07010176 --77777777 7
CITY OF CUPERTINO q.
BUILDING DIVISION PERMIT � L�T � tRMAT��N
BUILDING ADDRESS: PERMIT NO.
21452 ELM CT NELSON GONZALE.S' 07010176
OWNER'S NAME: PERMIT ISSUE DATE
BINO JACOB 2235 STORY RD 02/27/2007
4E. SANITARY NO. CONTROL NO.
(408) 39(1-5659
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB METH
i
00 LICENSED CONTRACTOR'S DECLARATION Job Description
v F I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z. Ujwith Section 70(10)of Division 3 of the Business and Professions Code,and my license is CONSTRUCT COVERED PATIO ENCLOSURE.
=y in full force and effect. 16
O 3'
r n? License Class Lte•
t—w Date Contractor
ARCHITECTS DECLARA N
7 z< I understand my plans shall he used as public records
>yU
G y Licensed Professional
•y
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
< Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area
2EEC
l-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $28000
i 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(5500). 3620101_-
. V V
❑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 q P
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
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 contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty or perjury one of the following declarations:
Lj I have and will maintain a Certificate of Consent to self-insum 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 Workees 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 permit is issued,1 shall not
employ any person in an anncr so as to become subject to the Workers'Compensation
Laws of California
Applicant
NOTICE TO APPLICANT:rt,a ing this Certificate of Exemption,you should
become subject to the Workdr'rCompcnsation 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
(�C/) I hereby affirm that there is a construction lending agency for the performance of
1]�,n> the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
.7 z Lender's Address
U O 1 certify that I have read this application and state that the above information is
U.►" correct I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives or this city to enter upon the
U above-mentioned property for inspection purposes.
CL (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 j
V Z in consequence of the granting of this permit. Date G __7 `__7►" APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOUR EG TIONS4M A.
0 Z Re-roofs
SiJusoure of I ntractor te t
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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
Cale,Section 25532(a)? All roofs ihall be inspected prior to any roofing material being installed.
❑yes ❑No
Will a roof i;installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
,:mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.I understand drat if the building
;;A�
W.Cbe nant that it is my responsibility to notify the occupant of the
met prior to issuance of a Certificate of enpan Signature of Applicant Date
Z �' 0 All roof coverings to be Class"B"or better
Ow r authorized agent Da