07060071 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDZ 1` "hILLCREST RD CRW INDUSTRIES PER07060071
OWNER'S NAME: PERMIT ISSUE DATE
MORRISON SUSAN M TRUSTEE 1157 DE:.jL AVE 06/11/2007
INE: SANITARY NO. CONTROL NO.
ARCHITEcriENGINEER: BUILDING
REPLACEMENT DOOR/WINDOWS BLDG ELTPERMIT PLUMB MECH
G7 O D D
0 Q LICENSED CONTRACTOR'S DECLARATION
V I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
H in full force and effect.
t'�? License Class Lic.8
F Date Contractor
ARCHITECTS DECLARATION
a< I understand my plans shall be used as public records
�yV
O y Licensed Professional
< OWNER-BUILDER DECLARATION
j< 1 hereby affirm that I am exempt from the Contractors License Law for the
:p O 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
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sc.Ft.Floor Area Valuation
t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
r that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered forsalc(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of 9 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.).
CKL as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am ex t under Sec B&P C for this reason
Owner Date •b
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insum for Worker's 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 will maintain Worker's 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 Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any manner sp tofubject to the Workers'Compensation
Laws of California.Date (» 1
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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z. CONSTRUCTION LENDING AGENCY
[.�►�-� I hereby affirm that there is a constructimn lending agency for the performance of
(Y. the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
Z Lenders Address
U C) I certify that 1 have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
a above-menrioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
r�r to liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
0,— _ _ 6111 10� Re-roofs
Signature of Applican ontractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
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 ja'IQo
If a roof is i
Will the applicant or future building occupant use equipment or devices which installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mate rials for inspection.
District?
❑Yes RM
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met p'or to issuance of a Ccnificate of Occo ancy Signature of Applicant Date
1 G�112Lot� All roof coverings to be Class"B"or better
Owner or authdrizcd agent 152tc