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07050228 CITY OF CUPERTINO BUILDING DIVISION PERMIT S Imo+ RMATIQN. BUILDTft reV'kkNN DR TBD - TO BE DETERMINED PERMIT 07050228 ll b b PERMIT ISSUE DATE OWNER'S NAME: 09/26/2007 SANITARY NO. CONTROL NO. iNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH (� 0 L__J p p LICENSED CONTRACTOR'S DECLARATION Job Description U :z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is NEW 2—Sr'ORY RESIDENCE• 3802 ' GARAGE. 654 ' PORC H t H in full force and effect t n? License Class Lic.# 466 t uun Date Contractor ARCHITECT-S DECLARATION i a< I understand my plans shall be used as public records )WU U.y Licensed Professional y OWNER-BUILDER DECLARATION > 1 hereby affirm that 1 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; prior to its issuance,also requires the applicant for such permit to file a signed statement .Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. $869852 2 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i R 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 tl Number Occupancy Type not more than five hundred dollars(5500). 326190154. [11,as owner of the property,or my employees with wages as thew sole compensation, will do the work,and the structure is not intended or offered forsale(Sec.7044.Business Required Inspections and Professions Code:The Contractors 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.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 U.the project(Sec.7044,Business and Professions Code:)The Contractors U. 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. ❑I am exempt under Sec. B&P C for this reason Owner Date�`^s'v' DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workcr 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 Workers 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 w ich this permit is issued,1 shall not employ any person in any manner so as to a bjec the Workcrs'Compensation Laws of Califomia ate Applicant NOTICE TO APPLI a tc Ccniricatc 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 E~.r I hereby affirm that there is a construction lending agency for the performance of tx.� the work for which this permit is issued(Sec.3097,Civ,C.) W Q Lender's Name z Lender's Address U C I certify that 1 have read this application and state that the above information is UL 0-4 correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ce) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the grantin of this permit. �^ APPLICANT UNDERSTA S AND WILL COMPLY WITH ALL N N-POINT Issued by: Date S n "7 Re-roofs Signature o ticonvactor D'le Type Of Roof HAZARDOUS MATERIALS DISCLOSURE 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 roofs;;hall be inspected prior to any roofing material being installed. ❑Yes [ 10 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? C]Yes [ANu I 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 not currently have a tenant,that it is my responsibility to notify the occu t of die requirements Da All roof coverings to be Class"B"or better