05020132 CITY OF CUPERTINO'
euamnc DrvIs1oN PERNIIT �C®NtTRACTUR INFORMATION: .
BUILDING ADDRESS: CRAFTSMENS GUILD INC PEa"'%5020132
OWNER'S NAME: PERMIT ISSUE DAIS
PqC NE: SANITARY NO. CONTROL NO.
CHITEC AENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iLICENSED CONTRACTOR'S DECLARATIONJob Description
1 hereby af0rm Nat 1 am licmucd under provisions of Chapter 9(Commencingwith Sabo,7")or Division 3ofOC Bellow and Professions Cade,and my license la
m"m Claandercat. g`o7f�O) DEMO (E) HOUSE
License Class T2 _—LM,N
Z Date Contractor
ARCHITECTS DECLARATION ARATION
�i understand my Phu shall he uxdupublic taords �\
oil
\\
�a
Licensed Professional 1`
^ 3 On,I am exempt
from
m the Com ION V
d i 9 I mem e(Otm Not 11. exempt from the Canom,Co License Lew for the
En O fallowing meson.(Sadao](171.3,Buslau and Profaviou Cade:Any city or County /
$ which requires a Permit to construct,alter.improve,demolish,or repair any Structure
FZ� prior be its Issue=,also requires the applicant for such permit to file a signed statement
FF On heis licensed putmanttoobeproviaiouofNeComtacmriLlacenselaw(Chapter 9 Sq.Ft. Floor Area Valuation
6�$ (commemdng with Saban 7000)of Division 7 of use Business and Professional Code)or
—
that he Is exempt therefrom and the hub for like alleged exemption.My vialmon of
Section 7031.7 by any applicant fw a permit subjects the applicant o a civil penalty of 3 5RRAE�k819]e1O 0 Occupancy Type
Cut mote than fin hundred dollars(5300).
❑1,a owner of the property.w my employees with wages as Nab sole campenudon,
will do the work and Nenrucam b not Intended a eRemA for We(Sa.7DN,Busircas
and Professor"
Coda:The Conuseth"Liceme law does not apply in owner of ownof Required Inspections
pmpeny who Wild,orimploom Ommortand whodoes suchwaric himselfw Woughh4
own employees,provided rhatsuch improvements are not Intended oraQered for sale If.
however,the building or improvement is mid within one year olcompladon.the owner
builder will ban the burden of proving that he did am bund or Improve for purpose of
ulc,).
❑I,as owner of the property.am exclusively contracting with licensed comsecmrs to
construct da,project(Sec.7044,Business and Professions Code:)The ConVactofs u-
cents Law don not apply to an owner of property who builds or improns thereon.and,
who Contracts for such pmjeca with a eonbacter(s)licensed pursuant on the Commences
License law.
❑I un exempt under Sao. ,B 4 P C for this maxon
Owner Date
WORKER'S COMPENSATIONDECLARATION
1 hereby of man under penalty,of perjury,can of Ne following Outstation:
hart ad will malnuln acertifreareo(Couentta selFlnum forworFeracomPen-
n,as provided for by Section 3700 of the labor Code,for rbe performance of the
k for which this permit is issued,
❑1 have and will maintain Workees Compensation Iuursnce,u required by Section
7700 of the Labor Code.for the performance of the wodt for which this permit is ivad.
My Wmkees Cnmwnsar)om Insunna Sprner and Policy n'_um--ber/It1''''nn��'''T �_
Carrier. fed Policy No.:(�.[�FLC(f!Y
CERDF ATEOFEKEMPI70N FROM WORKERS
COMPENSATION INSURANCE
(fhb seetinn and notbo completed If the permit Is forone hundred dollars(SIW)
ormes)
1 comfy the,in the pe,fmmuce of,Oe.wmk for,which Nis Permit Is lead.l Nall not
employ any person In any mannerso a m berme subject to Ne Workers ComPeuadon
laws of Califomb.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.,Q forthwith comply with such provisions or this permit hall be doomed revoked.
z CONSTRUCTION LENDING AGENCY
(~y
IherobYaflirm that Nee ba construction lending agency for Vm performance of
Ci? tho work fm which this permit is issued(Sec.3097,Civ.C.)
WM o Lendees None
D z Lenders Adm..
IT,QQ I ceA(y that 1 have teed this City
Ind Ctiun and sum Na On abort information mining to
C);"! Comers 1 ammo ,Comply with all city ad county mdtnmcea and sum laws mining m
21mveng eotutmctiom and hereby[aim audrodae,posca. 0ves of Nb city ro enter upon Vke
shave-(We)a ed Iola n lin inspection keep b.
(we)agrse m an,indemnify and hap hay in m Oke City of=against
c against
fq in codexuenceo ftnuud expenses which may In any vny accrue agalmtuldCity
fJ'l A APPLICANT
of Nemooting of this Permit. ` 6
Fi APPLICANT UNDERSTANDS LL COMPLY WITH ALL NON-POINT Issued by: Date ^
SOURCE REGULATIONS .__ af'/ / O'n;
Signature of ppllcimV onuM.7a ° Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fumes Wilding oceuputnoro or handle huudous material
as de0ad by the Cupertino Municipal Cade.Chapter 9.13.and Ne Health and Safety -
Code.Section 13531(a)7All roofs shall be inspected prior to any roofing material being installed.
❑Yea u
Will the applicant or ruutm building occupant use equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
r it herudnu air cnuminuts u dc0ad by da,Bay Area IY Air QeWMangement all new materials for inspection.
elf1T
oYe
I ban mad the bamNmsmamriab requirements under Chapter 6.93of Ne Califor.
nits nolth&Safety hamCode,aSatiom 25505,25533myrand25334,I understand than Klbcbuilding
does not currently hon a tenant,Out It is my responsibility m royl'y Na mcupml of On
requiremc'uw' m :11, eafnCenlOcamofOvmpmry' Signature of Applicant Date
OwneruravLlxO .gene Date All roof coverings to be Class"B"or better