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08060232 CITY OF CUPERTINO �y��+ BUILDING DIVISION PE1�LY111 � RT�� BUILDING ADDRESS: - PERMIT NO. 20755 STEVENS CREEK BLVD GETTLER—RYAN INC 08060232 OWNER'S NAME PERMIT ISSUEDATE 6747 SIERRA CT 09/25/2008 PHONE: SANITARY NO. CONTROL NO. (925) 551-7555 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description ; I hereby affirm Utat I can Licensed under provisions of Chapter (commencingP with Section 700Mof Division 3of the Business and Pro once lieenseis INSTALL ENHANCED VAPOR RECOVERY SYSTEM FOR in full fore and e Ak i n? License Class Lie.N SERVICE :t_ Date Contractor v ARCH TD STATION. ssAE0: t dmyplanss used public records .d C fin Licensed Professional - y OWNER-BUILDER DECLARATION < I hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5.Business and Professions Code:Any city or county e m which requites a permit to construct.alter.improve,demolish.or repair any structure yy prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation 2 l--$ (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $17 0 0 0 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by carry applicant for a permit subjects the applicant to a Civil penalty of Number Occupancy Type not more than five hundred dollars(s500). 3 2 6 3 2 0 5 6 '�'( ❑L as owner of the property,or my employees with wages as their sole compensation. will do the work and the structure is cot intended or offered for sae(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 theeon,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- bulkier will have the burden of proving that he did not build or improve for purpose of sale.), ❑L as owner of the property,am=elusively contracting with Ucrosed contractors to construct the project(Sec.7044.Business and Professions Code)The Conuactnrs Li- cense 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. ❑1 am exempt under Sec. ,B&P C for this reason Owner Dare WORKERS COMPENSATION DECLARATION I herby affirm under penalty of perjury one of the following declarations ❑I have and will maintain a Certificate of Consent to self-Insure for Worker's Compcn- sation,as provided for by Section 3700 of the Labor Code,rr the performan«of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Cote,for the performance of the work for which this permit is issued My Workees Compcnmdoo 1 �am/er/r d liry n Carriers J\1/ I J CERTIFICATE O� bN FROM WORKERS' COMPENSATION INSURANCE ('his waist need not be completed if the permit is for one hundred dollars(f 100) - ar less) I certify that in the prlforman=of the work for which this permit is issued.I shall not employ any person in any manner sou to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY [—r 4 I hereby affirm that there is.construction ending agency for the performance of �.,> the work for which this permit Is issued(See.3097.Civ.C) W7. A Lcndees Name =Z Lender's Address U 0 I ratify that I have read this application and state that the above information is LT correct.1 agree to co ply with all city and county ordinances and state lows relating to C V building consvuction d hereby authorize representatives of this city to enter upon the L7a above-mentioned ray for ins purposes. Ll. (We)agree to y d keep harmless the City of Cupertino against to liabilid udgments, and which may in any way scenic against said City U Z in conseq of s IL APPLICANT UND ST D ILL COMPLY WiTH ALL N- INT Issued by: Date SOURCE REG (J� Re-roofs SlgnawrofAppli °u ATERIALS DISCLOSURE Da Type of Roof Win the appli tor m building occupant store or handle hazardous material as defined by the Cu 'no Municipal Code,Chapter 9.12,and the Health and Safely Code,Sections f zs53z(a>0 Yes All roofs shall be inspected prior to any roofing material being installed. [(/ No// Win the applicant or fthvrffbuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as dcftncd y the Bay Area Air Quality Managcmenl all new materials for inspection. District? ❑Yer 1 have read the ors risk requirements under Chapter6.95 of the Califor• nia Healtheuwhich 505.25533 and 25534.1 understand thatif ore building does not �f�/ Ifatc All roof coverings to be Class'n 'or better