07030025 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILPERMIT NO.
Tb%' T'A:TERLING BLVD RIDDLE ,ONTAIN 07030025
OWNER'S NAME: S PERMIT ISSUE DATE
10534 STERLING BLVD 05/15/2007
PNE: SANITARY NO. CONTROL NO.
ARCHITEC IENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
i o
p LICENSED CONTRACTOR'S DECLARATION
V
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
2 with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADDITION-495 ' r LIVING ROOM, NO PLUMBING OR
to in full force and effect.
�°�z License Class Lieu MECHANI'AL-SANITARY IS SUNNYVALE' S JURISDICTION.
3
Do Date Contractor
ARCH DECLARATION
a< I understand my plans shall he used as public records
>yU
e win Licensed Professional
H� OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Cale:Any city or county
m which requires a permit to construct,alter,improve,demolish,or repair any structure
YJ
Z y prior to 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 Sq.Ft.Floor Area Valuation
EEC F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $106113
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 Number Occupancy Type
not more than five hundred dollars(5500). 3752303 3
❑1,as owner of the property,or my employees with wages az 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
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
sa
,
I,yaz owner of the properly,am exclusively contracting with licensed contractors to
constroct 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 contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt der Sec.
B&PCfor this reason
6
Owner
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure rorworkces 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 Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy 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 work for which this permit is issued.I shall not
employ any
Certificate of Exemption,you should
become subject to the Workces Compensation provisions of the Labor Code,you must
Oforthwith 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
tic > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z Lender's Address
V 0 I certify that I have read this application and state that the above information is
IIr— correct.I agree to comply with all city and county ordinances and state laws relating to
rJ U building construction.and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rFr rA liabilities,judgments•costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. �—
►-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date
SOURCE
? All roofs ;hall be inspected prior to any roofing material being installed.
[I Yes
If a roof i;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?
❑Yes to
1 have read the ha72rdtws 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 the
requirements which must be t prior to issuance ora Ccrtificatc of Occupancy. Signature of Applicant Date
Pd'� All roof coverings to be Class "Biz or better
Owner or authorized agent ate