07030273 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT � RT� II� C} ATII�t.
BUILDIN6AOIJrtYPRESS CT TBD TO BE DETERMINED PERMIT07030273
-.RR''SIJNAAMJE: PERMrf ISSUE DATE
STEVEN LIAO 09/21/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
O p LICENSED CONTRACTOR'S DECLARATION
W p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
t:z tUt1 with Section 7000)of Division 3 of the Business and Professions Code,and my license is NEW S F I IWL• 3065 ' GARAGE• 4501 PATIO' 100 '
=y in full force and effect
t ? License Class Lic.#
M tp Date Contractor
ARCHITECTS DECLARATION
i c< I understand my plans shall be used as public records
>dU
U.y Licensed Professional
OWNER-BUILDER DECLARATION
'> I hereby affirm that I am exempt from the Contractor's License Law for the
'00 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 to its issuance.also requires the applicant for such permit to file a signed statement
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
e.l`_ (commencing with Scction 7000)of Division 3 of the Business and Professions Codc)or $686266
u 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 316 3 0 0 E 0 Aft'Number Occupancy Type
not more than five hundred dollars(5500).
0 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 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 conaactor(s)licensed pursuant to the Contractors
License Law.
0 1 am exempt under Sec B&P C forthis
_
thisreasonn
:el. — r Date q—+--n 2
WORKSCS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Workcrs 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 Workcrs 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 foronc hundred dollars($I00)
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 man nc o�to ticctme,,mubject to the Workcrs'Compcnsation
Laws of California.Date_Y •2 I
Applicant --- ---
NOTICE TO APPLICANT:If,after making this Certificate 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.
z "" CONSTRUCTION LENDING AGENCY
H rA 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.)
WCI.Q Lender's Name
a Z Lender's Address
U C) I certify that 1 have read this application and state that the above information is
r-' correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding conswction•and hereby authorise representatives of this city to enter upon the
W about-mentioned property for inspccuon purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tom, liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date -2l
SOURCE REGULATIONS. k ;
--� !!`21'61 Re-roofs
Signature of App rcandContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
dc,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future building occupant use equipment or devices which If a roof i;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 materials for inspection.
District?
0 Yes P'No
1 have read the hazardous materials requirements underChapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which matt be met prior truance of a certificate of Occupancy. Signature of Applicant Date
—s
Owner orauthorizedd agent - — All roof coverings to be Class "B"or better
Datc