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090301320 Z a CIO .'7 U V. 0 F U CITY OF CUPERTINO PERMIT�� 0.� ��sk BUILDING DIVISION PERMIT NO. BUILDING ADDRESS: 20975 VALLEY GREEN DR #278 TBD - TO BE DETERMINED 09030132 PERMIT ISSUE DATE OWNER'S NAME: vC)nnm-POIZIDATION S A CONTROL NO. HONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION fob Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70W) ofDivision 3 ofthe Business and Professions Codcand my license is INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES in full force and effect License ontractor g E/M/P' S -SEE PERMIT #09030198 FOR PLAN CK Date Contractor D ARCHHcrsDECLARATION COMMENT 3 . 1 understand my plans shall be used as public records i i Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I 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 �q Ft. Floor Area Valuation r prior to its issuance, also requires the applicant for such permit to file a signed statement 9 r that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 3 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $100 . 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 APN Number Occupancy Type not more than fire hundred dollars (M). 32609041 .278 ❑ 1, 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 docs 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 arc not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - build improve for of builder will have the burden of proving that he did not or purpose sa y gA✓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 U. 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 exem t under Sec. . B & P �forshreaton Owner, Date '? 1 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 are.- re:Carrier. CarrierPolicy 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 14c worltror which this permit is issued. I shall not employ any person in any mantic belin su6icct to the Workcrs' Compensation 'K/ Laws of Calif i i Datc f Applicant NOTICE TO AP CAM: if, after making this Certificate of Exemption, you should b U become subject to the Worker's Compensation provisions of the Labor Code, you mast forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 4 1 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.) Lender's Name i~ Lcndees Address 0 1 certify that I have read this application and state that the above information is rl 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-mentioned 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 Z in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITHAL NON -POINT Issued by: Date REGULONS. S ` KlbqRe -roofs T of F.00f Type SigniLure of Applicant/Contractor bate HAZARDOUS 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, 25532(a)?All shall be inspected prior to any roofing material being installed. Section C] Yes VNo roofs 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? ❑Yes EZNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the Date mq�uirem `which m t be met p ' r to 'sats ce of a Certificate of OreJ�'an Signature of Applicant 11 l A .t^ .l ham- �/ � ` b4 All roof coverings to be Class "W' or better Owner or authorized agent Liatc