08060102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � 1 �fttT�� •
BUILDING ADDRESS: PERMIT NO.
7594 PEACH BLOSSOM DR CELTIC CONSTRUCTION
OWNER'S NAME: PERMIT ISSUE DATE
PRTT17r)rP IDArPRTCK I ADID MARTR 1094 )T
eHONE. A O. 8 8 9 CONTROL NO.
(408) 93-1224
ARCHrIECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
v p LICENSED CONTRACTOR'S DECLARATION Job Description
m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z 5 with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and effect ADD 36-r SQ FT / REMODEL KITCHEN & BATH
;�z License Lick
D3/9/09 CUST PD NEW PLAN CK FEES $2, 514 . 00 TO
La ARCHITECTS
Contractor
L F
ARCHITECTS DECLARATION
W U I understand my plans shall be used as public records
n,
`O in Licensed Professional
0.1 OWNER-BUILDER DECLARATION
rA
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
K m rE which requires a permit to construct,alter,improve,demolish,or repair any structure
yZ y prior to its issuance,also requires the applicant for such permit to rile a signed statement
x that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y.P_$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $125000
�,5 9 that he is exempt therefrom and the basis for the alleged exempdon.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than rive hundred dollars($5M). 36611122 . 00
0 1,as owner of the property,or my employers with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections
and Professions Code:The Contractor's License Law dace not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employes,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
sa1eJ.
as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense[aw docs not app( an owner of ro erty who builds or improves thereon,and
who contracts for such with a nuac s)licensed pursuant to the Contractor's
License Law.
0 I am exempt B&P C for this reason
Owner Date 1
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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.
0 I have and will maintain Worker's Compensadon 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:
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 perfo cc of the rk or which ffiis permit is issued.I shall not
employ any person' an m ncr so as me sub' t the Wo Com don
Laws o(Califomia
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(~i►�-. I hereby affirm that there is a construction lending agency for the performance of
p; the work for which this permit is issued(Sec.3097.Civ.C.)
WD.Q Lender's Name
Lender's Address
U C—) I 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
building construction,and hereby authorize representatives of this city to enter upon the
w above-mcntioncd property for inspection purposes.
04 (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 /
V z inconsequence of the granting is permit. Date ( ��
►� APPLIC UNDERSTA S A D WIL COMPLY WITH ALL NON-POINT Issued by:
SO RC R TIONS. t<Z,j
l Re-roof::
Signature of Applicant/Contractor Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municip 1 Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed.
0 Yes °
Will the applicant or future bui g occupant use cr�uipmcnt or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as fined by the Bay Arca Air Quality Management all new naterials for inspection.
District?
0 Yes N°
1 have read the ha7ardousmatc62 quirements de Ch plcr6.95 of the Califor-
nia Health& Code.Stxiitins 25505.25 3 and 25534.1 un d that if the building
d not rendy ave a tenant,that it is m responsibility to n the occupant of the
regm ch mttst be mel prior an
of a Certiftca f Occupancy. S ignatul a of Applicant Date
All roof coverings to be Class'JW'or better
Owner or authorized agent Date `