Loading...
07020069CITY OF CUPERTINO +C�ItAGT�QR'IRMTI®. '.; BUILDING DIVISION PERMIT BUIL INN ADDRESS: 230 STEVENS CREEK BLVD CONSTRUCTIVE BUILDING SVC, PERMIT NO. 07020069 ' rER'S NAME: C-- PERMIT ISSUE DATE PORRE AVENUE PROPERTIES 3937 39TH AVE 02/12/2007 PHONE: SANITARY NO. CONTROL NO. (510) 531-1175 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code y license is ADD ON] NEW WALL. DEMO INTERIOR PARTITION WALLS in full force and eff t. - License s Lic• � Dale Contractor ARCH RECTS DEC I understand my plans shall be used as public n Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I 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 License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractors (Chapter Professions Code) $8000 (commencing with Section 7000) of Division 3 of the Business and or 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 of Number Occupancy Type not more than five hundred dollars (5500). 36902031 . V ❑ 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 p 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.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors 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. C]1 am exempt under Sea . B & P C for this reason ierDate_—_ r - ----- - -_ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations ❑ I have and will maintain a Certificate of Consent to seif-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. ❑ 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 Wor ompe anon Insura ce err and Pol• n ! tel! 7y Carrier % 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.) 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 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 7 forthwith comply with such provisions or this permit shall be deemed revoked. n CONSTRUCTION LENDING AGENCY 1 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.) ~ Lender's Name Lender's Address 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 Jbuilding construction. and hereby authorize representatives of this city to enter upon the above -mention property for inspection purposes. yr (Wc) g e save, indemnify and keep harmless the City of Cupertino against y) liabilities,' d is and expenses which may in any way accrue against said City z in co of g ting of this permit. NON -y A E STANDS AND WILL COMPL -POI Issued by: Date 2- IFNv- O CE EG V 2 Re -roof; (�— pli uContraclor Dae ARDOUS MATERIALS DISCLOSURE gnat o;ya Type of Roof Wilapp) cant or future building occupant store or handle hazardous material inede Cupertino Municip ode. Chapter 9.12, and the Health and Safety Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes o 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 — 1 I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safcty ecdons 25505, 25533 and 25534.1 understand that if the building docs n ntly nant, Utas' pensibility to notify the occupant of the requi et prior to issuance of a Ccific of� pyaney Signatu) e of Applicant Date G All roof coverings to be Class "B" or better Owner ora h i- d ag nt Dare .