07060070CITY OF CUPEKI'11NO
BUILDING DIVISION PERMIT CTktA
CREEK BLVD
OWNER'S NAME:
KCR DEVELOPMENT
INE:
ARCHITECTIENGiNEER:
i p ZZ LICENSED CONTRACTOR'S DECLARATION
ulP I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z w with Secdon 70(0) of Division 3 of the Business and Professions Code, and my license is
> > m in full force and effect.
v� z License Class Lic. #
o Date Contractor
E W ARCHITECrS DECLARATION
j a < 1 understand my plans shall be used as public records
)dU
U. Licensed Professional
a OWNER -BUILDER DECLARATION
aI hereby affirm that I am exempt from the Contractor's License Law for the
Coo following reason. (Section 7031.5, Business and Professions Code: Any city or county
�i which requires a permit to construct, alter, improve, demolish, or repair any structure
u ' prior to its issuance, also requires the applicant for such permit to file a signed statement
Z a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
x tx- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
i 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
not more than five hundred dollars ($500).
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
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
sale.).
0 I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and ProfessiodeJ The Contractor's Li-
cense Law does not apply to an owner of property ilds or improves thereon, and
who contracts for such projects with a contracto licensed pursuant to the Contractor's
License law. B & P C for this reason
❑ 1 am ex
Date
I hereby affirm under qury one of the following declarations:
] I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
ration, 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 Workees Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXE/pertm'
W RKERS.
COMPENSA
(This section creed not be complets r one hundred dollars (S100)
or less.)
I certify that in the performance of the his permit is issued, 1 shall not
employ an�� t to the Workers' Compensation
comply
qcatc of Exemption, you should
id'ns of the Labor Code, you must
shall be deemed revoked.
PERMIT NO.
TBD TC BE DETERMINED 07060070
PERMIT ISSUE DATE
06/19/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ELECT PLUMB
Job Description
REVISION—INSTALLATION OF METAL/GLASS CANOPY.
ORIG
PERMIT 406120168 NO NEW PERMIT
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there 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 Address
I certify that I have read this application and state that the above information is
correct, l agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and kap harmless c City of Cupertino against
liabilities, judgments, costs and expenses which may i y way accrue against said City
in consequence of the granting of this permit.
�SO�URCE
PLICANT UNDERSTANDS AND W Z.—PLY WITH ALL NON -POINT
REGULATI 4 Q�
lAte
nalure of Applicant/Con
H ATERIALS DISCLOSURE
Will the applicant or uture 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)?
0Yes ONo
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
District?
C] Yes ONu
1 have read the hazardous materir
nia Health & Safety Code, Sections 2550'
docs not currently have a tenant, that it
requirements which must be met prig
Owner or
7hapter 6.95 of the Califor-
erstand that if Ute building
to notify the occupant of the
irate of Occupancyy J.
Sq. Ft. Floor Area
3 6 9 0 6 0 0,) APN Number
Issued by
Re -roofs
Type of Roof
uation
$0
Type
Required Inspections
All roofs shall be inspected prior to any roofing
If a roof is installed without first obtaini77,
all new riaterials for inspection.
Signaturt,
being installed.
I agree to remove
ate
to be Class '4%a
' or better