicator for a permit subjects the applicant to a civil penalty of not mom Nan five hundred dollars(s5Do). Ej 1, a owner of the propmry, m my employcn with vngn u Ne'u sole compensation, Required Inspections win do the work, m4 the Auctum u.intended oroffarad fm sale (Sec. 1066, Business and professions Code: The Contractors License Law don not apply on an owner of property who builds orimproves Neman. and who dousuch work himsuforthrough his , own employees, provided Nmsueh improwmenca are not intended moRemd for sada If. however, lie building or improvrnmnt is cold within am year of completion, Ne owner. builder will one the burden of proving Nat he did not Wild or improve for purpose of tile.). Q 1, as owner of the property. am eaGuaively contracting with licensed convectors to construct the project (Sec. 7014. Business and Professions Code:) The Comrumrs U. cense law dome out apply on an owner of property who builds or improves there m, and. who contracts for such projects wide a commcmr(s) licensed pur ono t to the GnnBaclnYs License Law. cacmptundm See .B&I'Crta Nuroamn oro n Date WORKER'S COMPENSATION DECLARATION I hereby mann under penalty of perjury one of the following dedandom: ❑ 1 have and will maintain a Carficetaof Conseouo self -insure for Warkers Compen- this hr' Section 3]00 a( Ito labor Code, for Ne Rrfarmana a( Ne hich vowlt for which permit is issued. ❑ I have and will maintain Warker'.s Compensation Insurance, as required by Section 3700of dM dab¢ Code. for the performance of the wort for which Nis permit is issued. My Workers Compensation Insurance carer and policy number �art: Carrier. ��ATE Policy No.: ' CERTIFRZATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu sectim need not becompiemd if the permit is foram hundred doilan (5100) or less) I anify that in the performance of the work for which this Permit is Issued, l shall not employ any person in any ma merso as to become subject to lie Warkeri Compo nsation Laws of California. Data Applicant - NOrICE TO APPLICANT. If. after making this Ccdificam of Eacreprim you should become subject to the Worker's Compensation provisions of the labor Code, you must forthwith comply with such fravisiem or this Pori shall W deemed mvaked. ' CONSIRUCr10N LENDING AGENCY 1 herebyaffirm that Nem iso cru.n n lending agency for one performanceof the work for which this Permit is issued (Sec. 3097, Civ. C.) Lender's Name Lenders Address 1 terry Nat 1 have read this application arta sons thm the above information is correct. l agree to comply with all city and county ornnancn and state laws relating he building concoction, and hereby autiome representatives of thm city an enter upon tM above-mcndoned Perfectly for impaction purposes (Wju agree m Asa indemnify and keep hay the City of against Iiabilitin,Judgmcno.costs Ad eapertsca which may in anyway accrue agaivaui0 City In an ailment Aconse a of Ne'rutin of this permit. APP A ofthe TA AND WILL COMPLY WITH ALL ON -POINT Issued by: Date S I ULATIONS Re -roofs ©( /0can Sig a anuactor De HAZARDOUS M ALS DISCLOSURE Type of Roof Will the applicanlmfutuer buil ngoccupamsbmorhaodlchooddousmmerim fined by the Cupertino Municipal Cock. Chapter 9.13, and the Health and Safety Suction 255324)? ❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed. Wi11 Nc applicant future building occupant use equipment it devices which If a roof is installed without first obtainingan inspection, I agree to remove P $ unsit i air conominants u denied by Ne Bay Arca Air Quality Management all new materials for inspection. P DISHharardnm D ammo C] Y. ON. 1 have mad Or bxvammsmamriaisre Ibirmu underChapter6.95oftheCalifor- niaHcalth&S Sections 15505.3 ,iJ and Z5536.I understand this if on, Wilding does not currently ha tenant,ft it st y ponsibilily m notify the occupaol of the er reguirementswhle ustW tfour anrace'tamof mpp,nry�l, Signature of Applicant Date All roof coverings to be Class 'j}" or better Owner 'zeds mOne, - or�