07040090 CITE'OF CUIPERTINO
BUILDING DIVISION PERMIT �_ ` `llT+} � T •
BUIL TNG DRESS: PERMIT NO.
�Z1��35 CORTE MADERA LA TBD TO BE; DETERMINED 07040090
PERMIT ISSUE DATE
OWNER'S NAME:
4. ALAMDAR 05/16/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHrrECTIENGINEER:
BLDG ELECT PLUMB MECH
10 p LICENSED CONTRACTOR'S DECLARATION Job Description
:V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
t Z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADDITION• BEDROOMS 960
'
a in full force and effect.
z License Class Lic.n REMODEL: KITCHEN & LIVING ROOM 100 '
3 r a Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
)W U
10.
n.l'- Licensed Professional
y.< 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
.4,� ,fi which requires a permit to construct,alter,improve,demolish,or repair any structure
a Z y prior to its issuance,also requires the applicant for such permit to fife a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
rF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $215870
y 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 ]]1 Number Occupancy Type
not more than five hundred dollars($500). 32645030
�C
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 q P
property who builds or improves thereon,and who does such work himself or through his
are own employees,provided that such improvements anot 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.).
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 con o s 'etue ursuant to the Contractor's
License Law.
0 1 am exem t under Sec B&P C for this reason
r+.,,W a Dale •
qsMRM COMPENSA ON DECLARATION
I hereby affirm under penalty of pequry one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Workefs 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 1 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 for one hundred dollars($100)
or less.)
I certify that in the performance of the ork 7f. which this permit is issued.I shall not
employ any person in any m r so as tdc subject to the Workeri Compensation
Laws of California
Applicant
NOTICE TO ,after m rng this Certificate of Exemption,you should
become subject to the Worker's Compefisation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z ' CONSTRUCTION LENDING AGENCY
"N- 1 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.)
aQ Lender's Name
z
Lender's Address
V Q I certify that I have read this application and state that the above information is
LI., " correct.1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction.and hereby authorise representatives or 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 \\`
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this rmr. Date
APPLICANT4UNDERSTA AN WI OMPLY WITH ALL NON- INT Issued by:SOURCEREON r� `t��-7
T r Re-roofs
Signature of pp rcant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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
^dc,Section 25532(a)? All roofs shall 1)e inspected prior to any roofing material being installed.
❑Yes ANO
If a roof is inst<Llled without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 33 and 25534.1 understand that if the building
does not currently a tenant.Lha it is responsibility to notify the occupant or die
requi is w oust be met pri faiftt ate of Occu1 Signature of AE plicant Date
° All roof coverings to be Class"B"or better
Owner or authorized agent Datc