08100195CITY OF CUPERTINO
BUILDING DIVISION
BUILDING ADDRESS:
1 17
OWNER'S NAME:
PHO
PERMIT
COl'rlll.OLNO.
ARCHlTEcrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
f-!:::: '~~~~i-=:;;-;-;;==----+--~--------....L..----=1==1_----=1==1_----61==::::!IL.....----...bl====,1_a1!5 ~ LI SED OIoITRAcroR'S DECLARATION ~~ I:: I bcn:by amrm thall am lia:MCd under provisions or Chaptcr 9 (commcncing Job Description
_.< ~ \do.. with Section 7000)or Division 3arthc Business and Prarcssian.,Code. and my license is
j~~ inrullralC1:anderr""l DEMO EXISTING HSE FOR NEW CaNST I 800SQ. ~ i= 9 ~~~nse Class -------~~:..,..,-r-----------
• - -ARCHITEcrS DECLARATION ~~ ~ f understand my plans shall be: used as puhlic records
J ~CJ I ;c======------------------~~ t; Licensed Professional
~",j OWNER·BUILDER DECLARATION
I hereby amrm thai I am excmpl rrum thc Contractor's License Law rar llu:
~~::ll rallawing reason. (Section 7031.5. Business and Pmrc.wans Code: Any cily or counly;::~~<.. llwhich rcquirc.s a pennil to construct. aller. improve. demolish, or repair any slrUClun:.,-", prior 10 ilS issuance. aJsu requires lIu: applicanl rar such permilla IiIc a signed stall:mcnl r--------:::---::;:-=:---;---~----__.,_-------__::_::_.,._-:__---------::?;~ lhal he is licensed pursuanllO llu: provisions or llu: CanlraClOr's License Law (Chapu:r 9 Sq. Ft. Floor Area Valuation ~::Q >:I-j (cammcncing with Section 7000) of Division 3 or the Business and Prorc:ssians C~) Or
f~-that he is exempl therefrom and the basis rar the allegcd exemption. Any violation or f---------:;-:;:~~;:___;--:-------__l'---......'--'Cl.L.w'l....=----__:=_-------
Section 7031.5 by any applicanl ror a permil subjeclS llu: applicanlla a civil penally or APN Number Occupancy Type
nol more than live hundred dallan ($500). 32622037.01D I. as owner or the propc:ny. or my employees with wages as their solc compensation. L """"::-_""':"'_~~--_:_------------------
will do the work.and llu:structure is nal intended or offered rar salc (Sec.7044,Business , • d
and Pmfessians Code: 1lIe CantrlClOr's License Law docs 1101 apply 10 an owner or ReqUIre Inspections
property who builds or improves lhucan. and who does such won: himselr or through his
own employees. provided that such improvemenlS an: nal inll:nded or alTered rar sale.fr.
however. the building or improvemenl is sold within one year or completion. the owner·
builder wiD have the burden or proving thai be: did nol build or improve rar purpose or
sale.).
D I. as owner or the property. am ""clusively canlraCling with Iiet:nsed c:onuac:la," 10
construct the projeci (Sec. 7044. Business and Pmrc:ssians Code:) 1lIe CanlraC\Or's Li·
cense Law docs nal apply 10 an OWner or property who builds or improves thereon, and .
who canlraClS rar such projects with a c:onlral:\ar(s) Iiet:nsed pursuanllO llu:Canuae:lar's
License Law.
D I
k/ 2.b'4
Issued by: Date
Re-roofs
Type of Roof
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 "R-J
' or better