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08040004e5' 0 zC CITY OF CUPERTINO x-,�a.��k'✓tem=w�"%� i��" �--" CONTRACTOR IIVEARMA 9 ONVI BUILDING DIVISION PERNIIT , BUILDING ADDRESS: PERMIT NO. 22580 SAN JUAN RD .11111, TBD - TO BE DETERMINED 08040004 A'S NAME: PERMIT ISSUE DATE SANITARY NO, CONTROL NO. ARCHITECf(FNGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby affirm most 1 w lircrced under provisiae arChap..9 (commencing with section 7000) o(Divislon 3ofthe Business and Professions Code, and my licenses REVISE FNSHD BSMNT,NEW LIGHTWELL,EXPANSION OF (E) in full force good effect LIcc.Clm L=.. LIGHT WELL,RND WALL,REARNG KTCHN,BTH,DECK POST Dam. Contractor ARCHIECTSDECLARATION CORRCTN &WNDOW SIZE OF END WALL-ORIG #06050101 -NO 1 undersand my plans d all x need ss public moods - . Licensed Professional OWNER -BUILDER DECLARATION I hereby aRml that I am eaempl from the COnlracar's Llecafe Law for die i following reason. (Secton 7031.5. Business and Professions Code: Any city or county which mquiru a permit to eovuueL also Imprint. demolib. or repair any srimum - prior In is issuance. also requires do applicant forsuch permit to rile a signed summer Nat he is licensed u to of the Conuazmr's License Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant poviSmas (commencing with section 7000) of Division 3 of Ne Busines,nd Profmiae Cole) or $ Q 1 • Nat W is cumin themdeom and the India for the alleged eaemptian. Any Holston of Section 7031.5 by any applicant far a permit subjects Ne applicant N a civil penally of Number Occupancy P Y Type non m. tun five hundred dollars(S50D). 34218044 ( 1, u owner of tie property, m my employee with wage a deetr sob compemdon, Required Inspections will do die work and dosouaum u notintendad or Offered forsale (See. 70th, Businessand Prof ..I.. code: rhe comtrxmrf t arta law does cat apply N an owner of pmpeny who Wildsorimproveatereon, and whodoessueh wart hirmlfor Wough his Own employaes, provided that such improvements was not intended mo@red (meals. It, h rwessr. me Wilding or Improvement is sold within are year of rompletion, Ne owmr- WBw will haw due hurdra of poring Nat he did not Wild or improve for Purpose of ole.). 1. as away of the property. w exclusively contracting wide Ranted contractors tacmn m ceesunm dee project (Su. 7014, Business and Pro(usime, Cade:) The Cunuscuse. Li- ccm law dues not apply W an Owner of property who Wilds or improves demon, and, who co dmi che fm such pojcm with a conmamods) licensed pmasnt as the Comminutes Lice. law. , B k P C for Nis mason got uemptundgqer Se(fe n'1 71l JbA m I 1✓ ORKER'S O SA DECLARATION I hereby allhm maker penalty of perjury arc of the fallowing declumions ❑ 1 haw and will maintain a certificate nfeo.m in self -insure mrwmtarseompen- netion, an provided for by Section 37M of the labor Code. for Ne Performance Of the work for which this Perron is issued. 1 have and will mrimam Wartime. Compensation Insurance, an myvired by sonic. 37D0o(de labor COtla, for the pcRormana Of Ne more: (mwhich this permit is issued - My Workees compemuon lwuana carrier and Policy number are Cartier. Policy No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE miusenlon and Out W comFbmd Buis Permit Is forme hundred coma ($100) or loss) 1 certify Net in Na p rfonnance of the wore for which Nis Permit s issued 1 shall not employ any Person in any mamas cat b cmblectm Ne Workcn'Campchsadon Laws of Cal' ice. m 1 Laws of CIZd ApPlicann NOTICE T6AP CANT: IL aBar eking Ni Ce.irheste or Exemption, you should Income subject m the WOettrm Com emuan revisions Of the labor Code, you most forthwith 10-PIY wide such Powisims or this permit shall x deemed .ked. 1 CONSTRUCTION LENDING AGENCY I herchy of ins that Nem I.. communistic. lending agemy for the Penformana of 1 the wart fur which Ns permit in named (Sec. 3097, Civ. C.) Isndcrs Name Landers Addma - I inanity that I have mad this application and sus Ngo dee above information is common- 1 at= as camPIY with LI city read county ar ho noes and sure uws resting to 1 Wilding construction, and hereby audso en mpossarsuves cloth; city to antro upon ft chow-mentionedpmpeny for impaction purpowhich (We) agree m Lw, Indemnify and kaep hamlW to City Of CUPCmnO a del ga ms errand uPeeewhich may in anY way acrneageiulaid City segue into consequence Aconsequence of the granting Of the permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SO CER GU TI S. ER Issued by: Date�--� / —/ z 3/0K e -roofs /.. Type of Roof 8igo f f� dCo nous n;ATEwA s DlsaosuR Data Will Ne applicant or future Wilding eccupanlsmrc or lundla hvsNous ..most 'Brood by dee Captors. Municipal Cade. Chapter 9.11. and t Health and Safety . Section 25532(a)? ❑Yea `IY!NO All roofs shall be inspected prior to any roofing material being installed. Will Ne i IICNt or f'u�tture Wilding oRv or devices which pp t pant yA c. If a roof is installed without first obtainingan inspection, I agree to remove P Air Qu eD�cenm it conuminants u defined by Ne 8ry Ara Air Quality Management all new materials for inspection. ❑Ye "14 No I have read the haarduumaterias requnnas s undo,Clupter6.95 orthe Califm- nuHdN k Safesy Cads, Savpu15505.25YU and25531.1 understand! NairNa Wilding Jou ten curmndy ltaw a hmta.L mm it is my haponvMthy, m notify Ne m<upent of dm ' requirernx whi xmetp;orN* uamcofaccrou"Mamofa -z Signature of Applicant Date W ., o8 All roof coverings to be Class'4" or better er authorrood agc te to IUL :Z, -c tea tH� 1aC tm�+ 1 � v .Zi �Fc D C H Q 6.4 v r CITY OF CUPERTINO BUILDING DIVISION PERMIT - I�RATI©lett - _? BUILDING ADDRESS: PERMIT NO. 22580 SAN JUAN RD TBD - TO BE DETERMINED 08040004 OWNER' 05/23/2008 PHONE: SANrrARY NO. CONTROL NO. A RC Hr'fECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is REVISE FNS HD B SMNT , NEW L I GHTWELL ,EXPANSION OF (E) in full force and affect License Class Lica LIGHT WELL, RND WALL, REARNG KTCHN, BTH, DECK POST Date_ Contractor ARCHITECTS DECLARATION CORRCTN &WNDOW SIZE OF RND WALL-ORIG #06050101 -NO I 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 mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that pursuant provisions (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $ 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of P Number Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 34218044 l7 ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections 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 Q p property who builds or improves thereon, and who does such work himself or through his own employers, 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.). '] 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- ' l W cense Law does not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.'J moo' ❑ 1 am exempt under Secy , B & P C for this reason Owner. / I /`A IR -A / `-�6ate r- - � IWORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: n /�Ir,�If�, O ' y /'y ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Camper- sation, as provided for by Section 3700 of the Labor Code, for the performance of the /� r tl iJ '�/ j t if work for which this permit is issued. (( ff {t J, u ❑ 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 Compensation Insurance carries and Polity number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify diet in the performance of the wort for which this permit is issued. I shall not employ any person in any mannCL t b c subject to the Workers Compensation Laws of Cal' ia. tc Applicant o NOTICE TO AP CANT: If. aftcryrriaking thi Certificate of Exemption, you should become subjca to the Worker's con 6sation ftovisions of the Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name . Lender's Address I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives or this city to enter upon the above-mentioned properly 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 Issued by: Date 50 CE RHG�UULL TI S. / I V `� * � - —/-2 3/ 0 K Re -roofs Type $�aturc/ f ApplicariUContractor JI Date HAZARDOUS MATERIALS DISCLOSURE of Roof Will the applicant or future building ocrnpanL store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cock, Section 25532(a)? ❑Yes )4 No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management .I all new materials for inspection. District? E] Yes �6Nu 1 have read the hamrdnus materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 75533 and 75534.1 understand that if the building docs not currently have a tenant, that it is my responsibility to notify the occupant of the requircme is whir bemet prior to nuance of a Certificate of Oc pansy Signature of Applicant Date `m r g All roof coverings to be Class rtdT r or better Owner authorized agent ) bate ',/ i/