06080209 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�I�T ZIQM�TI�N
PERMIT NO.
BUILDING ADDRESS:
20065 DE PALMA LN LAW' S CONSTRUCTION 06080209
.R'S NAME: PERMIT LSSUE DATE
SU LAW 10559 FELTON WAY 02/21 /2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 99(1-2353
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB METH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
%m 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 F DWL-1;i T FL 18 3 7 ' , 2ND FL 1 0 3 0 ' ,GARAGE 430 '
t a a in full force and effect.
License Class Lie-# GARAGE 4:30 ' X 56 .38 $24, 243 .40
)nZE 2Date Contractor
uJ ARCHITECTS DECLARATION
7 C< 1 understand my plans shall be used as public records
)ori
C.y Licensed Professional
< OWNER-BUILDER DECLARATION
1 hereby affirm that I 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
<.9 which requires a permit to construct,alter,improve,dcmolLsh,or repair any structure
Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 1q
r t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $638842
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 3693203( .
Number Occupancy Type
not more than rive hundred dollars($SW).
0 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 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.).
2�as owner of the property,am exclusively contracting with licensed contractors to
`uuct 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 congctor(I licensed pursuant to the Contractor's
License Law. B,4 P C for this reason
n I am exempt under ._ .. _
WORKER'S COMPENS DEC RA'TYbi3
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insum for WarkoesCompen-
cation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued
0 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 Worker's Compensation Insurance carrier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis 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 rmit'iss .I shall not
employ any person in any manners subj o if I Ice mnpensation
Laws of California Date
Applicant S14, F A299
NOTICE TO APPLICANT.If,after making this Certill ption,you should
become subject to the Worker's 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
Fr rte. 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 A Lender's Name
z Lcnder's Address
U 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- U building construction,and hereby authorize representatives of this city to enter upon the n '1
Iia above-mentioned property for inspection purposes.
A0Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expo w h may in any way accrue against said City y' _
U z inconsequence of
the g ng o this Date J
►- APPLICANT UNDE AND A LL COMPLY WITH ALL NON-POINT Issued by;
SOURCE REGULATI
s% v Re-roofs
Signature of Applicant/Contractor D to
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
lefined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
le,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes No
Will the applicant or future building occupant use equipment or devices which
If a roof is 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?
0 Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 2550.2 33 and 25534.1 understand that if the building
docs not currently have n at is y responsibility o notify the occupant of the
rcquircmcnts which ust be me to trona mr a certificate of Qccupancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Oate