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07030105 CITY OF CUPERTINO ILD.;�cDIVIS1oV PERMIT ORM' 3tNF �t BUILDING ADDRESS: PERMIT NO.' 8025 RAINBOW DR TBD - r10 BE DETERMINED 07030105 OWNER'S NAME: PERMIT ISSUE DATE LARRY HARA 7 SNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO MODIFY EXISTING PATIO DOOR, BLDG ELECT PLUMB MECH G7 D O D AN p C LICENSED CONTRACTOR'S DECLARATION REPtACJ Q Description v F thereby 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 ? N in full force and effect. License Class Ltc.fi F p Date Contractor ARCHITECTS DECLARATION i C< 1 understand my plans shall be used as public records )yU LL y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county COO which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to file a signed statement S< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Xl.Ft. Floor Area Valuation - (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars($500). [11.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 fired Ins ectlOns and Professions Code:The Contractor's License Law does not apply to an owner of 9 P 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 riot 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:)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 contractors)licensed pursuant to the Contractor's License W. - ❑1 am exempt u ar Seo. B&P C r thisreason L . L Owner Date -WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure far Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Polity 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,1 shall not employ any person i,any manner so as W to the Workers'Compensation Laws of COM."'i Applicant NOTICE TO A PLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY Er rte. I 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.) WCI.Q Lender's Name a Z Lender's Address U 0 1 certify that I 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 a above-mentioned property for inspection purposes- (We)agree to save,indemnify and keep harmless the City of Cupertino against F" liabilities,judgments, ests and expenses which may in any way accrue against said City (�'� in consequence of a granting at this permit. Date t"^ APPLICANT PERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURC NS. I 7 Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of R)of 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 Code,Section 25532(a)? All roofs:ihall be inspected prior to any roofing material being installed. ❑Yes 0lu Will the applicant or future building occupant use equipment or devices which If a roof i:.installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as dcrined by the Bay Area Air Quality Management all new m iterials for inspection. District? ❑Yes 2�140 have= e-hazardous materials requirements under Chapter 6.95 of thc Califor- nia With&S ty CPode,Sections 25505,25533 and 25534.1 understand that if the building does kt cu y'have a tenant t itis my responsibility to notify the occupant of the rcquircwhi h must be me 'or to issuance of a Certificate of Oc4pangy. Signature ofApplicant Date ` 3 All roof coverings to be Class"B"or better Owner or authorized agent Datc- U -C, c o ro c1,3 .�. O tC co to C) £: Ca v n� - ii q O m Q 101-1 n a et 3 � o F c mJ `3 O O CL �\ � O Xi m O , Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Cf(Y OF Fax(408)777-3333 ')PEkTINO Building Department JOB ADDRESS: �u assn�� PERMIT# cam- sz 0,-? OWNER'S NAME: a rence Y, �� PHONE # qoS - s3 �(�� , GENERAL CONTRACTOR: !� �,s� Cvry c FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile; 14 Owner/Contractor Signature Date