07030255 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
11085 CATALANO CT LOT 2 GREATER BAY CONSTRUCTION 07030255 DA
PERMIT ISSUE DATE
OWNER'S NAME:
PANCAL CATALANO 4125 BLPCKFORD A
SANITARY NO. CONTROL NO.
NE: (408) 24E-6600
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MM
p Z LICENSED CONTRACTOR'S DECLARATION Job Description
W
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ,
Z W with Section 70()01 of Division 3 of the Business and Professions Code,and my license is S FDWL-2 STORY 3 3 7 5 ' NEW GARAGE 434
t H in full force and effee tjP
Z License Clan Lie.#
Lic.Con# tar
W
Date AR H1TECl'S DECLARATION
J a a 1 understand my plans shall be used as public records
>yU
n.y Licensed Professional
5 a OWNER-BUILDER DECLARATION
3<7 I hereby affirm that 1 am exempt from the Contractor's License Law for the
,no following reason.(Section 7031.5,Business and Professions Cale:Any city or county
< ti which requires a permit to construct,alter,improve,demolish,or repair any structure
w prior tri its issuance,also requires the applicant for such permit to file a signed statement t' .Ft.Floor Area Valuation
?a that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 `'fl $747324
t= (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or
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 ofq64 Number
not more than five hundred dollars($500). 362180
6 I) V V
0 1,as owner of the property,or my employees with wages as their sole compensation, Required IRSpectlOIIS
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 sate.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 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors U-
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractors
License Law. B&P C for this reason
0 I am exempt under Sea
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]I ha and will maintain a Certificate of Consent to self-insure for Workers Compen-
satio as provided for by Section 3700 of the Labor Code,for the performance of the
wo 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 W° es Compensation Insurance carrier sand Policy number are:
CarierJLS�—"7�- 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 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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z 0 CONSTRUCTION LENDING AGENCY
(�Cn I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
0 z Lender's Address
U C) 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 ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
✓" a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of�DER77AND�WILL
e gting Date
►- APPLICA COMPLY WITH ALL NON-POINT Issued b'r:
SOURCE TE & - Re-roofs
Signature of Applicant/Co for T of:Zoof
RDOUS MATERIALS DISCLOSURE Type
Will the applicant or future ti"ding occupant store or handle hazardous material
as defined by the Cupertino Muni al Code.Chapter 9.12,and the Health and Safety
Cale,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
C3 yes N° If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future )ding occupant use equipment or devices which
emit hazardous air contaminants defined by the Bay Area Air Quality Management all new 1 naterials for inspection.
District?
0 Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code Sections 25505,25533 and 25534.I understand that if the building
does not currently h tenant,that it is possibility to notify the occupant of the Date
require stlxmetpriorto" u ceotacertificateofOccupancy. SignatureofApplicant
2-1 All roof coverings to be Class"B" or better
Owner or aut rued agent Da