07060230 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILTIiJ,G�l�TIM'ILLER AVE #1 ABLE EX"ERMINTATORS INC 07060230
BUJ j ji PERMrr ISSUE DATE
OWNER'S NAME:
CORY FUGEMAN 68 SUNSET AVE 06/26/2007
SANITARY NO. CONTROL NO.
SNE:
(408) 25:_-6500
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
i p Q LICENSED CONTRACTOR'S DECLARATION Job Description
r- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
i v Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is ATHROOM REMODEL, NONSTRUCTURAL. NO LIGHTING & NO
yin full force and effect.
Z License Class Lic.# ELECTRICAL.
c Dam Contractor
.�
ARCHITECTS DECLARATION
< 1 understand my plans shall be used as public records
)WU
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
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
`< which requires a permit to construct,alter,improve,demolish,or repair any structure
u—N prior to its issuance,also requires the applicant for such permit to rile a signed statementy,Ft.Floor Area Valuation
-?< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 S $1500
rN (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Q 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 369140 3 5 . Number
not more than five hundred dollars(S500).
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended oroffered 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 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
sok.).
I,as owner of the property,am exclusively contracting with licensed contractors to
construct th Sec.7044.Business and Professions Code:)The Contractor's Li-
cense does not cep an owner or peny who builds or improves Iherean,and.
wh ontracts for such with a con �or(s)licensed pursuant to the Contractor's
0 Law. B& aq f r
(]1 exempt under yup
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
cation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
0 1 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 am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION 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 wthis permit is issued,1 shall not
employ any=, �Tm nner b omc s b ct ta4he Workcrs'Compensation
Laws of Cit Date
Applicant
NOTICE TO APP after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code.you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
['".�• 1 hereby affirm that there is a construction(ending agency for the performance of
Q! the work for which this permit is issued(Sec.3097,Civ.C.)
w A Lender's Name
a• Lender's Address
U 0 1 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 stale laws relating to
U building construction,and hereby authoriim representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
Q. (We ve,indemnify and keep harmless the City of Cupertino against
Uj liabil'' ,judgments,cos d expenses It ch may in any wa cmc against said City J ��-
U Z in c nsequcnce of the grantin of this pe iL Date (,/---L (�
AP LICANT UNDERS S ND ILL QbMPLY H�L - I Issued b
SO CE REGULATTO
Re-roof:
Signature of Applicant/Contractor Date T of Roof
MATERIALS DISCLOSURE Type
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 Safely
Code,Section 25532(a)? / All roof.;shall be inspected prior to any roofing material being installed.
El Yes 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection.
District?
Yes
1 ardous materials m 'rcments under Chapter 6.95 of the Califor-
niaHe &Safety Code, ons 25505,25 and 25534.1 understand that i he
re
does t curntly have am an a it is y j:ibility to notify oc to Date
require nLc which most et t i a Certificate of pan
Signatul e of Applicant
All roof coverings to be Class"B"or better
Owner or authorized agent Dam