06090021CITY OF CUPERTINO -
AM
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO- 06090021
1305 S STELLING RD
OWNER'S NAME:
PERMIT ISSUE DATE
09 05 2006
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Descri tion
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
p
with Section 7000) of DivWon 3 of the Business and Professions Code, and my license is
in full force and CUM
REMOVE EXISTING SHED ROOF AT PATIO ABOVE GARAGE
LiceDate Class Conti
Date Contractor
PROVIDE NEW GUARDRAIL.
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (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 ur its issuance, also requires the applicant for such permit to file a signed statement
Sq Ft. Floor Area
Valuati$r7 0 0 0
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
.
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
qpN N tuber
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five: hundred dollars (5500).
3 6 6 2 6 16.00
❑ 1, as owner of the property, or my employees with wages as their solo compensation,
Required Inspections
will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The contraLicense law does not apply to an owner of
e q .p eC[IOI1S
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. 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.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-
cence 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 Contractors
License La"
❑ lam exempt der , B & P C for this mason
Owner
ER'
I hereby 'm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -Insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
O 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Workers Compensation Insurance carrier and Policy number arc:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need tut be completed if the permit is for one hundred dollars (E 100)
or less.)
I ccnify that in the performance of the work for which this permit is issued. I shall not
employ any person in ny manner o as to beconIc subject to the Workers' Compensation
Laws of California- a
of Exemption, you should
become subject to theWorker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 berchy affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
y
� Lender's Name
,
Lenders 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 authorise representatives of this city to enter upon the
above -mentioned property for inspection purposes
1. (We) agree to save, indemnify and keep harmless the City of Cupertino against
P) liabilities, judgments, costs and expenses which may in any way accrue aonasaid City
in consequence of the granting of this permit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REG
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 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes � No
If a roof is installed without first obtaining an inspection, I 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
-all new materials for inspection.
District?
❑Ycs No
I have read the hazardous materials requirements under Chapter6.95 of the Cali for-
nia Health & Safety Code, Sections 25505, 25533 and 25 534. 1 understand that if the building
does not currently have a tenant, thatrit is my responsibility to notify the occupant of the
requircmencsFwhich mar be me` nortoissuanceofaCertificateofo«upancy.
S ignature of Applicant - Date
�" �"
All roof coverings to be Class "B" or better