07080225 CIT�' OF CUPERTINO ! ` ' " `
BUILDiNG DIVISION PERMIT �������������������' `
, ;,:. .
PERMIT NO.
BUfLD ��� v � .ess BIANCHI WAY BAJA CCNSTRUCTION CO INC. 07080225 .
OWNER'S NAME: PERMITLS�'UEDATE
CUPERTINO COMMUNITY HOUSING PO BOX 3080 � 10/02/2007
N: SANiTqRY NO. CONTROL NO.
(510)229-0732
ARCHTi'ECT/ENGiNEER: BUILDING PERM17' INFO
BLDG ELEC7 PLUMB MECH
G7 � 0 �
i p Q LICENSED CON7RACfOR'S DECLARATION
� U F. l hcrcby affirm thai I am Iicenscd undcr provisions of Chapicr 9(cammencing Job Description
;�: � with Scction 700U) of Division 3 of thc Busincss and Profcssions Codc and my liccnsc is NEW CAR PORT C ONSTRUC T I ON ND L I GHT I NG
� a��„ in fuli furce and cCfec�
j�? Licenx Class Lic. N
+ F W Datc Contraztar
„� ARCHITECTS DECLARA710N
i� a 1 undcrsunJ my plans shall Ac uscJ as public rcconis
>qU
' t� y Licensed Pmfcssional
� � � OWNER-BUILDER DECLARATION
I hcrcby a1Trtn that 1 am cxcmpt Crom ihc Contractar's l.iccnsc Law for t6e
� p O following �ason. (Scction 7031.5. Busincss and Profcstions Calc: Any ciry or coumy
i,° �i which rcquires a pertnit to cnnswc[, altcr, improve, dcmalish, or repair any swcture
° z} prior to i�s issuancc, alw mquires thc applicant far such permit to filc a signcd s�aicmcnt
�_ � mai he is liccnscd pursuant to thc provisions o( ihc Conuacwr's ucensc Caw (Chapicr 9 iC�. Fi. F�OOr AiCS � 9 O O O Valuation
u t- �(commencing wi�h Secdon 70�0) af Division 3 of ihe Business and Professions Cade) or
L �.. that he is ezempt thcmfrom and Ihe basis [or t6e allcgcd eumpdoa Any violation o[
Section 7031.5 by airy applicant Cor a permit subjects the applicant to a civil penalty of e� Number Oeeupaney Type
not morc than five hundred dollars (5500). 3 5 9 0 7 � 1 9:'�Y �
❑ 1, u owner oC tlie property, a my employces with wages az the'v solc compenudon,
will do thc �rk, and �he swcsu�e is not intendcd or afterod for salc (Sec. 7044. Buv�xss R� u ired Ins eCtl O i1S
and ProCessions Cadc: The Conuactors Licente Iaw dacs not apply in an aw�xr of 9 P
property who builds or improves �hereon, and who does such worlc himself ar thmugd his
own emplayccs, providcd that such improvements are not imend�d or o[fered far saie. [f.
howevu, the building or improvement is sold within one year of compleuon, d�e owner-
builder will have �he burden of proving �Aat he did not build or improve far purpose oC
salc.).
[�[, as awner of ihe propeny, am ezclusively contncting wi�h liansed conuacwrs W
wnstmct ehe projea (Sec. 7044. Business and Professions Cade:) The Contnetors Li-
ccnse Law dacs no� apply to an owner of propeny who builds ar improves �heROn, and ,
who conuac�s tor such projects wi�h a comractar(s) lianaed pursuant to the Conuacwrs
L'uense Iaw.
I am exem t u ' , B 8c P C for teason
p P � Date �� ��
WORKER'S COMPENSATTON DECLARATION " " `
I hereby atricm under penalty o[ perjury one o[ �he following datara�ioas:
�] have and will maintain a Certificate of Consent to sel(-insure for Workc�sCompen-
sation, as provided for by Section 3700 af the [.abor Code, far We pedormaMe of �6e
woric Cor which Ihis permit is issued.
❑ I havc and will maintain Worker's Campensatian Insurancc, ac ecquired by S�xyion
3700 oC the Labor Codc, Cw Uie performance of the work for which this permit is issued '
My Workers CompensaGon [nsurance cartier and Poliry number are:
Cartier. Policy No.:
CERTIF[CATE OF EXEMPflON FROM WORKERS'
COMPENSAT[ON INSURANCE
(This sectian nccd not be completcd if the permit is for onc hundred dallars (5100)
or Icss.) �
I cenify th�t in thc performance of thc work for which Wis permit is issued. I shall not
employ any person m an� manncr so �s,lui6ccoroc�bjcct to the Workcrs' Compencation
Laws of Califomia. D7Ul� � ����J�
Applicant J
NOTICE TO APPLICAM: If, af�cr making ihis CcrtiGca�c of Ezcmption, you shauW
bccome subject to thc Workcr's Compcnsation provisions of thc La6or Codc, you muu
� O forthwi� comply wiih such pravisions or this pecrnit shall 6e deemed revoked.
� �"' CONSCRUCTION LENDING AGENCY
[—�+ � I hem6y a(irm that there is a conswcGon lending agenry Cor the performancc oC
f1i � ihc work for which this permi� is issucd (Scc. 3097, Civ. C.)
W� A Lendcr's Namc •
� z L.ender's Addrcss
U � I certitY that I havc rcad this applieation and sutc thai thc a6ovc informatiun is
w ► - + cortcct. I agree �o comply with all city and county onlinances and s�ate laws eelating to
� U building conswc�ion, and hcrcby authome represcnta�ivcs of ihis ci�y to cntcr u�n thc
r W abovc-mcntioncd property (or inspccuon purFwses.
a (Wc) agrce to save, indcmni(y and kecp harmless thc Ci�y o( Cupertino agains�
�� liabiliues, judgmcnts, costs and czpcnscs which may in any way accruc againsl said City
U z in consequencc oC thc granting of this permi6 ,����
"-+ APPLICA NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i Z
SOURCE ONS. , �
�-�� /o��-��� Re-roofs
Signaturc of ApplicanUConuactor Da1c °
HAZARDOUS MA7'ERIALS D[SCLOSURE Type of R� �of
wll ihe applicant or futurc building xcupant storc or handlc harardaus matcrial
az dcfincd by Uce Cupertino Municipal Codc. Chaptcr 9.12, and nc� Hcalth and Safety
c«��, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs �I No
�� If � roof is installed without first obtaining an inspection, I agree to remove
�11 U�e applicant or futurc building occupant �sc eyuipmenl or �k.wicct whicA
cmit ha•rardous air contaminan�s as dcfincd hy the Bay Arca Air Qasliry Managcmcnt all new m� �terials for inspec�ion.
District? ,��!
❑ Ycs �No
/�
1 havc rcuf Ihe ha�ardous materials rcqui2mcn�s undcrChapter 6.95 oC�he CaliCw-
nia Hcalih & Safciy Codc, Scctions 25505, 25533 and 25534.1 undcrs�and thu iC�Fic huilding
docs no� n havc a tcnacK at 't is my rc onsibiliiy w noul'y �hc occupant of Uic
rc arcry ` � C / ' � — muupc_m � rwissu c o[aCcnificaico(oc Signature��fApplicant Date
y �/ , l%� t � 9 _
,/ -� All roof coverings to be Ctass "B" or better
Owncr or au�horizcd agcnt Datc