08090127 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C01TRta.C2TORIN 'f1RMA�I�1Y°*�+;
BUILDING ADDRESS:ADDRESS: PERMIT NO.
10965 MTRAMONTE ED TRT) TO RE DETERMT]MET) n6noni -)7
W HER'S NAME: PERMIT ISSUE DATE
A CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
' HLDG ELECT PLUMB MECH
O
o o LICENSED C'ONTRACTOR'S DECLARATION
w C 1 Mxby affirm out 1 am licensed under pmvishem of Chaps 9(commencing Job Description
U with Section 70f10)ofDWison Sof On Business and Profcssims Cade.and my he..is
=T in(ulltorcoamec(fe¢ CONSTRUCT SHED & FENCE 7 ' 5" MAX HT.
License Class Lie.k
I„q Dau Contractor
F 7W ARCHITECTS DECLARATION
[22 I imemaand my plana shall he used as public records
JyU
ItLicensed Pmfesuaml
-
5 5OWNER-BUILDM DECLARATION
E T hereby affirm Nal 1 am exempt from the Conlmctm's License law rot the
y e a following reason.(Section 71131.5.Business and Professions Code:Any city or county
which requirs ea permit to compact,alter.improve.demolish,ser nepair any suamme
prior to it,issuance.also requires the applicant for such permit to file a signed suument
ppxx< than hculicensed pumamtoOnpr..W.ofthe ConuxtafsU..Iaw(Chapter 9 Sq.Ft.Floor Area Valuation
YI-$ (commencing with Section 7000)M Division 3 of We Businessand Prof...Coe).,
— that he is esemps tnerrtrmn and the bass for the alleged exemption Any violation of 52000
Section 7031.5 by any applicant for a Permit subjects the applicant he a civil Penalty of APN Number Occupancy Type
not come Wan five handled dollars(SSW). P y ''p
❑1,as owner of die property,a my employed with wsges ss Heir sole compensstion. 35601032 , 00
will do the wart,and the structure u not intended..ffered(a,sale(Sec.70x4,Business
and Profound.Code The C.mmoulrs License Law does at apply to an owner of Required Inspections
property who builds orimproves Wn e r n,and vha does such work himself ser Orough his
own employed,p n ided Oat such improvements are not inmnded aro@ted forsale.V,
however.Oe building or improvement is sold within one year of cmnplcuon,the owner,
builder will haw the burls of proving that M did cot build or improve for purpose of
sale.).
.u owner of the property.am delusively contracting with licensed contrannrs to
co.tmct the project(Sec 7064.Real..and Profusions Code:)The Contractor's Li.
cone law docs not apply to an owner of property who builds or improves thereon,and,
who concocts for such projects with a coma ou(s)licensed pursuant to the Conuanats
License Law.
lam dcmpt under See ,B&PCr O"mma
to Dau 0
COMPENSATION DECLARATION
1 iv—
Rby aRino under penalty of perjury ante of Oe following declaratimu:
❑Ihaveond velli mainuinaCertifiao of Cansemwxl(-Wort(or WerkmY Compeo-
action, provided Ins Section 37W.(the labor Cade,for Ne perfannenco of de
wort fart which Out permit is banned.
1 haw and will msimsin Wofkelt Compensation Iruerazus,u required by Section
3700.(ft Labor Cade.fm On performance of the wort(.,which Old permit is issued
My Worker's Competecation huvvanco carrier and Policy numbs arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Clhu senl.n need and be completed if Ibo pemtitu furans hundred dolhrs(SIM)
or loss)
1 certify Oat in Oe performance of We wails
for wh'h this ermit u WOOIL 1.hail era
emPldyany person in any marecrsolala a� s t Wart Compensation
Laws of Caiifomia. tJ C
APpB ant
NOTICE TO aw of Exemption.you should
become subjcn a Wohefs mallouuan provisionsser do Ichor Cade,yot moa
Q z forthwith comply with such provisions or Oct permit shall bo deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
��+ I hereby affirm Oat then,is a co.uacuon Imaningagency far the perfarmance of
11 Oo wotk far which this permit is issued(Sec.3097,Civ.C.)
W 0 Lender's Name
.7 z undoes Address
IJ Q I conify that 1 ham Rad this application and sLLu Out the above information is
[L.F corRn.l agree to comply with all city and county ordinances and sou laws minting In
0 building construction.and hereby aobodm representatives of this city to cnur upon the
r 6. above-mentioned property for i.pccdan pureses
(We)agme to caw.indemnify and kdp harmless the City of Cupenlno against
F'UA liabiliticsjudgmcou.coso and expenses which mayinanyway accrue agaiutsaid City
U z in Cmuccomme Of the gmntint of that permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Dau
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t appOdm a future bantling e.Chapter
cremate the
h oulth and Safe,t
u deHncd by We Cupeniw Municipal Code.CTapur 9.13,and de HdIW and Safety '
ads.Section 25332ta)? / All roofs shall be inspected prior to any roofing material being installed.
❑Yes t;,-/
Will the applicant or future wilding Occupant on,equipment w devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air contaminants as defined by dee Bay Area Air Quality Management all new materials for inspection.
DistrictT tQ/ •
❑Yd Q
I have Rat the m aardO.materials requinumnes under Chapur6.95ofOe Califm-
nuHealth k SarctyCodc.Section,25505,25533 and 35534.1 undersand thatif Oc building
dad not currently naw a e cot.that it u my me onsiMliry m natry the Occupant of the
2 Date All roof coverings to be Class'ns'or better