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07050198 CITY OF CUPERTINO BUILDING DIVISION PERMIT ) � }R [�TIUN• PERMIT NO. BUILDING ADDRESS: 6743 CLIFFORD DR TBD - TO BE DETERMINED 07050198 PERMIT ISSUE DATE OWNER'S NAME: STEVE CHAO SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p o LICENSED CONTRACTOR'S DECLARATION Job Description U P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing y with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADDITION• LAUNDRY, BATH ROOM & STORAGE AREA y in full force and effect. ? License Class Lic•8 t ❑ Date Contractor ARCHITECTS DECLARATION i a< I understand my plans shall he used as public records t�U a m t- Licensed Professional i y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the no 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 Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area t= (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $32584 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 A P1 Number Occupancy Type not more than five hundred dollars($500). 36911045 .T( 0 1,as owner of the property.or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offend for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). V,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves themon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 I am exem u der Sec. ,B tit P C for this anon Owner Date 6 'r a WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the tabor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($I00) or less.) 1 certify that in the performance of thew rk for which this permit is issued,l shall not employ any person in any manner so as bcW1 6 ect to the Workers'Compensation Laws of Califomi D !V Applicant NOTICE TO AP LICANT: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 0- CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Y, the work for which this permit is issued(Sec.3097,Civ.C.) lra Q Lender's Name Z Lcndees Address U 0 1 certify that I have read this application and state that the above information is LT, — correct.I agree to comply with all city and county ordinances and state laws relating to Q U building construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. L>ti (We)agree to save,indemnify and keep harmless the City of Cupertino against t� liabilities,judgments,costs and expenses which may in any way accrue against said City V,Z inconsequence of the granting of this permit. r- APPLICA U ERSTANDS AN WILL COMPLY WITH ALL N N-POINT Issued by: Date SOURCE TIONS. S- Re-roofs Signa rc of pplicanU ontractor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE 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 shall he inspected prior to any roofing material being installed. C]Yes Will the applicant or future building occupant use equipment or devices which If a roof is inst,.11ed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes fl'Nu I have mad the hazardous materials requirements underChapter 6.95 of the Califor- Alh� ode,Sections25505,25533 and 25534.1 understand that if the buildingve a tenant. at it is my responsihility to notify Oreust a prior to issuance of a Certificate of Of / Signature of AF pl icant Date All roof coverings to be Class"B"or better Owner or authorized agent Date