07080244 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT e" Q �MATIO .
PERMIT NO.
BUILqM[XY' EGNART RD VIA BUI ,DERS INC. 07080244
ERR'SS NAME: j{ PERMIT ISSUE DATE
MIKE & KATHY YATES 4600 EL CAMINO REAL STE 209 09/21/2007
SANITARY NO. CONTROL NO.
PHONE:
(650) 943-1077
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0
p p LICENSED CONTRACTOR'S DECLARATION Job Description
W 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
2 with Section 7000 of Division 3 of the Business and Professions Code,and my license is DEMO L I T L ON, 1-STORY S F D
r<v in full force and efC t
zLicense Class Lic.#
F Dateg-a t-e Y Contractor
ARCHITECT'S DECLARATION
i < I understand my plans shall he used as public records
>yV
'
U.yLicensed Professional
O< OWNER-BUILDER DECLARATION
ja I hereby affirm that I am exempt from the Contractor's License Law for the
"co 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 yy prior to its issuance,also requires the applicant for such permit to rile a signed statementValuation
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area 10 O O 0
e. (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 36647015 Number Occupancy Type
not more than five hundred dollars(5500).
❑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 oroffered 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 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.).
0 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 Ui
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the conuactoes
License Law.
1 am exempt under Sec B&PC for this reason
ner Date
WORKER'S 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 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 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 Worker's Compensation lnsurancl;carrier and Polity number ate:
L µ�'Q' 1 ISR�
Cartier:CSD Chu �0`I NT 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 any manner so as to become subject to the Workers'Compensation
Laws of California.Date
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
Htom. I hereby affirm that there is a construction lending agency for the performance of
.7 the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
0, z Lender's Address
U 0 1 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
Jbuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
V) 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
SOURCE REG ATIONS.
Re-roofs —Z ,
Signature oflicant/Contractor Date Type Of]Roof
HAZARDOUS MATERIALS DISCLOSURE yp
Will the applicant or future building occupant store or handle hazardous material
is defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
'ode,Section 25532(a)? rptAll roofs shall be inspected prior to any roofing material being installed.
D Yes XNo
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 IT aterials for inspection.
District?
❑Yes it 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 not currently have a tenant that it is my responsibility to notify the occupant of the
requiremen hick must be met prio to issuance of a Certificate of Occupancy. Sjgnature Of Applicant Date
�" �'0 All roof coverings to be Class"B"or better
Owner 4 a hari-zcd agent Date