07030297 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ..T�� `
PERMIT NO.
BUILDING ADDRESS: TBD _ TO BE DETERMINED 07030297
10128 MELLO PL '
PERMIT ISSUE DATE
'.R'S NAME:
�ICHON ULYSSES A AND RISE J 03/27/2007
_ SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p p 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 7000)of Division 3 of thc Business and Professions Code,and my license is BATHROOM REMODEL, NON STRUCTURAL
>>y in full force and effect.
h n? License Class Lic.S
p Date Contractor
?E ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)yU
LL l- Licensed Professional
a OWNER-BUILDER DECLARATION
aI hereby affirm that 1 am exempt from the Contractors Liccnsc 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
- - prior w its issuance,also requires the applicant for such permit m rile a signed statement Valuation
S Ft.Floor Area $24000
-?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
e (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 Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �,�1 Number
not more than eve hundred dollars($500). 36905042 .
U V
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 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.).
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 Contractors
LicenseLaw. /
0 lam exem u Ae ea B&P C far this reason
-d ,c
r WO KER'S CO PENSA ION DECLARATION
I hereby affil unde"ty of perjury one of the following declarations:
0 1 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 Workces 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 are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars 1$100)
or less.)
I certify that in the pZ.,
race of the work far which this permit is issued,1 shall not
employ any person i ncr so as to bjec4 the Workers'Compensation
Laws of Califo
Applicant -
7-1
NOTICE TO I� A :If.,after hi this Certificate of Exemption,you should
become subject to the orkcr Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z 04 CONSTRUCTION LENDING AGENCY
(.�to) 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 A Lendcis Name
0Z
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
(3,Hcorrect.I agree to comply with all city and county ordinances and state laws relating to
C, 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
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
U rZ in consequence oC c granting of this permit. Date L� U
►� APPLIC ERSTANDS A W L COMPLY WITH ALL NON-POINT Issued b is
SOU C LATIONS.
7W� Re-roof:
si aturc of plicaryUC ntractor Dare T e of hoof
H/tZARDOUS MATERIALS DISCLOSURE yP
Will the a cant or future building occupant store or handle hazardous material
1crined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Section 25532(a)? All roof:;shall be inspected prior to any roofing material being installed.
0Yes P140 If a roof is installed without first obtaining an inspection,I agree to remove
Wi11 the applicant or future building occupant use equipment or devices which
emit hazardous air contaminams as defined by the Bay Area Air Quality Management all new i naterials for inspection.
District?
0Yes ON.
I have read the hazardous materials requirements under Chapter 6.95 of thc Califor-
nia Health&S c ode,Sections 25505,25533 and 25534.1 understand that if tbe building
does not cu ave a tenan5��ity to notify the occupant of the
rcqui c hch m�be mrttfici Octagon . Signatute ofApplicant Date
.% All roof coverings to be Class"B"or better
Owner or auth rite nt
Date