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07010067 CITY OF CUPERTINO BUILDINGDIVISION PERMIT �� T GR IQRMATI©lY�. PERMIT NO. BUILDING ADDRESS: 10716 STEVENS CANYON RD SIERRA FRECAST INC 07010067 PERMIT ISSUE DATE OWNER'S NAME: /19/2007 STEVENS CANYON VILLAS 1 LIVE OAK SANITARY NO. CONTROL NO. NE: (408) 775-1000 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH Ip o LICENSED CONTRACTOR'S DECLARATION Job Description W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ;Z� with Section 7000)ofDivision3oftheBusinessandProfessionsCode,andmylicenseis APPROX 70 LINEAL FEET OF 6 ' TALL PRECAST y in full force and effectCONCRETE; License Class Co # t„•,p Dam Contractor CHITECTS DECLARATION WALL j < 1 understand my plans shall be used as public records �� )yU a l- Licensed Professional O< OWNER-BUILDER DECLARATION aI 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 which requires a permit to construct,alter,improve.demolish,or repair any structure y prior o"S issuance,also tcquircs dtc applicant for such permit to rile a signed statement .Ft.Floor Area Valuation ?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $36120 r H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 3560304'7 .1W ❑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 oroffered for sale(Sec.7044.Business Required Inspections and Professions Code:The Contractor's License Law docs 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 We.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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contmtoes 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. B&P C for this n ❑1 am exem t under Sec OR 'S CO EN1 ION D• O I hereby affi under penalty o rjury one oC the following de ons: L31 have and will maintain a Certificate of Consent to self-insure for Workees compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. p 1 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 Com enation Insurance carrier and Policy number arc: Carrier. Policy No.: ��jjy�QQ,, ERTIFI ATE OF EXEMPTION FROM+,�i/ORKERS COMPENSATION INSURANCE (This 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.I shall not employ any person in any manner so as to become subject to the Workcrs'Compcnation 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 ,J Z forthwith comply with such provision or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) 6f1 A Lender's Name az Lender's Address U C) I certify that I have read this application and state that the above information is fL correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. >.a (We)agree to save,indemnify and keep harmless the City of Cupertino against „E rA liabilities,judgments,costs and expenses which may in any way accrue against said City U z �incoosequcncc:of the ti this permit. Date L7 ANT U S AND WI COM WITH ALL NON-POINT Issued b is E REG !VU, Re-roof: /"✓ Signature of Applicant/Contractor Date Type of f2oof HAZARDOUS MATERIALS DISCLOSURE yP 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 roof;shall be inspected prior to any roofing material being installed. ❑Yes C]No 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 Arca Air Quality Management all new naterials for inspection. District? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth& cty ,Section 25505.25533 and 25534.1 understand that if the building docs not c tl a tenant,that it is responsibility to notify the occupant of the Date requirem must be m nor uance of a Certificate of Occu ancy. Signatui a of Applicant All roof coverings to be Class"B"or better Owner or authorized agent D re