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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
18841 PENDZRrAST AvE
JOSEPH
OWNER'S NAME:
PERMIT LSSUE DATE
S CONTROL NO.
ARCHTTECTIENGINEER:
BURRING PERMITINFO
Y
DEMO SFDWL, 1379 S
BLrx PLUMB MECH
LICENSED CONTRACTOR'S DECLARATnON
licensed
Job Description
p
1 hereby affirm that I am under proviaiorts of Chapter 9 (commencing
with Section 70DO) of DivWon 3 of tlti Busirtess and Profession Code, and my license is
in full force and effect.
License Class Lie. g
Date Contractor
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I bereby affirm that I am emmpt from the Contractor's L.iecnac Law for the
following reason. (Section 703IS, Business and Professions Coda Any city or county
which requires a permit to construct. alter, hrprovc, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed sulement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(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 esempdon. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mole than five hundred dollars (SS00).
❑L 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 Pm[essions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through hit
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 hurdea of proving that he did not build or improve for purpose of
sale.).
.1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec- 7044, Business and Professions Code:) The Contractors L.i-
carise 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 Contractor's
License Law-
❑ I am exam t and e . B & P C for reason
.
O Ih
under penally of pejury one of the following declarations
❑ I have and wM maintain a Certificate of Consent to self -Insure for Worker's Compen-
sadon, 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
'
My Workers Compeatalion insurance carrier and Polity number ate:
Carrie. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This season need not be completed i the permit Is for one hundred dollars (S I OO)
or lest)
1 cenifv that In the performance of the work for which this permit is issued. I shill not
employ any person in any mamnc q s je cl to the Works' Compensation
Laws or Cal -ifon
ption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby alum that there Is a construction lending agency for the performance of
the work for which this permit Is issued (Sec. 3097, Civ. C)
Lcndees Name
Lenders Address
I certify that I have read Lids application and state 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 this city to enter upon the
above-mcntioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilides,judgmonts, costs and expense which may in any way scenic against said City
in consequence ofahe granting of this permit.
APPLICA NDER NDS AND WILL CO LY WITH ALL NON -POINT
Issued by: Date
SOUECU
°R(oofs
Type of Roof
U
a,uu%$
the applicant or future building occupant store or handle hrardous material
as defined by the Cupertino Municipal Code, Chapter 9,12. and the Health and Safety
Code, Section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes �;Ro
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 harsrdous air contaminants as defined by the Bay Arta Air Quality Management
all new materials for inspection.
Disuiet7
❑ Yes (No
'}
I have read the harardous materials requirements under Ctmptcr6.95 of the Califor-
nia Health & Safety Code. Sections 25505.25533 no 25534.1 understand that if the building
does not currently have a . ant. that it is my responsibility to notify the occupant of the
rtyaircm