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07020004 CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUIL�ICQjtE SAN JUAN RD DHUEY MICHAEL J 07020004 / / PERMIT ISSUE DATE OWNER'S NAME: DHUEY MICHAEL J 02/01/2007 SANITARY NO. CONTROL NO. ,NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 00 LICENSED CONTRACTOR'S DECLARATION Job Description U F I hereby affirm that I am licensed under provisions of Chapter 9(commencing :z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WINDOWS LIKE FOR LIKE ON A A TWO STORY M in full force and effect-- z License Class '` Lic.# if I S INGEL FAMILY HOME w Date 2�f d Contractor Lev ARCHITECTS DECLARA N i < I understand my plans shall be used as public records )aU U.y Licensed Professional yOWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county < which requires a permit to construct,alter,improve,demolish,or repair any structure Q—y prior m its issuance.also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area 2 0 0 0 j t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3421708 4 .W Number Occupancy Type not more than five hundred dollars(5500) I,as owner of the property,or my employees with wages as their 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 Contractor's License Law does not apply to an owner of property who builds or improves 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 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. 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I]1 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 arc: /" Carrier. ���e _�V\ Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('oris section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z. CONSTRUCTION LENDING AGENCY (tet►CA-+ I hereby affirm that there is a construction lending agency for the performance of p(> the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name a z Lender's Address U 0 I certify that I 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 Ubuilding construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. 0. (We)agree to save,indemnify and keep harmless the City of Cupertino against F". liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permitDate ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b C. SOU ATI S. 2-b 0 Re-roof: -Siva—ture of Applicant/Contractor 'DateT of Roof MATERIALS DISCLOSURE Type 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)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes If a roof is installed without first obtaining an inspection,)agree to remove Will the applicant or future building occupant use equipment or devices which :mit hazArdous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. District? Yesu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cote,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a t�enanen Lhat it is my responsibility to notify the occupant of the requircMea W1" fmust be' met prior issuance of a Certificate ofettpaney. Signatul a of Applicant Date ` ( All roof coverings to be Class "B"or better nes or authorized agent Date