06110117 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � ' �Q '
BUILD N Q.p ESS' PERMIT NO.
iS4 6 SANTA CLARA AV TBD - 'IO BE DETERMINED 06110117
OWNER'S NAME: PERMIT ISSUE DATE
EMILIO FRANCISCO 05/09/2007
NE: SANITARY NO. CONTROL NO.
ABUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
2 U 5 with Section 7000)of Division 3 of the Business and Professions Code.and my license is NEW 2 ETORY S FDWL. IST STORY 1167 . 18 ' ,
Q- in full force and effect
License Class Lic.S 2ND STC'RY: 529 .39 ' , BASEMENT (LIVING) 1077 .24 ' ,
E
in
Date Contractor
ARCHITECTS DECLARATION GARAGE: 429 ' , PORCH (C) 17 '
j a< 1 understand my plans shall be used as public records
)yU
U.y Licensed Professional
y.tea OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p Oy following mason.(Section 7031.5,Business and Professions Code:Any city or county
64 which requires a permit to construct,alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requites the applicant for such permit to file a signed statement
=G that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 Sq.Ft.Floor Area Valuation
R
t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $619504
u 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 ofj�j�Number Occupancy Type
not more than five hundred dollars($500). 3 2 6 2 4 014`.�C)V
❑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 Contractors 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 employers,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.).
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li.
cerise Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License law.
❑I am exempt under Sea B&P C for this reason
Ow :� 4L--t 0&&W trite '-P
WORKE CONIPENSA71ONDECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 have and will maintain a Certificate of Consent to self-insure for 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 Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 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 orris.LbtM
ApplfcandA T �b
NOTICE APPLI A .I Iter n ing this Ccrtificatc�Excmption,you should
become subject to the Workcr s Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z"' CONSTRUCTION LENDING AGENCY
��+►�-� I hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
az Lenders Address
U 0 1 certify that I have read this application and state that the above information is
w► correct.l agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
i3 (We)agree to save,indemnify and keep harmless the City of Cupertino against
fA liabilities,judgments,costs and expenses which may in any way accrue against said City
J Z in consequence of the granting of this permit.
►'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
URCE tit ULATIONS.
ID Ci "'�7Z Re-roofs
-Signature of pplicanU ntrac r Date
HAZARDOUS MATERIALS DISCLOSURE Type of F.00f
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 be inspected prior to any roofing material being installed.
Cl Yes �No
If a roof is installed 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?
C]Yes �No
I 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
docs not currently have a tenant,that it is my responsibility to notify the occupant of tihe
requirements which must bemel ' r to issuance of a Certificate of Occupancy. Signature of Applicant Date
- All roof coverings to be Class"B"or better
wncr or authorized cnt v Date'