Loading...
04090139296F�k A= D U CITY OF CUPERTINO " +� 7' ` ,W, ''. BUILDING DIVISION PERMIT g�'� ©NTR".C'� O 1100 IA.i`T41 a * BuILDING ADDRESS: PALISADE BUILDERS INC PERMITNO. 04090139 OWNER'S NAME: PERMITLSSUR DATE 2C�iMGL E: SANITARY N NO. ARCHITEC rEHOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O O LICENSED CONTRACTORS DECLARATION lois Description 1 hereby afilm Nu 1 Am IittuWprovisions under of Chapter 9 (enmmlrem, with Salon ]IXSI) of Division 7 o(the Bugrauand Pro(essinm Cede, and my Ilcenm it anicfe^Imfone�ne ercecl. L,I $3$6N& NEW CONDO -1087 SQ. FT. o 1.0 , A s SHCC Data can ARCHITECTS DECLARATION 1 under tend my Plan, shsi PuM1 s . Licenacd Professional ER -BUILDER dOECLARATION I hemby affirm that I em exempt from the Contractor's License Lew for the following moan. (Section 7131.5. Business and Potassium Code: Any city or county which requires a Permit to construct. eller, improve, demolish, or mpalr any structure prior In its ia,aawe. also requires the Applicant for such Permit to rile a signed statement Sq. Ft. Floor Area Valuation that he is licensed ponos. to the provialnuof the Cman en's Llccnm Lav (Chapter 9 (commencing with Section?") of Division 7 of the Budneuud Profeninm Code) of that he Is exempt therefrom sad the buts far the alleged exemption. Any vWlNort of APN Number Occupancy Type Section 7031.5 by Any Applicant for a pemtl subjects the applicant to A Civil penalty of not more than Eve hundred dollen ($500). ❑ 1, a owner of the property, or my employees with wages u their sale compensation, 31620084. 00 Required Inspections willdo thawork,and Neswctumisnotintendedoroffemd forsale(Sec.7044,11ualneu and Pruftedma Code: The Contractor's License Law doss not Apply to an owner of 9 P property who but ldsmr improves daroon, and who dauuch work hi mse if or through his own employcca, provided that such Improvemanu are not Intended at offered forage. If, however, the building or Improvement is mid within one year of completion. the owner. builder will have the burden or proving that he did ant build m Improve for purpose of u1o.1. ❑ 1, as owner of the property. am exclusively contracting with licensed contractors m construct am pmjca (Sec. 70". Business and profudona Code:) The Cash mmte Lb cense Law doss not pply to an owner of property who builds or Improve themon, and who comment for Much projects with a cmmetot(G licensed pursuant m the Coruscate. License Law. ❑ I am exempt under See , B h P C for this rcuan Owner Date WORKER'S COMPENSATION DECLARATION 1 hemhy affirm under penalty of perjury one of the following declualloul: 1 baro And will maintain a CenlRnte of Consent to selGlnwm fa Warears Compere orlon, u provided far by Section 37M of the Loner Code, fm the performance of the work for which this reach Is booed. ❑ 1 have sad will maintain Worker's Compenasdon buurance, u required by Section 7700 of the tabor Code, fa the Performance of dm work for which Nis permit is Issued. My Workers Compensation Insurance carrier d Policy number are: Carrier. gfAjc f L .Tbv=Polity Nn.t?me.��s33[1 ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This maim wed not becomplewd liters pemit is for one hundred dolim(SIM) or lees.) I certify, that In the perfoma ce, or the work (or which this Permit Is Issued, I shall not employ any Karen In any manners As to become subject to tho Workcn Compcnsellon U., of California. Data Applicant NOTICE TO APPLICANT: If, afar making this Cenlftcarc of Exemption, you should became subject to the Workers COMrZMtion pmvlsiane of Ne labor Cook, you most forthwith Comply with such provisions Or this Permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby that there gamuSec.3097. agency for the Performance of which th the work for which this perch h Inad (gee. 71197. CO.Civ. CJ Name . �Leader's LenderM's Address 1 certify that 1 have teed this application end sun, that the above Infomulon is caneL'L I agree m comply with ail city and county ordinances end stem laws relating to building construction, and hereby authorise representative, of Nb city la enter upon the above-mentioned property for Inspection Puyaaca (We) e,me to save, indemnify and kap hamlets the City of Cupertino against j IlabllltleLjudgmenu, costs end expenseswhich may In anyway accrue agalntrald City in APPLICANT UNDEonce of the RSTANDS Aranting of IND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS, Re -roofs Type of Roof Signarumof Applic onmwmr Den, HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupml store w handle huardous TMWHH As dented by Ute Cupenlno Municipal Code. Chapter 9.13, and the Health and Safety Cada,Sadann57:(a)T NitlO All roofs shall be inspected prior to any roofing material being installed, ❑Yna If a roof IS Installed without first obtaining an inspection, I agree to remove Will the applicant or future building arupam use cyulpmenl or JevimA which It haveranus sit cmuminanu u declined by the Day Ama Air Quality Management all new materials for inspection. nria1 ❑Yus 1 have mW the hanrdmemetetullmqulmocau underChapW6,93ofJa CAli(or. nix BOOM <SAfnyCode, Sadmu255113.35533 And35534. IunJcnuM rive bribe building Jws ret eunenJy have a tenenk that It b my msparesha ry In notify the occupant of the reyvimmenta which mug he met Prior to issuance of a CeNOa,te of Occupancy. Signature Of Applicant Date -�/ All roof coverings to be Class "B" or better Owner Orarch cda ml Dea