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CITE' OF CUPERTINO��s,11�
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BUILDING DIVISION PEhLYT
CLINTRACTt?�t.IIFUR1YfATI�lY '
.............. ;.....<. .;..........:..
BUILDING ADDRESS:
PERMIT NO.
10950 SANTA TERESA DR
G T BUILDERS
08080120
OWNER'S NAME:
PERMIT ISSUE DATE
18630 OVERLOOK RD
08/18/2008
PHONE:n n o r T T
SANITARY NO. CONTROL NO.
(408) 354-9406
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 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
I N STL NEW RF SKYL I GHT DWN SHFT TO CEI LNG IN
in full forte and effect
License Class Lit. x
UP STARS
Date Contractor
ARCHITECTS DECLARATION
HALLWY INSLT R-13
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 70315, Business and Professions Code: Any city or county
which requires a permit to conceit. alter, improve, dcmolish,'nr repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed to the of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
19 5 0
$1950
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
Number
Occupancy
P y T ype
not more than five hundred dollars ($500).
3 5 613 0 0 4 .q
❑ I, as owner of the property, or my employees with wages az their sole compensation,
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
Required Inspections
property who builds or improves lhemon, and who does such work himself or through his
awn employees, 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 -
cease 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 to the Contractor's
License Law.
❑ I am exempt Sec , B & P C for 's mason
Owner Date / /
/WORKER'S COMPENSATION DECLARATION
I e by affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Certificate of Conscnl to self-insum 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 Workces 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 carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
(This section need not be completed if the permit is forone hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this pe it is issued, I shall not
employ any person in any man crso az to etomc sub'ccl t orkcri Compensation
Laws of California. Date �'
Applicant
NOTICE TO APPLICANT: If, after making this Ceni c c f Exemption, you should
become subject to the Worker's Compensation provisibpt of the Labor Code, you must
forthwith comply with such provisions or this permits all be deemed rcvoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a consuuctinn lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
'
Lender's Address
) certify that 1 have read this application and state that the above information is
cortecL I agree to comply with all city and county ordinances and slate laws relating to
building
construction. and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes
against
(We) agree to save, indemnify and kith harmless the y ac r against
liabilities, judgments, costs and expenses which may in any way accrue against said City
Issued by:Date
SOURCE REGULATION - ��
Re -roofs
Type of Roof
Signature of AppliranrC. r Date
HAS MATERIALS DISCLOSURE
OU
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code. Section en 25532(a)?.
❑Yes —ho
All roofs shall be inspected prior to any roofing material being installed.
Will Z'
If a roof is installed without first obtainingan inspection, I agree to remove
P
thea applicant orbuilding occupant use
PP g p equipment or devices which
emit ha-rardaus air contaminants az defined by the Bay Area Air Quality Management
all new materials for inspection.
District? ,,��qq
C] Yes Og No
1 have read the hamnlous materials requirements under Chapter 6.95 of the Califor-
nia Hallh & Safety Codc, Sections 25505, 25533 and 25534.1 understand that if the building
does not
l l/�
All roof coverings to be Class'n`' or better
g
Owner or auth sed agent Date '