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BUILDING DIVISION
BUILDING ADDRESS:
20075 DE PALMA LN
R'S NAME:
SU LAW
ARCHITECT/ENGINEER:
PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License Class Lic• 8
Date Contractor
ARCHrrECrS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which 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
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
not more than five hundred dollars (5500).
❑ I, 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
and Professions Code: The Contractor's 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.).
I, as owner of the property, am exclusively contracting with licensed contractors to
struct 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 themon, and.
who contracts for such projects wit a contractor(s) licensed pursuant to the Contractor's
License Law.
am ------B R P:C ar this reason
r -t I t under
:r _ w Date
COMPENSATION 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:
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 which it' issued, I shall not
employ any person in any m )ec Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this a 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.
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CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
I 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
building Conswction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of th g C permit.
APPLICANT ERST S D WILL COMPLY WITH ALL NON -POINT
SOURCE REG TI
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
icftncd by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
:c, Section 25532(a)? y�
❑ Yes Y�-"u
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
District?
C3 Yes we
1 have read the hazardous mate 'als requirements under Chapter 6.95 of the Califor-
nia Health & Safcty Code Sectio 25 5.25533 and 25534. I understand that if the building
does not current) atopatcop it is my responsibility to notify the occupant of the
requirements w rch mupb6 et r tetissuancc of a Certificate of Occ�tpanc�I. 1
Owner or
12
Date
LAW'S CONSTRUCTION
10559 FF;
(408) 99(1-2353
PERMIT NO.
06080211
PERMIT ISSUE DATE
02/21/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
SFDWL-1ST FL 1837',2ND FL 1027',GARAGE 430'
GARAGE 1-30' X 56.38 = $24,243.40
3q. Ft. Floor Area
36932003.,
Issued by
Re -roofs
Type of Roof
$638199
Required Inspections
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new rr aterials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better