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06090257Z LICENSED CONTRACTOR'S DECLARATION [ hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ? License Class Lie. A m Date Contractor J ARCHITECTS DECLARATION I understand my plans shall be used as public records U �- Licensed Professional ;n OWNER -BUILDER DECLARATION g 1 hereby affirm that I am exempt from the Contractor's License Law for the O following mason. (Section 7031.5. Business and Pmfcssions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure r priori its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 c(commencing with Section 7000) of Division 3 of the Business and Professions Cnde) or °2 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 not more than five hundred dollars ($500). L as owner of the property, or my employees with wages as their sole compensation, willdo the work, and the structure is not intended or offered forsale (Sec. 7044. Business 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 EnelecLs with a contractors) licensed pursuant to the Contractor's License Law. I am � _ _ , B & P C for this reason PERMIT NO. 06090257 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REPAVING ALLEYWAY AT APARTMENT LOCATION DOES NOT INCLUDE TRASH ENCLOSURE. HAS BEEN REMOVED FROM PLANS. Sq. Ft. Floor Area 36901029 Apwj Number Date; ©' emby Ir penalty of perjury one of the following declarations: ❑ I have and willmaintaina 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 [his permit is issued. ❑ f 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 arc: Carrier: Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars (b100) 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 bcco p the Workers' Compensation m -- NOTICE f after making this Certificate of Exemption, you should become ect to orker's Compensation provisions of the labor Code, you must O forthwith compl with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm [hat there is a construction lending agency for the performance of > the work for which this permit is issued (Sec. 3097, Civ. C.) c� Lender's Name Lender's Address Q 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 Jbuilding construction, and hereby authorize representatives of this city to enter upon the ahovc-mentioned property for inspection purposes. I>r (We) agree to save, indemnify and keep harmless the City of Cupertino against f) liabilities,judgments,costsand expenses which may in any way accrue against said City ',Z in consequence of the granting of this permiL _ 3RI " WITH ALL NON -POINT Issued by: Wure�licant/Contractor IDow HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Cade. Chapter9.12, and the Health and Safety Cade, Section 25532(a)? pees o Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as dcf cd by the Bay Area Air Quality Managcmcnt District? ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safely Code, Sections 25505, 25533 and 25534.1 understand thatif the building does not or authorized agent Date Re -roofs Type of Roof $100000 %'Required Inspections Valuation kiccupancy Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. of Applicant Date All roof coverings to be Class "B" or better