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09030094CITY OF CUPERTINO K k i ixx �J� BUILDING DIVISION PERMIT r;Fdt 3„ BUILDING ADDRESS: PERMIT NO. 20975 VALLEY GREEN DR #213 TBD - TO BE DETERMINED 09010094 OWNER'S NAME. PERMIT ISSUE DATE PHONE CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description ons of Chapter 9 (comencing 1 hereby affirm that I am licensed under pmvlsim inullooreNWct«ta3�ft ��my�� INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES License D Class LIC. 2 Contractor E/M/P' S -SEE PERMIT #09030198 FOR PLAN CK ARCHITECT'S DECLARATION 1 understand my plana shall be used as public records COMMENTS. Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from t)ic 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, demolish, or repair my structure prior to its Issuance, also requires the applicant for such permit to rile a signed statement Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pariment to the provisions of the (commencing with Section 7000) or Division 3 of the Brininess and Professions Code) or $100 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of nor more than five hundred dollars (M). 32609041.213 ❑ L as owner of the property, or my employees with wages as their sok compensation, Required Inspections e 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 does not apply a an owner or q P property who builds orimproves thereon. and who does such wort himself or through his own employees, provided that seep improvements tae not Intended or offered for sale. If. however. the building or improvement is sold within one year of completion. die owner - builder will have the burden of poring that he did not build or improve for purpose or 7sale. L as owner of the property, am exclusively contracting with licensed cuntracara a construct the pmject (Sea 7044. Business and Professions Code:) The Contractor's Li- cense Law does mot apply to an owner of property who builds or improves Uiemmom, mad. who contracts for such projects with a comurector(s) licensed pursuant to the Contractor's Li== Law. ❑ I am eaempt undo Senna v B h P C for this mason Ownter'YV�LcX/�4-�Q (�l �•L awe S a 1614 WORKER'S COMPENSATION DECLARATION 1 hereby amrm under penalty of perjury ale of the following deelam dons ❑ 1 have and will maintain a Cartineam or Consent to self -insure for Worker's Compen- sation. as provided for by Section 3700 of the Labor Code, for the performance or the work for which this permit is inued ❑ 1 have and will maintain Worker's Compensation Iruurmcc, as mqulned 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 ane: Carrie: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred doll= (3 10(l) ' or less) I certify, that in the performance of the work f r which this permit is issued, I shall nal employ any person In any manner 9thec m�s ct to time Workers' Compensation Laws of California. Due Applicant I _- - ''- — ` NCMCE TO APPLI� after making this Cenificatcof cmption, you should become subject to the Worker's Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be firmed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm this them is a construction lending agency for time performance or the work for which this permit Is issued (Sex. 3097, Crv. C) Lendds Name Lc= Address j I earthy that 1 have read This application and suite that the above information is correct 1 agree to comply with all city and county ordinances and stale taws misting to ibuilding construction, and hereby authorize representatives of this city to cater upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 1 liabilities, judgments, costs and expenses which may in any way accrue against said City =in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N -POINT Issued by: Date SO� REGII T10NSI Re -roofs Type of Roof ACBA fl,,-I� � ha Signs= ofAppl HAZARDOUS MATERIALS DISCLOSURE D.m 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. sectio, 25532(4? ❑ Ya voo 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 Will the applicant or future building occupant use equipment or devices which emit hazardous air cottamhtanta as defined by the Bay Area Air Quality Management all new materials for inspection. District? [:]Yes o 1 have read the I,,,,rdous materials requirements under Cdspler 6.93 or time Califor- nia Health k Safety Codc, S=km 25303.23333 and 23334.1 understand thatl(the building does not cwenUy Imave a tenor that Il is my resporcsibilily ur notify the occupant of time ri rata which be mr traumcc eI Cerr;rmate or ��ILI Signature of Applicant Date '—A ' 1 5 6 0 All roof coverings to be Class'%q'' or better r Dark Owner or authorised agent