06120001 7 7-77
CITY OF CUPERTINO
BUILDING DIVISION PERMITw �IERIVIAT�f�N�
PERMff NO.
BUILDING ADDRESS:
10773 STEVENS CANYON RD MARINKO
PERMIT ISSUE DATE
OWNER'S NAME: 01/03/2007
MARINKO BALDE
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
a 0 o a
a O p LICENSED CONTRACTOR'S DECLARATION Job Description
e U P I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REVISION• TRUSS CALC S
=z w with Section 7000)of Division 3 of Ute Business and Professions Code.and my license is
°may in full force and effect ORIGINAL PERMIT:
j n? License Class Lic.8
Date Contractor
,t ARCHiTECPS DECLARATION
U I understand my plans shall be used as public records
a
u.H Licensed Professional
n 0 OWNER-BUILDER DECLARATION
<2 1 hereby affirm that 1 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
which requires a permit to construct alter,improve,demolish,or repair any structure
Z y prior ht its issuance,also requires the applicant for such permit to file a signed statementF4:2::17:1:0
; ,Ft.Floor Area Valuation
e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9q $450000
xH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation ofNumber Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty o[ L:F9 U'
not more than five hundred dollars(5500).
0 1,as owner of the property,or my employees with wages as their sole compensation.
will do the work,and t he swcture is not intended or offered forsale(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.U,
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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's U-
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with ac tractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exe under Sec. B&P C for this reason
Owner P Date r
WORKER?CMWENSAAO 6CLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
L3 1 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.
0 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 pert ance aC th work_for which this permit is issued,I shall not
employ any person in rtecso to t to the Workers'Compensation
Laws of Ca11fOf11iL
APPS
NOTICE TOA C NT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
�`L forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(~�►-, 1 hereby affirm that there is a construction lending agency for the performance of
(�> the work for which this permit is issued(See.3097,Civ.C.)
W A Lender's Name
03 Lender's Address
1 certify that I have read this application and state that the above information is
[UL correct.I agree to comply with all city and county ordinances and state laws relating to
Q V building construction,and hereby authorize representatives of this city to enter upon nhc
above-mentioned property for inspection purposes.
t�nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City — 7
U 2 in consequence of the granting of this permit. A0 Date �JC�
APPLICANT UNDER AN AND W LL COMPLY WITH ALL NON-POINT Issued b�:
SOUR GULA S , Y, a
Re-roofs
I of Applicant/Contractor Dare T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofE shall be inspected prior to any roofing material being installed.
zim
0 Yes
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
,nit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new I naterials for inspection.
District?
0 Yes 2+M'
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
docs not currently havve�a 4 tis my responsibility to notify the occupant of the
require whichmlt met to coCaCertificateofOccupancy. Signatur'of Applicant Date
All roof coverings to be Class"B"or better
O er or authorized agent Date'