06080263 '777777777777 7- 777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
GIA GQ�Z IRMATI�N•
PERMIT NO.
BUILDING ADDRESS:
10554 APRICOT CT TBD — TC BE DETERMINED 06080263
PERMIT ISSUE DATE
R'S NAME:
-,NDY & AMY DRAKE 02/22/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0
cz
O C LICENSED CONTRACTOR'S DECLARATION Job Description
"Up i hereby affirm that I am licensed under provisions of Chapter 9(commencing
z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license isREMODEL-KITCHEN, FAMILY RM,DINING RM,ENTRY
�N L License
and effect. Lie•ggfk3ADDITION OF NEW COVERED ENTRY PORCH
Licenac Class
p Date Ca
�a ARCHITECTSDECLAR TIO NO SANITARY REQUIREMENTS 9/7/6
i < 1 understand my plans shall be used as public records
)aU
U.E- Licensed Professional
a OWNER-BUILDER DECLARATION
a1 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 a cture
"y prior to its issuance.also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation
-?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q 5 O O O 0
r (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 �p� Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3163014 Number
not more than five hundred dollars($500).
❑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 forsale(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.).
❑I,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 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.
am exempt under Sec. B&P C for this reason
.er Date
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 self-insure far Worker's Compen-
n,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 r' Co pfIFICATE
' n lnsuragce carrier and Policy numbeA
Cartier. { Policy No.:
CEOF EXEMPTION FROM WO ERS'
COMPENSATION INSURANCE
(This section aced not be completed if the permit is far 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 Workers Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions 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
f�> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z Lender's Address
O 1 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
rJ J building construction,and hereby authorize representatives of this city to enter upon the /t
above-mentioned property for inspection purposes. /
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
(/) liabilities,judgments,costs and expenses which may in any way accrue against said City -�. J
U Z in consequence of the granting of this permit. Date` /
�+ APPLICA UNDERSTA S AND WILL COMPLY WiTH ALL NON-POINT Issued b):
SOURCE G ATIONS. '� I
�� Re-roofs
Signature o Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
Icfincd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
odc,Section 25532(a)? �l All roofs shall be inspected prior to any roofing material being installed.
❑Yes RI 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 Area Air Quality Management all new r laterials for inspection.
District?
C]Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Code,Sections 25505,25533 and 25534.1 understand that if the building
does not c mly have a am,that it is my responsibility to notify the occupant of the
rcyuircm is w 'ch must et pri w issuance of a Certificate o!Occ pan $lgnatlln:Of Applicant Date
All roof coverings to be Class'B"or better
Owner ol authorized agent Date