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CITY OF CUPERTINO 7��,�
BUILDING DIVISION PERNIIT
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PERMIT NO.
VAI AVE
TBD TO BE DETERMINED
08030019
05/08/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHiTECT/ENGINEIR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Chapter 9
Job Description
p
I hereby affirm that I am l-tcsnacd under provisions of (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
NEW TWO-STORY HOUSE 4 r 5 8 8 ' r BA S EMENT 1 r 0 9 6 '
in full force
LicensClassnd�� eLice
,
ATTACHED GARAGE 627 ' -TOTAL SQ FOOTAGE 6,311.00
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors 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 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 Conractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 700M of Division 3 of the Business and Professions Code) or
$14 0 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 6 2 0 5 0 2 6 Number
Occupancy
Pane Y 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).
❑ 1, as owner of the property, or my employees with wages as thew sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Contractors License law does not apply to an owner of
property who builds orimproves 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 Contractor's li-
cense Law does not apply to ar' owner of p y o builds or improves thereon, and
who contracts for such projects with a con r(s) li nsed pursuant to the Contactors
License Law.
❑ I am exempt under
, perj one of the following declarations:
❑ 1 have and will maintain a Certif Consent to self -insure for Workers Compen-
sation, as provided for by Section of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I 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 are:
Carrier, Policy No.:F
EXEMPT CERTIFICATE OION FROM WORKERS'
COMPFNSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars ($100)
or less)
I cerdfv that in the performance of the wpt c�or which this permit is issued, 1 shall not
employ any person in any b/ccrmme o Worker!Pchnipcitudon
Laws of California D
Appue:
'on, you should
become subject 16 the �yorkers Corn fnsauodprovisions of the labor Coda you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which thn� Oi( is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Address
I certify that 1 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 authorim representatives of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities,judgmems, costs and expenses which may in any way accrue against said City
inconsequence of the granting of this rmoL`'
APPLICANT UFM.
(•.— HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Or future p(ruilding Occupant store or handle hazardous material
as defined by the Cupeni o Munfi pal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?'
❑ Yes 010
All roofs shall be inspected prior to any roofing material being installed.
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?
❑ Yes (y Nu
I have read the hazardous materials requirements under Chapter &95 of the Califor-
nia Health & Safely Code, Sections 25505, 2 533an;i 0534.1 understand that if do building
does not currently h a aril that it islmy responsibility to notify the oceuppnt of the
requirements sv " in �% met prior to Tuanca or a Certificate of Ocsppan6,,,
Sii?nature of Avvlieant late