07010002 CITY OF PERTIi�tO
CU
BUILDING DIVISION PERMIT
� llT7�,QR I }RMATION*'
PERMIT NO.
BUILDING ADDRESS:
SPAR - S A
OWNER'S NAME:
t SCHWALBACH FREDERICK 879 AZA],EA DR. 01/02/2007
SANITARY NO. CONTROL NO.
NE: (408) 37'7-8045
BUILDING PERMIT INFO
ARCHTTECT/ENGiNEER: BLDG ELECT PLUMBa MECH
a o a
ce Z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
zm with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADDING
m ? SKYLIGHTS
"0 y in full force and effect.
v�z LicensC CI Lic•
o Date— Contractor
t-m ARCHITECT'S DECLA A ON
i�< I understand my plans shall be used as public records
�yU
u.y Licensed Professional
< OWNER-BUILDER DECLARATION
i hereby affirm that 1 am exempt from the Contractors License Law for the
3 p o following reason (Section 7031.5,Business and Professions Code:Any city or county
0.
. demolish,or repair any structure
which requires a permit to construct,alter,improve, Valuation
t'y prior to its issuance,also requires the applicant for such permit to file a signet statement fl,Ft.Floor Area $1500
Z< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9
I=- (commencing with Section 7000)of Division 3 of rite Business and Professions Code)or
I R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 9 3 8 0 0 9��Number P Y YP
not more than five hundred dollars($500).
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 employes,provided that such improvements anot intended or offered for sale.If.
are
however,the building or improvement is sold within one year of completion,the owner-
e
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 Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
0 i am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One of the following declarations:
ptj I have and will maintain a Certificate of Consent to self-insure Cor Workers Compcn-
on,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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
([Itis 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 permit is issued.I shall not
employ any person in any mannyr SoAeme subject to the Workers'Compensation
Laws of R
Applicant
NOTIC CA making this Certificate of Exemption,you should
become subject to the worker's Compensation provisions of the Labor Code,you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(..t 4 1 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.)
W QLenders Name
�z Lcndees Address
V C) 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
Ubuilding construction.and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
tit liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date (�
�-+ APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON-POINT Issued b
SO C RE LATiO . .) j_t,t
Re-roof:
ignat of Applieant/Com D1� A*
au T of Roof
OUS 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 roof;shall be inspected prior to any roofing material being installed.
E]Yes V"Ne If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
_mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
0 Yes GI No
I have read the hazardous materials requirements under Chapter 6.95 of thc Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
!docs not urrcntly vc a tenant that it is m�responsibifyno� Date
ire mast be met or w "ance of a CSignatula of Applicant
All roof coverings to be Class"B"or better
Owner or thorized agent ate