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09030137FA CITY OF CUPERTINO PERMIT�7'��©� BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 20990 VALLEY GREEN DR #610 TBD - TO BE DETERMINED OWNER'S NAME: PERMIT ISSUE DATE 99 PHONE: SWg#5g2 CONTROL N0. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job DOSCTIpt10n I hereby affirm that 1 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. INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES License enxClazs Contractor Date Contractor D E/M/P' S -SEE PERMIT #09030198 FOR PLAN CK ARCHITECTS DECLARATION I understand my pians shall he used as public records COMMENTS. Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rite a signed statement License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractors (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 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). 32609053 . 610 ❑ 1, as owner of the property, or my employees with wages as their sale compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec.7044,Business and Professions Code: The Contractors License Law does not apply to an owner of 9 P property who builds or improves thereon, and who does such work himself or 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 cam fiction, the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.) as owner of the property, am exclusively contracting with licensed contractors to c stroct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. 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 Contractors License Law. ❑ I am exempt under Sec. B & P C for reason Owner AJC A T WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers 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 Workers 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 Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars ($100) or less.) I certify that in the performance of Ihq work r which this permit is issued, I shall not ' employ any person in any manncrsaatilto bee mq s'ubjotI to the Workers' Compensation '7 Laws of California..11alc 1 ! I l '••f Applicant {_� w �� - 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 forthwith comply with such provisions or this permit shall be deemed revoked. i CONSTRUCTION LENDING AGENCY I 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.) Lenders Name Lender's Address I certify that I have read this application and state that the above information is - correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby amhorim representatives of this city to enter upon the above-mentioned property for inspection purposes. (WF) 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 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -PO NT Issued by: Date tX SSE REGULATIONS. Type of Roof /1/-1� .l � Ate.,. k 5 4 AlRe-roofs Sign ture of Applicant/Contractor D to HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle harardous material az defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed, r_1 Yes No 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 defined by the Bay Area Air Quality Management all new materials for Inspection. District? ❑Yes u 1 have read the hazardous materials requirements under Chap ter6.95 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 nodfy the occupant of the req ' men which must be me prior to r trance of a Certificate of Occu ey a �6 Signature of Applicant Date n' ,'t ^^^- � d � All roof coverings to be Classor better - Owner or authorized agent Date