070601140z
z,
CY+ �
W�
UC
OF
C
Ha
U2
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CC1�ACTflR: IRMT�()N'�
BUILQIT^Ic%QIR
MINE CT LOT 2
(NAjME:
TBD TO BE DETERMINED
PERMIT NO.
07060114
OWNER'S
PERMIT ISSUE DATE
06/11/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
S FDWL - 2 STORY 1,748' PATIO 405', GARAGE 437'
in full force and effect.
License Class Lic. 0
TOTAL
Date Contractor
•ARCHITECTS DECLARATION
SQ FOOTAGE 2,590'
I understand my plans shall be used as public records
PERMIT APPLICATION EXPIRED 12/14/07 -EXTENSION .
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 to its issuance, also requires the applicant for such permit to file a signed statement
the the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to provisions of
$180000
(commencing with Section 7000) of Division 3 of the Business and Professions Codej or
that he it exempt therefrom and the basis for the alleged exemption. Any violation of
3 1 6 4 7 0 17 lY','
Occli anC T e
p y yP
Section 7031:5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber
not more than five hundred dollars (3500).
.`
-
I, as owner of the properly, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law dors not apply to an owner of
property who builds orimproves thereon, and who does suchwork himself or through his
own employers, 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 btdld or improve for purpose of
sale.).
;C 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 -
came Law docs 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 Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner l_ Date
WORKER'S PENSATION DEC RATION
-
I hereby 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 Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance 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 Code, for the performance of the work for which this permit is issued.
'
My Worker's Compensation Insurance carrier and Policy number are:
Cartier. Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
• COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of
h1iQDnificam of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
rorthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby apiece that there is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097, Civ. C.)
-
Lender's Name
Lender's Address
I unify that I have read this application and state that the above information is
'
correcL 1 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
j liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date -- �•--�
SOURCE,
Signature Of Applicant/Contractor •• Date
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
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)?
❑Yes +�]No -
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 ❑ No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
niaHcalth & Safety Code, Sections 75505, 25533 and 75534.1 understand thaif the building
docs not currently have a tenant that it is my responsibility to notify the occupant of the
requirements
All roof coverings to be Class" `' or better
Owner V
or authorized agent Date