08090060CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.BUILDING ADDRESS:
20400 MARl XL CONSTRUCTI
OWNER'S NAME:
PERMIT ISSUE DATE
PH CONTIl.OL NO.
BUILDING PERMIT INFO
ELECT PLUMB MECH
ARCHlTECTJENGlNEER:
SHELL IMPRVMNTS&SEISMIC c:3 CJ CJ a~~ LICENSED CONTIl.ACTOR'S DECLARATION UPGRD w1l'J~ ROOFING IR~lbescription~~\;"U ___I'bcr1:l>Eflil'!1l'JIIa~nseAu!l<!crcpIQyjsions"of-ClWller 9 (""-,,,moncin· ";::;-__-..-...,...:;0 -:;::.---- :..;;;., .:.. ~:....;:-...=----:.~: --~.;,i-~:;;;:.-:;..-~~-~._~¥,..i:-:..-~--~:.~~-" .•z &l wilil Sectinn 7(00)of Division 3 of the BusiriciSizid ProfCSSions CodC,jjfd-mj'liccifsEU
~:§ e; in, full force and effect. . T -, I iJ; go
J [:l 2S License Class Lie. # v-r -,-3: ~ - c Dale Conlnl:tor '-C "'CS_ ~~~ ARCHJTEcrS DECLARATION
~ <Ii :c! 1 understand my plans shal/be: used as public records
J if U ~ U. I-Licensed Professional !:o~ OWNER-BUILDER DECLARATION ~'" .... 1 hereby .ffinn liIal I am excmpl frum liIc Conlnle:tor's License Law for liIc~:C~-cO following reason. (Section 7031.5. Business and Professions Code: Any cily or counlY ~:il~ which requires a pennil to construcL, aller, improve, demolish, or n:pair any structure
~-", prior lO ilS issuance, also requires the applicant (or such permit La file a signed stalCmc:nl r--------;::--~:-;;::;---_;_----~---T--------___::_::__:_-..,...---------:2'::c thal he is licensed pu[Suanllo liIc provisions oflilc ConlnlClDr's License Law (ChapICr 9 Sq. Ft. Floor Area Valuation ~:l:c (commencing wilil Section 7(00) of Division 3 of liIe Business and Profession. Code) or >: I-:i
liIal he is exempl liIererrom and !he basis for liIe alleged exemplion. Any violatian off~~_ml~~~_~~a~~~~lhc~-~a~~-~~-------M~~N~N~u-m~b~e=r~------~------O~C-C-u-p-~-c-y~T=y-p-e-----
nol more liIan live hundred dollars (SSOO).
o I, as owner of liIe property. ormy crnployees wilil wages as liIeirsole compensation. L-----------------=------:--::-.l.-----------------------will do the work. and"lbe structure is nOI inlended Dr olTered for sale (~. 7044, Business r
and Professions Code:: The Contrac~r's License Law docs no' apply 10 an owner of Required Inspections
propeny who builds or improveslilereon. and who docs such work bimself or through his
own emplo)'CCS, provided liIal sucb improvemenlS are not inlended Dr alTered for sale. If.
however, the building or improvement is sold within one year of completion. the owner-
builder will have the burden of proving liIal he did nol build or improve for purpose of
sale.).
o I, as owner of liIe property. am ""elusively contracling wilil licensed conlnlc:lorS 10
construcllile prnjee:t (Sec. 7044, Business aod Professions Cadc:) The Conlnl:tor's Li·
cense Law docs nOI apply 10 an owner of property who builds or improves !he",on, and .
who eonlnlClS for such projeclS wilil a contrac~r(s) liccnsed p.,...nllO !he ContnlClor's
License Law.
o 1 am aem pi under Sec. • B &: P C for liIis reason
Owner ----;;W:::O;;;R;-;;K:;:ER=.Sc;C;;:O:;'M-;;P;;;EN=S....7.:n=O~Nc;D:;E:;:C;;-LA-;-;;-RA~~N.,......---
1 bereby affinn under ~nalty of peljury OllC of the follOWing declarations:
o I b."" and will maintain a Certificale of Consent 10 self-insure for Work.er'sCompen
salion. as provided for by Section 3700 of liIe Labor Code. for liIe ~rformance of liIe
work. for which thu pcnnil is issued.
o I have and will maintain Worlccr's Compensation Insuranee, IS required by Section
3700 of lhc Labor Code. for liIc perfonnance of liIe worIt for which liIis pennil is issued.
My Work.er's Compensation Insurance carrier and Policy number an::
Carrier. ~.,-¥, ,Ito..1tY'~c."", Policy No.: 'S~~1.\'5c>
CERTIACATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lllis seelion nced nolbe: completed if lite ~nnil is for one hundred doll ... (SIOO)
aries..)
I cenify lhlll in the pcrfonnanc:c of lbc work. for which this pcnnil is issued. I shaJl nOl
employ any ~[Son in .ny manrlCr so as 10 be:come subjecllo liIe WorIccrs' Compens.tionLaws of California. Dale _
Appticanl ..,..,.---,---,-----------,---------
NanCE TO APPUCANT: If. aflCT making liIis Ccrtificale of Exemption. you sbould
become subjecl lD lhe Worker's Compensalion provisions of the Labor Code:. you must
rorthwiLh comply with such provisions Dr this pc:fJ11il shall be deemed revOked.
CONSTRUCTION LENDING AGENCY
I herehy amnn thatlhcre is a construetinn lending agency for the perfonnancc uf
liIc work fur which liIis ~rmil is issued (See. 3097. Civ. C.)Lender's Name _
Lender's Addrcss _
Issued by: Date
Re-roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.DNa
If a roof is installed without first obtaining an inspection, I agree to removeWill the applicanL or future building occupanl USC cquipmcnl or devices which
emil hazardous air conLaminanLS as defined hy lhe Bay Area Air Qualily Manas:::menl all new materials for inspection.
Disuict~
DYes ONu
Signature of Applicant Date
All roof coverings to be Class ",q." or better