07030074 77-r77777-777777-
CITE'OF CUPERTINO
BUILDING DIVISION PERMIT e� Th � TaR I1r�IMATIE� `
PERMIT NO.
BUIL 1 G DD ESS:
�l1089 CATALANO CT LOT 3 GREATER BAY CONSTRUCTION 07030074
PERMIT ISSUE DATE
OWNER'S NAME:
PANCAL CATALANO 4125 BLACKFORD AVE 06/27/2007
SANITARY NO. CONTROL NO.
INE:
BUILDING PERMrr INFO
ARCHITECT/ENGINEER:
SFDWL-;? STORY 3 , 477/GARAGE BLDG EO PLS ME�cH
t
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
v I hereby affirm that I am licensed under provisions of Chapter 9(commencing
.Z, with Section 7000)of Division 3 of the Business and Professions Code,and my license is
t H in full force and effec
License CI Lic•#
p
Date Con D for
F Lu A CHITEC7'S DECLARATION
7 a< 1 understand my plans shall be used as public records
�aU
U.in Licensed Professional
a OWNER-BUILDER DECLARATION
} 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
Cp O following reason.(Section 7031.5,Business and Professions Code:Any city or county
`e 9 which requires a permit to construct,alter,improve,demolish,or repair any structure
u- prior m its issuance,also requires the applicant for such permit to file a signed statement Valuation
s that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 rea
Sq.Ft.Fioor A
t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Ll 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 for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs mot 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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code)7Lc Contractor's Li-
ccase 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 Contractoes
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation, provided for by Section 3700 of the Labor Code,for the performance of the
wo or 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 'atria and Policy number arc: dT
erE/T�1
Carri -0..�. S c Polity No.:\VL312 A-3 o D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis section need not he 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,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 O CONSTRUCTION LENDING AGENCY
(..t cn 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.)
(la Q Lender's Name
z Lender's Address
U 0 1 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
J U building construction,and hereby authorise representatives of this city to enter upon the
(rel above-mentioned property for inspection purposes.
r"" a (We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilides,judgmcnts,costs and expenses which may in any way accrue against said City
U'Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURC GULATIONS. - 6
6A7-1 o Re-roofs
Signal of ApplicanutontraZior I Dfe
HAzARDOUS MATERIALS DISCLOSURE Type of F:oof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici 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.
[I Yes No
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as recd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs No
I 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
does not currently have a tenant,that it is my responsibility to notify the occupant of the
rcquiremen ich must be met r to issuance of a Certificate of Occupancy. Signatur( of Applicant Date
--� b 2-::z 44-7- All roof coverings to be Class "B"or better
Owner or 6uthorized ag t Pte - -