07090136 CITY OF CUPERTINO PERMIT y^�:
BUILDING DIVIMON r
g�El�1Yi1T
PERMIT NO.
BUILTd q,DORE 14 WOLFE RD #212 8 RIDGE CONSTRUCTION CORP. 07090136
l U l G S 1V PERMIT nUE DATE
OWNER'S NAME:
LANDMARK PROPERTIES 280 TOVTiE CENTER DR 09/27/2007
SANITARY NO. CONTROL NO.
'NE: (732) 338-9677
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0
00 LICENSED CONTRACTOR'S DECLARATION Job Description
v— 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z w with Section 7000)of Division 3 of dte Business and Professions Code,and my license is REVISION—CORE 5" HOLE THRU CROSS MEMBER 23" DEEP.
t a din full force and effect. ORIGINAL #07040149
j
=)(n
? License Class Lie.N
E Date Contractor
ARCHITECTS DECLARATION
i < I understand my plans shall be used as public records
)aV
w0 y Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
jp O following reason.(Section 7031.5•Business and Professions Code:Any city or county
<m 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 rile a signed statement Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area 0
a Ir (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 3162003 7 A ff Number Occupancy Type
not more than five hundred dollars($500). "l�
Q 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 docs 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.).
Q I.as owner of the property,am exclusively contracting with licensed contractors to
construct the proje (Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs n app to an owner of property w builds or improves thereon,and,
who contracts fo h cu wi ntra o ) used pursuant to the Contractor's
License Law.
Q 1 am exe n C. B&P CC for thismasonmason
Owner 13.21750 '7"' _
ORKER'S&MITNATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Q 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.
Q 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 Worker's Compensation Insurance crier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not mpletcd if the permit is for one hundred dollars($100)
or less.)
I certify that in the perfo cc the work for i is permit is issued.1 shall not
employ any person in a co Workcrs Compensation
Laws of California.
Applicant
NOTICE TO PLICA :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(1) CONSTRUCTION LENDING AGENCY
F~" 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.)
Cw.Q Lender's Name
Z Lender's Address
U C) I certify that I 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
p U building construction,and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
Q.
(We)
ogre to save,indemnify and cp harmless the City of Cupertino against
� liabilities,judg rs,casts and expert w tch may in any way accrue against said City
U z in consequcnc f c rantin i r Date c�
►+ APPLICA U R S D L COMPLY WITH ALL NON-POINT Issued by
SOURC G Z 7 �
V/2
Re-roofs
-Orgitaturillif App icant/Co tort 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 Code.Chapter 9.12,and the Health and Safety
Code,
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Q Yes Q No
If a roof i 3 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 rr aterials for inspection.
District?
Q Yes Q No
oSafaazardous materials vire cnLs under Chapter 6.95 of the Califor-
c.Sectin505, 5 3 d25534.fundcrstandthatifthc building
e a that it' nsibility to notify the occupant of the
ustbe�pri aceniyclteySoeStt g• Signature of Applicant Date
l50'�gent
Dare All roof coverings to be Class"B"or better