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07030037BUILDING DIVISION z O .-r ►-r A z _o U W a :n z CENT CT LOT 3 I KELLY GORDON DEVELOPMENT OWNER'S NAME: t.'V mk' KELLY GORDON DEVELOPMENT CORP 12241 SARATOGA - vry (408)873-8774 ARCHrfELTIENGINEER: rrrcrvtrt NO. 07030037 PERMIT iS'SUE DATE 05/03/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB LICENSED COMLRACIOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing .lob Description with Section 7000) of Division 3 of the Businim and Professions Code, and my license is S FDWL - 2 STORY 3 , 9 91 ' GARAGE 7 9 4 ' in full form and effect Q License a Tic. • FLR : 2,535 2ND FLR : 1,456 Date Contractor v RCHITECPS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's license Law for the 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 prior to its issuance, also requires duo applicant for such permit to fife asignccistatement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Arl (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt therefrom and the basis for the alleged exemption Any violation of Section 703 L.3 by any applicant for a permit subjects the applicant to a civil penalty of N Number not more than firs: hundred dollars (S300). 13261709 , ❑ 1, as owner of the property, or my employ= 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 Contsactofs License Law does not apply to an owner of property who builds or improves thereon, and who does such work himulf or through his own employees, provided that such improvements are not intended or offered for sate- If, however, the building or improvement 1s sold within one year of completion, du owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ L as owner of the propeny, am exclusively contracting with Boned contractors to construct the project (See.7044. Business and Professions Code:) The Contractor's L3- cam law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuitat to the contractor's L.lcense law. Q f am exempt under See , B & P C for this mason Owner Date WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations Q 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 iterformance of the work for which this permit is issued ❑ 1 have and will maintain Worker's Compensation insurance, as required by Section 3700 of the Labor Code, for die performance of the world for which this permit is issued My WorlicelCompensation ranee carrier IT Policy number Cartier Polity No CERTIFICATE OF © PTION FROMWORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (5100) 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 Competmion Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compenudom provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I 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.) Lendds Natnc Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mendoned 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 in consequence of the granting of this permit APPLICA STANDS AND WILL COMPLY WiTH ALL NON -POINT SOUR F.ti 1 NS� Si ofAppli t/Contractor Date HAZARDOUS MATERIALS DISCLOSURE r appGant or future building occupant store or hat" hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 25532(a)7 ❑Yea � 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 District? Q Yes £ 1 have read the hazardous materials requirements under Chapter 6.95 of the Caller- nia Health & Safct Code: Sccdom 25505. 25533 and 25534.1 understand that if the building does a tenan4 drat it is my responsibility to notify the occupant of the require w ' must be 11Qtpilim4a ebsuitace g&<6ufieaic of ommarI6. # Issued by: Re -roofs Type of Roof $900316 Required Inspections Occupancy Date S 1ST All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class " S" or better