07030141 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 0�ZAT��
PERMIT NO.
BUILTJ]6QDRESS: WY TBD - I'0 BE DETERMINED 07030141
l l y - PERMIT ISSUE DATE
R'S NAME:
JARUJAN NAJARYAN — 03/27/2007
SANITARY NO. CONTROL NO.
—!ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: REVISION-ROOF TRUSS, BLDG ELECT PLUMB MECH
(I
LICENSED CONTRACTOR'S DECLARATION Ob escnption
Vp I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z' with Section 7000)of Division 3 of dtc Business and Professions Codc,and my license is
y in full force and effect.
License Class Lc-
Date
Contractor
� ARCHITECTS DECLARATION
j a a 1 understand my plans shall he used as public records
?aV
u.y Licensed Pmfcssional
Oy
OWNER-BUILDER DECLARATION
r I hereby affirm that 1 am exempt from the Contractor's License Law for the
.00 following reason.(Section 7031.5.Business and Professions Code:Any city or county
10 which requires a permit w construct alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant Cor such permit to file a signed statement .Ft.Floor Area Valuation
Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
2 t-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and die basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number P Y YP
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 "'Required Inspections
and Professions Code:The Contractor's License Law docs 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 Wild or improve for purpose of
sale.).
0 I,as owner of the property,am exclusively conuacting 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 Wilds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
I am exem tt�perSSec. B&P C for this mason
r IW1WO a
+ Date
RKER'S C ENS DECLARATION /
I hereby affirm under penalty of perjury one of the following declarations:
EI hsve and will maintain a Certificate of Consent to self-insure far Workers Compcn-
ion,as provided for by Section 3700 of the Labor Code,far 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 number am:
Cartier. CEPolicy No.:
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc 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 r ttcom bject to the Workers'Com on
Laws of Cal-form.Doc /
Applicant
NOTICE TO APPLICANT:If,after making this Ceni cats of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(..r 1 hereby affirm that there is a construction lending agency for the performance of
(Y..7 the work for which this permit is issued(Sec.3097,Civ.C.)
W Q
Lender's Name
Lender's Address
U O 1 certify that 1 have read this application and state that the above information is
LL, ►- correct.I agree to comply with all city and county ordinances and state laws relating to
Jbuilding 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
`E'y liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date 1 /�
Z L
►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b-/:
SO C R ULATIONS. ,
r e9 Z D Re-roofs ��---�
i n u plicandC Date T of Zoof
HAZARDOUS
MA ALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
le,Section 25532(a)? All roof,;shall be inspected prior to any roofing material being installed.
❑Yes �° If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new i naterials for inspection.
Dis,r -__/
❑Yes o
1 have read the hazardous materials requirements underChapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the Wilding
docs not currently have a tenant.that it is my responsibility to notify the occupant of the Date
requiremc w'ch must be mel ' r to issuance of a Certificate of Occupancy. Signatui a of Applicant
201'00v, a:?AzzAll roof coverings to be Class"B" or better
Date
3wn-e r h razed agent