06040007 CITY OF CUPERTINO � *
BUILDING DIVISION PERMIT C�lk 'TRAC' � �" }
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BUILDING ADDRESS: LEO SVERDLOV PERMIT N0.0 6 0 4 0 0 0 7
11127 LINDA VISTA DR
PERMIT ISSUE DATE
'ER'S NAME:
LEO SVERDLOV OS'10112006
SANITARY NO. CONTROL NO.
PHONE:
(650) 967-5271
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION Job D2SCTlptlOn
W C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U m with Section and
of of ecDivision 3 of the Business and Professions Code,and my license is TRELLIS STRUCTURE REAR YARD/INSTALL 220 OUTLET
'z y in full force and effect
-z LicenseClassLica FOR PREFAB SAUNA/INSTALL PREFAB COUNTER CABS
3 t:L Date Contractor
ARCHITECTS DECLARATION
7 ode< I understand my plans shall be used as public records
)yU
C y Licensed Professional
OWNER-BUILDER DECLARATION
}x I hereby affirm that I am exempt from the Contractor's License Law for the
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00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct,alter.improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valu*00 0 0 0
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
ti i- (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 of APN Number Occupancy Type
not more than five hundred dollars(5500). 35626003 . 00
❑1,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 Contractors 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 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
wct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
corse Law does not apply o 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 exemp1junder Sec B&P CC for this o
ier �� Date
WORKEWS CO F,NSA N DECLARATION
I hereby a[fimt under penalty of ane of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers 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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number arc:
Carrier, Policy No.: T
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE _y ` (� r
(This section treed 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 Cali fomi a
Applicant
NOTICE TO I]CANT.If,after making this tc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
C)
Z'_' CONSTRUCTION LENDING AGENCY
[~-t CA I hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
W
0 Lenders Name
Lenders Address
V C) I certify that I have read this application and state that the above information is
LL correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
f� (We)agree to save,indemnify and keep harmless the City of Cupertino against
►q liabilities,judgments,costs and expenses which may in any way accrue against said City (�
V Z in consequence of the granting of this permit. Date
r+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SR RE LATIONS. S s
G2
Signature of Applicant/Contrattor f. Dao Re-roofs T of Roof
HAZARDOUS MATERIALS DISCLOSURE ype
Will the applicant or future building occupant store or handle hazardous material
u defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Ac.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes (�Oo
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
1 have read the hazardtws materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
docs not c rc�ntl.yhavc tenant,that itis my responsibility o notify theoccupant of the
rc ai is be met prioro issuance of a Certificate of Occupaner� Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Date