06070202 CITY OF CUPERTINO owii ESN«
BUILDING DIVISION PERMIT
BUILDING ADDRESS: LAWS S CONSTRUCTION PERMIT NO. 06070202
20065 D
PERMIT ISSUE DATE
IWNER'S NAME:
FRANKIE & SUE LAW 105
SANITARY NO. CONTROL NO.
PHONE:
(408) 996-2353
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
UJ
=y in full force and cffeCL DEMO ONE STORY S FDWL
v�Z License Class Lic-#
t p Date Contractor
ARCHITECTS DECLARATION
cc< t understand my plans shall be used as public records
tUU.U
-a
H Licensed Professional
y OWNER-BUILDER DECLARATION
'> I hereby affirm that 1 am exempt from the Contractor's License Law for the
pO 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 at its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
t=-$ (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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of IQ,ffiaQr- 0 0 Occupancy Type
not more than five hundred dollars(5500).
❑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
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 sate.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 Contractor's In-
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.
❑I am exempt under Se B&P C for this real
-,vnerDate �0
WOR MPENSATION DECLARATION
1 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 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:
Cartier. 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 person in any man r iAXPTd9*ect to the Workers'Compensation
Laws of California.
Applicant
NOTICE TO APPth ompe ng this Certificate of Exemption,you should
become subject to on provisions of the Labor Code,you must
�`L forthwith comply with such provisions or this permit shall be deemed revoked.
z O 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.)
fro A Lender's Name
aLender's Address
U 0 1 certify that I have read this application and state that the above information is
LL correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives or this city to enter upon the
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and expenses which may in any way accrue against said City
C)z in consequenceZ1hei permit. Date /��f�-4APPLICANT UD WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGRe-roofsSignature ofApDare T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
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
17odc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes KN
Will the applicant or future building occupant use equipment or devices which If a roof is installed 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?
❑Yeslo
1 have read the harardou materials requirements under Chapter 6.95 of the Califor-
nia Health&Safct cti ns 505,25533 and 25534.1 understand that if the building
docs not curse y have t, at it is my responsibility to notify the occupant of the
requirements h st be et 'or to issuance o[a Ccrtificatc of oc p Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or autho nt Dare