Loading...
09060171 CITY OF CUPERTINO BUILDING DIViS;ON PERMIT 4r1\t�l. Q lbYTlr, • . PERMIT NO. BUILDING ADDRESS: 10185 RICHWOOD DR QUALITY FIRST FQMF 09060171 PERMIT ISSUE DATE OWNER'S NAME: IMPROVEF ENTS C!M W999 S A CONTROL NO. 'ONE: — (916) 7E8-2921 BUILDING PERMIT INFO ARCHTTECTIENGiNEER: BLDG ELECT PLUMB MECH � p LICENSED CONTRACTOR'S DECLARATION Job Description V I hereby affirm that I am licensed under provisions of Chapter 9(commencing with section7000)ofDivision 3ofthe Business and Professions Code,and mylicense is RE-RF RMV OLDWD SHK RF & DISPOSE OF INSTL 50YR a SMin full force and z LicenseClasa _e Color S GRND SEQUOIA RF INSTL 5/8 OSB PLYWD & DECK ARMOR Date ARCHITECTS DECLA ATI N CLS A 2-'SQ I undebe used as public records m< ©C.TAvtn /7�itr7 7yU U.y Licensed Professional OWNER-BUILDER DECLARATION <I i hereby alTirm that 1 am exempt from the Contractor's License Law for the i 1o following mason.(Section 7031.5,Business and Professions Cafe:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any StructurePi _ prior to its issuance,also requires the applicant for such permit to Glc a signed statement t;q.Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 y (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $24234 y .. 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 five hundred dollars(M). 36908040 . 0 0 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does 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 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 sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Cale:)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 de contractor's License Law. ❑i am exempt under Sec. B&P C for this reason Owner Date 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 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 Compensation Insurance,as required by Section 3700 of the Labor Cale,for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number am: Carrier. C% 00104 Policy No.: t4 CERTIFICATE OF EXEMPTION FROM WORKER' COMPENSATION INSURANCE (Mis section need not be completed if the permit is for one hundred dollars($100) or less.) i certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date 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 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.) W QLender's Name 51. Lender's Address V 0 I certify that I have read this application and state that the above information is LL E" correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the Uabove-mens tioned property for inspection purpose a (We)agree to save,indemnify and keep harmless the City of Cupertino against hF,y to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date P� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU Rc�EGULATIONS. _ (JLT�4 10 L3 f,4 4 o6'3� 'fir( Re-roofs Signature of Applicant/Contractor Dae Type Of Roof MATERIALS DISCLOSURE yP 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 Cotte,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea a If a roof .s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which :mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes we I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Code.Sections 25505.25533 and 75534.1 understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the Date rcqu�rcnts which must be met Por to issuance of a Certificate of Occupancy. Signaturf:of Applicant (/6rAoo T Iate 06-3" 0 R All roof coverings to be Class" `'or better Owner or authorized agent Date