06080208 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C1NT GQ I 'QRMATI()N
BUILDING ADDRESS: PERMIT NO.
20055 DE PALMA LN LAW' S CCNSTRUCTION 06080208
R'S NAME: PERMIT ISSUE DATE
SU LAW 10559 FELTON W2 02121 /2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 996-2353
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
a 0 0 0
Ig p LICENSED CONTRACTOR'S DECLARATION Job Description
Lit
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is S FDWL-1:T FL 18 0 6 ' , 2ND FL 10 4 6 ' ,GARAGE 430 '
a a in full force and effect.
License Class Lic.# GARAGE 430 ' X 56 . 38 = $24, 243 .40
F w Date Contractor
ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)4U
n.l'- Licensed Professional
H OWNER-BUILDER DECLARATION
I 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
`<mwhich 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 Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 :)q.Ft.Floor Area
2 Fz (commencing with Section 7000)of Division 3 offt Business and Professions Code)or
$635627
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of App
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 9 3 2 0 0 E . UU Number Occupancy Type
not more than five hundred dollars(5500).
❑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 Contractor's License Law docs trot apply to an owner or
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.IL
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.
I am exempt under S B tit P C f this reason
er Date
WOR NSATION 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 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 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 Compensation Insurance carrier and Policy number are:
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 f which this permit is issued,I shall not
employ any person in any malau bee I ubj.VJ0a,0ersCompcnsation
Laws of California.Date
Applicant
NOTICE TO APPLICA g this CcrtiCcatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
(�- CA 1 hereby affirm that there is a construction lending agency far the performance of
> the work for which this permit is issued(See.3097,Civ.C.)
WGA.Q Lender's Name
=z Lender's Address
V Z I certify that 1 have read this application and state that the above information is q
�-" correct.I agree to comply with all city and county ordinances and state laws relating to ,{
rJ Ubuilding construction,and hereby aulhorire representatives of this city to enter upon the 'y // � _.o f7
U above-mentioned property for inspection purposes. 4— /
(We)agree to save,indemnify and keep harmless the City of Cupertino against
�F 9t liabilities,judgments,costs and ex n s which may in any way accrue against said City
U Z in consequence of ing this rmit. Dal
APPLICANT ER S D WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE RE ULATI S.
N 6/ oRe-roofs
Signature of App or DateType of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
tefined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Je,Section 25532(a)? All roofs ihall be inspected prior to any roofing material being installed.
❑Yes %No
Will the applicant or future building occupant use equipment or devices which
If a roof i;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes it No
I have read the hazardous materials requirements underChapter 6.95 of the Califor-
nia Health&Safety Code,Sectiorp,254.25533 and 25534.1 understand that if the building
docs not currently th is my responsibility to notify the occupant of the
requircmcnt.swhi must tp t issnaneenracertirtcatcorOc upon y. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Date'