06080210 . 7777777777777,
CITY OF CUPERTINO
BUILDING DIVISION PERMITC� I��GT�1R I (}RMATJ.,9, .'
BUILDING ADDRESS: PERMIT NO.
20085 DE PALMA LN LAW' S CONSTRUCTION 06080210
:R'S NAME: PERMIT ISSUE DATE
SU LAW . 10559 FELTON WAY 02/21/2007
PHONE: SANITARY NO. CONTROL NO.
(408) 996-2353
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
o p LICENSED CONTRACTOR'S DECLARATION Job Description
v F 1 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:iT FL 1 8 0 8 ' , 2ND F L 10 2 7 ' ,GARAGE 4301
' in full force and effect
License Class Lac.n GARAGE z,301 X 56 . 38 = $24, 243 .40
[-z Date Contractor
ARCHITECT'S DECLARATION
i < 1 understand my plans shall be used as public records
)yU
u.y Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
Ca O following reason.(Section 7031.5,Business and Professions Code:Any city or county
Ii which requires a permit to construct,alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
oF- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $631982
u F F 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 N Number Occupancy Type
not more than five hundred dollars($500). 36932039 .
❑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 Ll P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc 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.).
CJ L 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 co actor..)licensed pursuant to the Contractor's
License Law.
M t am exempt under Se B&P C for this reason
_,-.
_r te
WORKER'S COMPENSATION DECLARATfON
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.
❑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 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 for which this perm• tied,I shall not
employ any person in any man r + ser ctmtpensuioa
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ce 'Ica cmption,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 CA 1 hereby affirm that there is a construction lending agency for the performance of
f2!> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
az Lender's Address
U 0 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
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
CLI above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hto liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the On
s permit Date 2 L I /
►+ APPLICANT ER S ND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE RE LA O
Re-roofs
Signature of Appli ontractor Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
termed by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
.c,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
E]Yes ANo
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 rr aterials for inspection.
District?
❑Yes 09 No
1 have read the hazardous materials requirements under Chapter 6.95 of the Cali for-
nia Health&Safety Code,Seco 25 5,25533 and 25534.I understand thatif the building
does not currently a ten th t is my responsibility to notify the occupant of the
requirements w is t to uance of a Certificate of occupancy. Signature of Applicant Date
All roof coverings to be Class"B" or better
Owner or authorized D -