08110073CITY OF CUPERTINO
PERNUT
BUILDING DIVISION
BUILDING ADDRESS:
PERMIT NO.
7554 WATERFORD DR
CAL CUSTOM CONSTRUCTION
OWNER'S NAME:
PERMI7 05UE DAIS
:
A 0. CONTROL NO.
(408)529-6110
ARCHn'ECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o a o 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I bemby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of tbo Business and Professions Code, my luenm is
in full fora and cL
EXPND KITCHN INTO EXT LAUNDRY IN
G _ t/1"/-
sass
Dato contractor
,
GARG (6X9 , 180SQ) &RMDL KTCHN, RLOCT LNDRY, NEW
DECLA
I understand my plans shall be used as publkArecord&
WTRHTR , PNL UPGRD 2 0 DAMP (13 0 SQ )
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
rollowing 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
.
prior to its issuance, also requires the applicant for such permit to rile a signed ststermem
that he is licensed pursuing to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
7 5 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. 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 more than five hundred dollars (SS00).
36616009.00
❑ L as owner of the property, or my employees with wages as their sole eompenudon,
Required Inspections
q
will do the wort, 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 an owner of
property who builds or improve thereon, and who does such wort 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 am year of completion, the owner.
builder win have the burden of proving that he did not build or Improve for purpose of
sake.)_
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec 7044, Business and professions Code:) The Coaoactar's Ll-
cense Law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a conlrstor(s) licensed pursuant to the Contrsaor's
License Law.
❑ I am exempt under Sec, , B 4 P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations
�I
alb ve and will maintain a Certificate of Consent to self -Insures for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
wort for which this permit is issued.
❑ I have and will maintain Worl efs Compensation Insurance, as required by Season
3700 of the Labor Code, for the performuree of the wort for which this permit Is Issued
.
My Worker's Compensation Laurance carrier and Policy number am:
Cimer. Ptdicy No.:
CERTIFICATE OF_DCEMFnON FROM WORKERS'
COMPENSATION INSURANCE
(This season need not he completed if the permit is fox one hundred dollars ($100)
or ICIL)
I certify that In the performance of the work for which this permit Is issued, I shall not
employ arty person in any manner �o bg9� sub' the Worley Compensation
[awe of Califo ate `
Applicant
NOTICE,;@'iXP_0LJCA1qTAPl1W making this Certificate of Exemption. you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lender's Name
Lender's Addtess
I certify that I have read this application and auto that the above information is
'
comet I agree to comply with all city and county orNnuxms and stale laws relating to
building construction, and hereby authorim representatives of this city to enter upon the
above -mentioned property for inspection purpows.
(We) agree to save, indemnify and keep barmless the City of Cupertino against
j liabiliUes, Judgments, case and expenses which may in arty way accrue against said City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued
of Applicant/C&Gcuor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle haardous malcrial
'
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.
❑Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Wfll Uto applicant or future building occupant use cgtdpmenl or devices which
emit hazardous air contaminants as do y the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes o
`�
I have read the haardous materials mqu mmenu undCh er apter 6,95 of time Califs -
ma Health & Safety Code, Sections 25505, 25533 and 25534.1 undmmnd that if the Gdkhng
don not currently have a tenant, Usl it is my mspomibilily to notify the occupant of the
rcqul n s which mist l>c t pri to issuance era Certificate: of Occupancy.
Signature of Applicant Date
All roof coverings to be Class '% or better
Date '
Owner or authorised agent