07100029 CITX OF CUPERTINO ' �������10�l:
BUILD[NG DIV1S10N PERMIT ��������
>: ;::: __.. . ..
— PERMIT NO.
BUTC.D i Nr ��� ss CATALANO CT LOT 4 GREATER BAY CONSTRUCTION 07100029 .
PERMIT LSSUE DATE
4125 BL�.CKFORD AVE ' 10/16/2007
SANITARY NO. CONTROL NO.
PHONE:
(408)24f'�-6600
BUILDING PERM11' INFO
ARCHITECC/ENGINEER: BLDG ELECT PLUMB MECH
� 0 � �
i p p LICENSED CONTRAC7'OR'S DECLARAT[ON IOb DeSCI'1pL10❑
� V� I hcreby afGrm U�at I am licenscd undcr provisions oC Chapicr 9(commencing _
: z� with Sccuon 700U) of Divisian 3 of ihc Busincss and Prafcssiuns Codc and my liccnsc is REV I S I OP 1 TRU S S CALC S OR I G # 0 7 0 3 0 0 7 5
�� y in full (orcc and eCfect
�� ? Licensc Class Lic. #
p Datc Conuactor
: F' � ARCHCCECI'S DECLARATION
j a a 1 undcrstanJ my plans shall bc used as public records
)yU
' u. y Licensed Pn�fcssional
: � a OWNER-BUILDER DECLARATION
� N .-7
1 hcreby alTirm that 1 am cxcmpt Crom �hc Convactor's Liccnsc w or ihc
� p o foliowing rcason. (Sccuan 7031.5, Business and Profcesions Codc: Any eity ar county
�,°, .�c� which tcquires a pcnnit to coaswct, allcr, improvc, dcmolish, nr repair any svucturc
�' y prior w i�s issuance, also requiics the applicant for such permit to file a signed staiement ` r Valuation
-? a that hc is liccnscd pursuanl lo thc provisions of thc Conuacwr's Liccnsc Law (Chaptcr 9 C�. Ft. FlOOC ACC3 ' O
ti t �(commcncing wi�h Section 7000) of Division 3 of Ihc Busincss and Profcssions Cadc) or �
i�� Ihat he is axampt theccfrom and ihe bazu for the al(cgcd exempdon. Any violaUan o[ Oceupancy Type
Section 703I.5 by arry applicant for a pem�it subjecu the applicant to a civil penalty o( 3 6 218 0 6<3'.°'(�� Number
not more than five hundeed dollars (5500).
❑ I, as owner oC ttie property, or my employees with wages az their solc compensation,
wiil Co the wock, and the suunme is not intendcd or oftered for sale (Sec. 7044, Business Required Inspections
and Professions Codc: The Conuactors Licenu Law does no[ apply w an owner af
propeny who builds or improves thercon, and who does such work himself or through his
own employces. providcd that such improvemenls are not imended or o(fered Cor sale. lf.
hawever, building or impeovemenl is sold wilhin one year of compledon, the owner-
bui►de ill have the burden of proving Wai he did not build or impro� for pucpose of
�� .
I, u owner oC the property, am weclusively conuacting wiU� licensed conuacwrs w
construct the projea (Sec. 7044. Business and ProCcssions Code:) The Contncmr's Li-
cense [aw dacs oot appiy w an ownec of propeny who builds or improves �Aeteon, and ,
who contraces for such projects with a convactor(s) licenud pursusnt w the Convactar's
License Law.
❑ I am exempt du Sec . B� P C tor this rcason
� Date _ . -
DECLARATION
1 hercby atTim� under nalty ot perjury one of the following declaraGons:
❑ I have and wil! maintain a Cutificam of Conscnt to self-insure tor Workers Compen-
sation, as provided for by Secdon 3700 of the Labor Code, for �he performancc of the
work for which Nis permit is issced.
❑ I havc and will maintain Workcfs Compensation Insunnce, at �cquired by Scction ,
3700 0( �hc Labor Codc, for thc performance of �he work for which this pertnit is issued.
My Warker's Compensation Insucance nrticr and Policy number are:
Cartier. Policy No.:
CHRTIFICATE OF EXEMPI'(ON FROM WORKERS'
COMPENSATION iNSURANCE
(This section necd not be complctcd if the pertnit is for anc hundred dollazs (E100) ,
or IcssJ
I cenify that in thc perfortnancc of the work for which �his permit is issucd, 1 shatl not
employ any persan i mannc so as �' t to �he Workcrs' Compcnsation
Laws o[ Califomia.
Applicant
NOTICE TO APP CAM: If, r making ihis Ccni�catc of FaccmpGon, you should
bccome subjcct to lhc Worker's mpensation provisions of ihe Lador Codc, you must
�,Z foMwiih comply with such provisions or this permit sha0 bc dcemcd mrokcd.
Z O CONSTRUCTION LENDING AGENCY
[� r�-. I hcreAy aRrm U�at thcre is a constnxtian Icnding agc�y for thc perfortnan�x of
pl� .� ihc wurk far which this permit is issucd (Scc:. 3097. Civ. CJ ,
W A Lendcr's Narnc
� � L,ender's Address
V � I mni(Y �hat 1 havc rcad �his application and s�atc tha� thc abovc infocmaliun is
�� cortcct. I agrce to comply with all city and county arttinances and state laws rclating to
� U building conswction, and hercby authori�e represeniatives of ihis ciiy to enter u�n lt�c
ahovc-mcnuoned properry for inspccuon purposes.
�� (We) agree �o save, indemni(y and kecp hartnless ihe Ciry aC Cuperiino against
�� liabilitia, judgmcnls, costs and expcnscs w6ich may in any way accruc against said City /�
(„) z in consequencc oC Uic granting of 1hi ���. Date /C1� � v \
�+ APPLICA NDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by:
SOURC ULATI NS.
Re-roofs �� �
SignawreofApplicanUCo uxW �a T of Roof
US MATER[ALS DISCLOSURE YP
Will ihe applicant or fuwrc buildi g occupantstorc or handlc harardous matcrial
icfincd by the Cupertina Municip odc. Chapter 9.12, and [he Hcallh and Safcty
:.Scction25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑vcs o .
Will �he applicant or fuwrc bui mg accupant use equipment or dcvices which
If a roof i� installed without first obtaining an inspection, I agree to remove
cmit harardaus air conuminan�s u fincd hy the Bay Area Air Quatity Managcmcm all new m aterials for inspection.
DistriciT
0 y� No
I havc reaci ihe ha7ardous matcrials re uircmcn�s undcr Chapter 6.95 of �hc CaliCor-
niaHcalth&SafclyC Scctions25505, and25534.IundcrstnndthatiC�hc6uilding
docs noi currcnt h a unan�, ihat it' my sponsi6iliry to notify thc occupant of �hc
rcyuircmcnts w ic ust be prior iss cc of a Ccrtifx 1� o��,a��r. Signature of Applicant Date
�
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