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07030049 77777 CITY OF CUPERTINO BUILDING DIVISION PERMIT CST G7t� I1 `C?RM1�t ' E�N ;s " PERMIT NO. BUILDING ADDRESS: HILLCREST RD TBD - TO BE DETERMINED 07030049 PERMrr ISSUE DATE OWNER'S NAME: 03/08/2007 PETER KO SANITARY NO. CONTROL NO. AE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG EO PLUMB MECH TEMPORf�RY POWER C #2bb4l i 0 a LICENSED CONTRACTOR'S DECLARATION Job Description i Vp I hereby affirm that I am licensed under provisions of Chapter 9(commencing z iv with Section 7000)of Division 3 of the Business and Professions Code and my license is y in full force and effect v�z License CIw --Lic.# 77 a E p Date Contracwr a ARCHITECTS DEC ATIO a< I understand my plans shall be used as public records >aU U.H Licensed Professional < OWNER-BUILDER DECLARATION } I hereby affirm that 1 am exempt from the Contractor's License Law for the Co following reason.(Section 7031.5,Business and Professions Code:Any city or county <_ff which requires a permit to construct,alter,improve,demolish,or repair any structure u'm prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation "?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q i H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i r3 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(3500). 0 1,as owner of the property,or my employees with wages as their sale 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 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 1,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 projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sea — a&f C for this reason - --ner Date —� WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of thedollowing-declarations> 0 I 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 r,lam-r nu mbeyarg Carrie � Policy No.: b666 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,1 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z. 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 jz Lender's Address U C) 1 certify that I have read this application and state that the above information is LL. " tercet.I agree to comply with all city and county ordinances and state laws relating to (D 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 L4,) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. A0hjtL_Dat�e _.5' 1s- UAPPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NON-POINT Issued b):SOURC REGULATIONS. 3 k 0 Re-roofs Si of A Dam T e of hoof HAZARDOUS MATERIALS DISCLOSURE yP 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 Safety Inde,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Yes [�No .l 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 r laterials for inspection. District? 0 Yes fiNo 1 have read due hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cotte,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 due requirements ich must be m t pri to issuance of a Certificate of upas . Signatur.of Applicant Date All roof coverings to be Class"B"or better Own thorizedagent Datc CITY OF CrUPERTINO EMP POWER UPERTiNO PERMIT APPL[CATION FORM ©70300A APN# 3;,6 ` G o 5z, L Date: Building Address: Owner's Name: ! [ Phone#- ��f (61SV)�F5 3 Contractor: err Phone: 5 l 36 / j� License #: �71 cP - Contact: Phone: Cupertino Business License#: Building Permit Info: Elect Job Description: ' Residential Commercial ❑ l Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP ,,m orary Power - ELECTRICAL EPERMITFEE E ect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING