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09010096°Do .z g U. g�1 N Lpe7 Kai -Zt YFO CITY OF CUPERTINO PERNUT100 x , �"�h BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 20673 GREENLEAF DR NICE & RIGHT CONSTRUCTION OWNER'S NAME: INC EMIT ISSUE DATE PHONE_ S CONTROL NO. (408)861-0928 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR's DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. NON-STRUCTRL KTCHN RMDL, ADD LITE FXTRS @FAM Dates Clan — Co�� RM,HALL,DINING RM& SKYLITE RPLCMNT ARCHr1EC1'S DECLARATION I undersand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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, demollsk or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuation that he is licensed pursuant to time provisions of the Contractors License Law (Chapter 9 Sq. (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the allcgcd exemption. Any violation of $15000 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (SM. 32656005 . O O of the property, or my employees with wages as their sale compensation. ❑ L as owner ens Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law dints not apply to an owner of property who builds or improves thereon, and who does such woric him -1f ur 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 - budder will have the burden of proving that he did not build or imprme for purpose of sale.). T, as owner of the property, am exclusively contracting with licensed contractors to truct time project (Sec 7044. Business and Professions Cada:) The Contractors Li- ccase Law does not apply to an owner of property who builds or improves theeon. Ind, who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec , B & P C for this reason O Date "-KER'S NSATION DECLARATION I hereby affirm ander ty of perjury one of the following declarations ❑ I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- sadon. 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 Polley number arc: Carrier: Policy Na: CER77FICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section mad not be completed if the permit is for one hundred dollars (S 100) . or less) 1 cenify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any mamhcr so.#to beeo!n subject m the Workcri Compensation . lAsys of Calif ria. Doc . �- Oat Apsplicaut ���4X - NOTICE TO APPUCANT: If, alter making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the I,bor 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 perfornatre of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Landers Address I certify that I 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 reladng to building construction, and hereby authorize representatives of this city to enter upon the above-mendoned property for inspection purposes. (We) agme to save, indemnify and kap 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 ", 2� permit APPLICANT UNDERSTANDS AND WILL COMPLY Wrni ALL NON -POINT g Issued by: Date C - / RCE REG ONS. _ Re -roofs Type of Roof 'z�-- Signume ol'AppliAnt/CoAficter Date HAZPDOUS MATERIALS DISCLOSURE 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)? '¢No All roofs shall be inspected prior to any roofing material being installed. ❑ Yea (� 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? ❑Ye No 1 haw read the hazardous materials requimmcans under Chapter 695 of the Califor- nia Hcalth & Safety Code, Sections 25505.25533 and 25534.1 undersand that if Use building ktito'not currently have a WML that it is my responsibility to notify the occupan of the Ip roof coverings to be Class 'j'' or better DateAll Own o' agent h)