07010029 CITY OF CUPERTINO
BUILDING DIVISION PERMITmIO '
PERMIT NO.
,41�.(
BUILOJNG "aOHNSON AVE 2001 CON;3TRUCTION GROUP 07010029
l�J /y PERMIT ISSUE DATE
OWNER'S NAME:
JOHN PAEK 1405 CA DEN AVE 06/11/2007
SANITARY NO. CONTROL NO.
'NE: (408) 371-2006
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p C LICENSED CONTRACTOR'S DECLARATION Job Description
' t= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REVISION TRUSS CALC S
y with Section 7000)of Division 3 of the Business and Professions Code,and my license is
"Iy in full force and effect.
t 12_Z License Class Lic•
t, Date contractor
ARCHITECTS DECLARATION
i a< 1 understand my plans shall be used as public records
tyU
U.y Licensed Professional
'O r OWNER-BUILDER DECLARATION
3< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m which requires a permit to construct,alter,improve,demolish,or repair any structure
t prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
S Ft.Floor Area $431151
?'< that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 �•
tT G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 37531061 ti�: Number
not more than five hundred dollars(5500).
0 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 for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc 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 Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such L
contiERA110N
' ursuant to the Contractor's
License Law.
1 am exemp oder ,B&P C for 1
Owner Dale
VWO
If
1 hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure 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.
0 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 Worker's Compensation Insurance carrier and Policy number are:
Pal' No.:
Carrier CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
1 certifv 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 core subject the Workcrs' mpcnsadon
Laws of Calif ia.Da
Applicant
NOTICE TO
A A :If, r ak g is Certificate of Exemption,you should
become subjc to the Worker's ompensadon provisions of the Labor Code,you must
,J 2 forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
p;> the work for which this permit is issued(See.3097,Civ.C.)
W Q
Lender's Name
z Lender's Address
U 1 certify that 1 have read this application and state that the above information is
LL— correct.I agree to comply with all city and county ordinances and state laws rclating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
Wabove-mentioned property for inspection purposes.
R. (We)agree to save,indemnify and keep harmless the City of Cupertino against
�Fy liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
�+ APPLICANT UNDERST DS AND WILL CO PLY WITH ALL NON-POINT Issued by:
SOURCE REG ATI C /` (�,
�J(� fl e-too s
Signature of ontractorDate T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Mu 'tpal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs:hall be inspected prior to any roofing material being installed.
0 Yes 0 No
Will the applicant or future building occupant use equipment or devices which
If a roof iE 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 materials for inspection.
District?
0 Yes '6No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 an 25534.1 understand that if the building
does not currently h a tenant.th ' is my res ibility to notify the occupant of the
require hich be met or ssuan crtificatc of Occupancy C Si n u e AA pplicant Date
fi/s All roof coverings to be Class"B"or better
Owner thorired agent Date