07040150 CITY OF CUPERTINO
BUILDING i,IVISION PERMIT � T] Tt?R INMTTEN:
BUILD NG D ESS: PERMIT NO.
�1s`�� CATALANO CT LOT 1 GREATER BAY CONSTRUCTION 07040150
OWNER'S NAME: PERMIT ISSUE DATE
PANCAL CATALANO 14125 BLkCKFORD AVE 09/14/2007
AE: SANITARY NO. CONTROL NO.
(408) 24 -6600
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 p LICENSED CONTRACTOR'S DECLARATION Job Description
W p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is S FDWL—2 STORY 2, 83 8 ' /GARAGE 44 9 ' (LOT 1)
<o in full force and effect.
License Class Lle.# 449 X 56 .38 = 23315
t Date Contractor
ARCHITECTS DECLARATION
i a< 1 understand my plans shall he used as public records
ryV
U.y Licensed Professional
w< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
.9 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
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
uF- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $633697
.. 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 ofNumber Occupancy Type
not more than five hundred dollars($500). 3 621806 5 q(
0 I,as owner of the property,or my employees with wages as their sale compensation,
will do the work and the structure is not intended or offered for sale(Sec.7(44,Business Required fired Ins eCtIOnS
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.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.).
�...1 as owner of the property.am exclusively contracting with licensed contractors to
cbnstroct the project(Sec.7044.Businem and Professions Code:)The Comracutes 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 Contractors
License Law.
01
am exempt underSte B&P C f this mason
Owner �_Dare
WO 'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 1 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 Workers Compensation Insurance carrier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(E 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 any mannrpss a to become subject LaUte or ;'Coompcnsaflon
Laws of California.
Date `✓I�.—r�P� /Applicant
NOTICE TO APPLICANT:I,ilfcFmaking this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
Er►�-� I hereby affirm that there is a construction lending agency for the performance of
(x > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
aLender's Address
U 0 1 certify that I have read this application and state that the above information is
L, correct.1 agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
a (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
U Z in consequence of the granting of this permit Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by.
SOURCE REGULATIONS
q&;(16 17 Re-roofs
Signature o[Applicant/CbrifEctor r I Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Codc.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes $No
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
0 Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does noeV=ntly have a tenant that it is my responsibility to notify the occupant of the
requirenots which mast berrictpriortoissuancc of a Certificate9f Gcea Signature of Applicant Date
Own or authorized agent
/(Cl
Da All roof coverings to be Class"B"or better