07080166 CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
PERMIT NO.
BUILD N ADDRESS:
�(�131 DEEPROSE PL TBD — TO BE DETERMINED 07080166
' PERMIT ISSUE DATE
R'S NAME:
MIKE CRAWFORD 09/05/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p zO LICENSED CONTRACTOR'S DECLARATION Job Description
vr 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 REV I S I O]1 FRAME AT GARAGE, CALLS, WINDOW AT LIVING
<s in full force and effect.
;t? License Class Lic.ft ROOM SKYLIGHT AND WINDOW AT REAR ADDITION
in Date Contractor
w ARCHITECT'S DECLARATION
i a a t understand my plans shall he used as public records
>aU
wy Licensed Professional
O a OWNER-BUILDER DECLARATION
3< 1 hereby affirm that 1 am exempt from the Contractors License Law for the
:n o 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 q 0
t= (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
that he is exempt therefrom and the basis for the alleged exemption Any violation of Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars($500). 3 6 9 0 5 0 2 1
❑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 dmrcon,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 impmvement is sold within one year of completion,the owler-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
as owner of the property,am exclusively contracting with licensed contractors to
consitct the project(Sec.7044.Business and Professions Coote:)The Contractors 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.
1 am exempt fhdff Sec. B&P C for this reason
erDate
r WORKER'S COMPENSATION DECLARATION
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I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of Ute Labor Code,for the performance of the
work for which this permit is issued.
❑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:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is fox one hundred dollars MOM
or less.)
I certify that in the performance of the work for which this permit is issued,)shall not
employ any person in any manner so as to become subject,to 'Compensation
Laws of California.Date 0
Applicanta `
NOTICE TO APPLICANT:If, ter making this Certificate of Exemption,you should
become subject to the Workces Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
��. I hereby affirm that there is a construction lending agency for the performance of
p� the work for which this permit is issued(Sec.3097,Civ.C.)
W Lenders Name
aLenders Address
U 0 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
U U building construction,and hereby authorize 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
tiC/) 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 jr
t r APPLICANT UNDERSTANDS NO WILL C MPLY WITH ALL NON-POINT Issued b)
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Contractor °ac t0 r
T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
tefined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
de,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Ifd ryo
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
District?
❑Yes Attu
1 have read Lite hazardous materials requirements under Chapter 6.95 of Urs Califor-
nia Hcalth&Safety Code,Sections 25505,25533 and 25534-1 understand that if the building
docs not currently have a tenant.that it is my responsibility to notify the occupant of the
mquircmens wh' m be m or to issuance of a Certificate of"pat". Signaturt:of Applicant Date
w 0� All roof coverings to be Class"B"or better
Date
Owner or authorized agent