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07090172-, 'z C idE iz tact :amu_ j�- .a� U. �pC i^u �=C tt a L CITY OF CUPERTINO PERMIT Cfi� T'Rr TO ��OIZM�TI�N• '. BUILDING DIVISION BUILj?I);1�TIR TEVENS CREEK BLVD 1 `� / U TBD - TO BE DETERMINED PERMIT NO. 07090172 OWNER'S NAME: PERMTr ISSUE DATE KCR DEVELOPMENT 09/25/2007 SANITARY NO. CONTROL NO. jNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is DEMO OF (E) C ONDT I ONS ( NON- BEARNG INTER WALLS, in full force and effect. Lic.B DRS, IN'iER WNDWS, TOILET CORE, DEILNG & MEP License Class Date ARCHITECTS DECLARATION Contractor INFRAST.RCT I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 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 Sq Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement Law 9 that he is licensed pursuant to the provisions of the Contractor's License (Chapter $10000 (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 3690600 8 Number Occupancy Type not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to in owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder wiy have the burden of proving that he did not build or improve for purpose of sale.). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractors) ' d pursuant to the Contractor's License Law. ❑ 1 am ere esSe B & P C for this Owner DateN71�r�Z WORK ON DECLARATION - I hereby affirm undo aeaity of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workeescompen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars ($I00) or less.) I certifv that in the performance of the work for which this permit is issued, 1 stall not employ any person in any m to c?m;.i jest to the Workers' Compensation Laws of California ate Applicant NOTICE TO APPLICAlWafter making this Certificate of Exemption, you should become subject to the Wo is Compensation provisions of the Labor Code, you must 7 forthwith comply with such provisions or this permit shall be deemed revoked. j CONSTRUCTION LENDING AGENCY 1 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.) atender's Name Lender's Address I certify that I have read this application and sate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of ibis city to enter upon the above-mentioned property for inspection purposes. �. (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 Z in consequence of the granting of this permit. —+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT ?r Issued b): Date l�7 SOURULATIONS. --�—.�� Re -roofs T of Roof Type Signature of Applicant/Contrac Date US MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cotte, Section 25532(a)? All shall be inspected prior to any roofing material being installed. Yes roofs ❑ a roof is installed without first obtaining an inspection, I agree to remove ll the applicant or future building occupant use equipment or devices which Will emit hazardous air contaminants as d cd by the Bay Arca Air Quality Management all new materials for inspection. District? C3 Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 undersand that if the building docs not currently have a tenan4 dual it my responsibility to notify the occupant of the Date requirements w ' h must be. m issuance of a Certificate of Occupancy. Signaturc of Applicant e --a All roof coverings to be Class "B" or better OwnerC"uthori-zed agc ate