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03100095 CI'rY OF CUPERTINo BUILDING DIVISION PERMIT 'CONTRACT aRIIVF,ORMATl©N, BUILDING ADDRESS: PERMIT NO.03100095 3 1 0 0 0 9 IJ 9;0 STEIZEN2 CANYON RD 'R'S NAME: PERMIT LSSUE DATE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 00 LICENSED CONTRACTOR'S DECLARATION i I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description / :z with Section? M))af Division Sof the Business and Professium Code,and my license is < a full force and effect. License ClassLic.0 DEMO it Date rSContractor CONTRACTOR: NAVICO, INC. (#24836 ITE ££ ARCHCTS LARATION i C< 1 undursetW my plans shall M used as public records OG Licensed Pmfeosioind S OWNER-BUILDER DECLARATION <Y I hereby affirm thin 1 am exempt from to Contractor's License Law for the :O O following maxim.(Section 1131.5,Business and Pmfcssions Code:Any city or county 5$ which acquires a permit to construct.alter,improve,demolish,or repair any structure .26 prior to its issuance,also requites the applicant rot such Permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area ValuatL 8000 l�$ (commencing with Section 7000)of Division 3 of be Business and Professions Code)or 4 — that he is exempt therefrom and the beau for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of 3rA B1d ALr. per00 Occupancy Type not marc than five hundred dollars(5500). �0 V/lY 4 ❑I.m owner of the property,in my employees with wages as their sole compema0on, will do the work,and thesweturc is nut intended or offered fonale(Sec.7044,Beton,$ Required Inspections end Professor,Code:The Contractor's License Law dim at apply ra as owner of q P property who builds or improves thereon,and who does such work himself or through his 704 - DEMO own employees,provided that such improvements an,not intended or offered for sale.If. however.Ne building or improvement is sold within an year of completion,the owner. builder will haw the burden of proving that he did not Wild or improve for purpose of sale.). O h as owner of the property,am exclusively contracting with licensed contractors to consumer the project(Sec.7044,Business and Professions Cade:)The Conlnem's Li. come Law docs not apply to an owner of property,who builds or improves Burman.and - who contents for such projects with a eonuactor(s)licensed pursuant o the Contractah u�9f m Law. 6 lamcmmprurni e. B h P C far this rcmnn Date�Q (�1Q3 WORKERS COMPENSATION DB6(,ARATION I hereby M.under pcnelry of per jury osteo allowing declardiums: I have and will maintain a Cerrificase of Current o self-insure for Worker's Camper. cation,m provided for by Section 37M of the Lather Code,for the performance of Re work far which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 311 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 ass: Carrier: Policy No.: CERTIFICATE OF EX EM"ION FROM WORKERS' COMPENSATION INSURANCE (iTu section neutron be completed If the permit is forone hundred dollars(SIIX) ,it leu) I certify Rz>e performance of the work for which this Permit u issued,I shall not employ any person in any manne ___7 m�e�su/y mu the Worked Comprnsatlon Laws ofC a.De s'P/Ti) Applicant r p (k'fLaG ,f&�c cam subject APPLICANT:If,after making this Ccnins of of Exemption,ont you should ante momp y Nr,such Compensation provisions mal of the meed Labor Code,you must D,Z forthwith comply with such Prnviainns or this Permit be deemed revoked. r O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a convection lending agency for the Performance of Yv r7 the work for which this permit Is issued(Sec.3097,Civ,C.) 37 Q Under',Name z Lender's Address; I certify that 1 bow read this application end arm Ret the above information is 3. (" correct.l agree to comply with all city and county ordinances and shote laws relating to 5 C.) building convection,and hereby authorise mpresenutisea or this city an enter upon the N W abovcmentioned property for impectian purposes (We)agree to sats,indemnify and lump harmlms the City of Cuperdia]illation faA Iiothllitles,judgmenu,casts and eapcnses which may in any way acerae against said City J,Z in consequence of the granting or this permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date R EREGULq S. to Re-roofs ignow of PplicaHAZARDOUSMATERIALS DISCLOSUR d tar Type of Roof Will the applicant or future building occupant stere car handle hararduus materiel as dented by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety •.section 35s33(a)9 i All roofs shall be inspected prior to an roofing material beim ❑Ym 'ejNm P P Y g g installed. Will the applicant or future building accupann use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove it havardaus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. uuicR ❑va IS}Na I have mail the havardaus matenalsrcyuitemenu under Chapter 6.95 of the Califar. nia Health @Sacty Cadc,Sections 25505,35533 and 25534.1 understand RWtfo.building rA, does not currently have a tenant,that it is my rmponsiolity to notify the Occupant of the r f\ ndl rcyuircmcn�u which in norwissu oor a Ccoaroate or occupancy. ,�,/,sq Signature of Applicant Date Ownerar ea—" thorirca spent \ Dam All roof coverings to be Class "B"or better