07040157adZ
00
U
z
<a
7 rn
FC
m
�a
4 V
0 U
oa
C
pC
�—m
za
FG
i��
CITY OF CUPERTINO
� :r
BUILDING DIVISION pERNUr
...
^,
BUILDING ADDRESS:
PERMIT NO.
10712 FARALLONE DR
2001 CONSTRUCTION GROUP
07040157
OWNER'S NAME:
PERMIT 155SUE DATE
1405 CAMDEN AVE
06/21/2007
PHONE:
SANITARY NO. CONTROL NO.
(408)371-2006
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70DO)��j'vismon3ofthcBusinrssan Po Codc hs
in full force and e'R,
REMODEL—KITCHEN, BATHS,WINDOWS, SKYLITE ROOF
Lice I l �� Lie•»
WINDOWS, HOT WATER HEATER, ROOF, PANEL
Date Contractor
A HITECTSDECLA A oN
Lerstand
UPGRADE, EXTERIOR DOOR, FURNACE, DUCTS .
1 Iny plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to iLs issuance, also requires the applicant for such permit to file a signed statement
he is l'rccnsed to the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant the provisions of
(commencing Section 70DD) of Division 3 of the Business and Professions Code) or
$175000
with
that be is exempt therefrom and the basis for the alleged exemption Any violation of
34 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 (5500).
36934012 (
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
(1
will do the work and the structure isnot intended oroffered forsale(Sec.7044,Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
p
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 will have the burden of proving that he did not build or improve for purpose of
sale.),
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec , B & P C for tris reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Ccrili atc of Consent to self -insure for Workers Compen-
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 w' maintain Workers Compensation Insurance, as required by Section
3700 of the
perlormacc ofthe work for which this permit is issued.My
NorICmWo,,n
* re`, 3
Workerc amen and Policy "*27,003
Carrier. licy N..:2—G
CERTIFICATE OF EXEM ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this Permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after 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.
j CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a consYmctinn lending agency for the performance of
"
the work for which this permit is issued (Sec. 3097, Civ. C.)
-
LcndcrsName
Lenders Address
1 I certify that I have read this application and state that the above information is
' correct I agree to comply with all city and county ordinance and state laws relating to
building construction, and hereby authodre representatives of this city to cntcrupon the
above-mentioned property for inspccuon purposes.
( gree 10 save, indemnify and keep harmless the City of Cupertino against
'
j liabili , ju mcnts, costs and expenses which may in anyway accrue against said City
' in
Date
HAZARDOUS MATERI ISCLOSURE
Type of Roof
Will the applicant or futwo building pantstorc or handle hazardous material
as claimed by the Cupertino Municipal c, Chapter 9.12, and the Health and Safety
Code. Section 25532(a)?
All ro s sh 11 be inspected to any roofing material being installed.
❑Yes
prior
If a oof is i stalledit wut first obtaining an inspection, I agree to remove
Will the applicant or future buildin pant use equipment or devices which
emit hat s it contaminants as def d by the Bay Area Air Quality Management
all
Date
A11 roof c verings to be Class "B" or better
0 &omcd
cr or agcm Da