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06060222 CITY OF CUPERTINO BUILDING DIVISION PERMIT � �` � ` BUILDI�ADDRESS: t JOHN & KRIST INE FERGASON PERMIT N00 6 0 6 0 2 2 2 198ERRITT DR PERMIT ISSUE DATE OWNERS NAME: JOHN & KRISTINE FERGASON6 SANITARY NO, CONTROL NO. ONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: H© EO PLUMB MECH Up C LICENSED CONTRACTOR'S DECLARATION Job Description Y V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing =z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is KITCHEN REMODEL - NON STRUCTURAL. NEW CABINETS, 11�c, in full force and effect. �z License Clazs contgraewr COUNTERS, FLOOR 3= Date ARCHITECTS DECLARATION a� 1 understand my plans shall he used as public records m6 3:0. U y Licensed Professional OWNER-BUILDER DECLARATION Gn .2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county Q.Pi which requires a permit to construct alter,improve,demolish.or repair any structure y" prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area ValuW 0 0 0 —?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q y ts- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom anOccupancy Type d the basis for the alleged exemption.Any violation of OCCU Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A�N Number not more than five hundred dollars(5500). 3 1 3 0026 . 00 ❑I,as owner of the property,or my employees with wages az 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 Contracwrs 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.). 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 Contractors r License Law. ❑1 am e�tundwvSec. ,B&P C for this nOwner Date ORK G�MPEINSATIONI DECLARATION i � 1 hereby affirm under penalty of perjury one of the following declarations: L]I 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 Workers Compensation Insurance,az 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 are: Cartier. 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 w01 ch this permit is issued.I shall not employ any person in any man o ipet to the Workers'Compensation Laws of C ' a. O Applicant Nano A ,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY (.y rA 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.) W A Lenders Name 0 Lenders Address U O 1 certify that 1 have read this application and state that the above information is V." correct 1 agree to comply with all city and county ordinances and state laws relating to O Vbuilding construction,and hereby authorise representatives of this City to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ham- liabilities,judgments,costs and expenses which may in any way accrue against said City f,,,)2 in consequence of the granting of this permit. Date, ► APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU REG A, . � Re-roofs Si rc of Appli ontractor Date T Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle ha7mtous 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. ❑Yes �° 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 whicn all new materials for inspection. emit havardous air contaminants as defined by the Bay Arca Air Quality Management District? Cl Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not curentl have a tenant,that it is my responsibility w notify the occupant of the Date re encs tch m prior w issuance of a Certificate of Occu CY• O Signature of Applicant All roof coverings to be Class"B"or better wncr or authorized ag Date-