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07050023 CITE'OF CUPERTINO h T T Bhh BUILDING DIVISION PERMIT ESS:DD BUILD J RPERMIT NO. ��3fi5 S DE ANZA BLVD BARRY SWENSON BUILDER 07050023 r 7R'S NAME: PERMIT ISSUE DATE 3UNKER GREGG C 777 N FIRST ST 05/25/2007 PHONE: SANITARY NO. CONTROL NO. (408) 287-0246 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CON'TRACTOR'S DECLARATION v— I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description :z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REVISION—FIRE RATING OF MULTI FAMILY DWELLING, =*4)y in full force and effect. t ' z License Class_ Lk.ft ,�?•,,+�-- 1 HR F o Dale Contractor ARCHn EC I'S DECLARATION SHAFT REVISION ORIG #05030230—NO 1 undcrsta m tans shall sed ubli cords td� tL� NEW PERIIT y Licensed Profess al w OWNER-BUILDER DECLARATION j a 1 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 <$E,4 which requires a permit to construct,alter,improve,demolish,or repair any structure z r prior to its issuance,also requires the applicant for such permit to file a signed statement =e` that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 .>q.Ft. Floor Area Valuation u F $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $0 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 Number O riot more than five hundred dollars(s500). 3 6 619 07 1 q64CCu Occupancy Y Type ❑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 and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections 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.). ❑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 Contractors License Law. ❑I am exempt under Sec. B tit P C for this reason x Date 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 Worker's 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 Workers 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 ca cr and Policy number are: Cartier. 1JX 19 14%9292121 Policy No.: CER I XEMPTION FRO S 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 manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT,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. CONSTRUCTION LENDING AGENCY E-+ I hereby affirm that there is a construction lending agency for the performance of CG the work for which this permit is issued(See.3097,Civ.C.) Wfs.A Lender's Name Z Lender's Address U 0 I certify that I have read this application and slate that the above information is [>n r correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the a above-mentioned property for inspection purposes. r (We)agree to save,indemnify and keep harmless the City of Cupertino against ` L4,) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DateL"7 SOURCE REGULATIONS � S �� Re-roofs Signature of Applr on tort ate HAZARDOUS MA ALS DISCLOSURE Type of Ro)f 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 e,Section 25532(a)? ❑Yes All roofs st all be inspected prior to any roofing material being installed. �No Will the applicant or future building occupant use equipment or devices which If a roof is nstalled without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of die rcquircments which must bet rior to issuance of a Cerificate of qccupan Signature o'Applicant Date Ate, *01 -5 VS 7 � Owner or authorized agent bateAll roof coverings to be Class "B"or better