07080072 CITY OF CUPERTINO '
BUiLDINGDIV1S10N PERMIT �����"'�o����������
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PERMIT NO.
aur � D � x �g o l o � ess CRESCENT RD—LOT 4 KELLY GCRDON DEVELOPMENT 07080072 .
PERMIT 155UE DATE
12241 SPRATOGA — SUNNYVALE 10/12/2007
D n SANITARY NO. CONTROL NO.
PHONE: �408� 87�-8774
BUILDING PERMITINFO
ARCHIIECT/ENGINEER: B� EL� PL� M�
� p o LICENSED CONTRACTOR'S DECLARATION JOb DeSCilptl0❑
: v� I hcrcby afGcm that I am 1"�ccnsed undcr provisioas oC Chaptcr 9(commcncing
; z� wiih SccGon 7IXx�) of Division 3 of thc Busincss and Prafcssions Codc. and my �iccnse is S FDWL 2 S TORY 3� 8 2 8 GARAGE 7 7 5'
>> y in fuli fotce an d e f tec�
j v� Z Licensc Clazs ��• �
n p Conuaclor
: F' � ARCHITECI'S DECLARATION
j a 4 I undcrstanJ my plans shall be uscd as puAlic rcwrds
)aU
' u. y Licensed Pmfcssional
� � a OWNHR-BUILDER DECLARATION
� a� 1 hcrcby alTirm U��t 1 am excmpt Crom ihc Con�ractor's Liccnsc Law Cor Ux
p o Collowing rcason. (Sccuoa 7031.5. Eusincss and Profccsions Codc: Any city or cauniy
�°„ � which roquires a permit to cnnswct, al�cr, improve, demolush, or eepair any ��^
°' y prior W ils issuancc, also rcquires the applicant for such pertni� to filc a signed stauYnen� � q . Ft. Floor Area Valuation
-? a �hat hc is liccnscd pursuant �o thc provisions of thc Conuacwr's Liccnsc Law ((]up�er 9 $ 9 5 7 0 0 0
Y�� (commcncing with Scction 7000) of Division 3 of Ihc Business and Profcssions Codc) w
i�., thai he is ezempt themfrom and tAe basis [or the allcgcd exempuon. Aoy viola[ion ot Occupancy Type
Sectlon 703 i.3 by arry applicant for a pertnit subjccu the applicant to a civii penalty af 3 2 617 0 9 EJ�N Number
not mare than five hundred dollars (5500).
❑ l, as owner oC ttie property. or my employces with wages az their solc compensa�ion.
will do thc work, and ihe st�ucture is not intcndcd or offered forsak (Sec.7044. Businesa Required Inspections
and Professions Code: The Conuxwr's License Law does not apply to an mvixr of
propeny wha builds or improves thereon, and who does such wark himul[or Uvoug6 hia
own employces. Providcd that such improvements are no[ imended or offered f� sal� I[.
however, the building or improvement is sold within one year o[ wmpleuon, ihe owner-
builder will have the barden of pcoving �hat he did not build or improvc (or pu�pose af
salc J.
� i. u owner o[ the property. am ezclusively convacting wi�h ticenud convactors W
construct �he projea (See. 7044. Business and Profcssions Code:) The Coateacwrs Li-
ccnse [aw does wt apply to an owner of propeny who builds or improves tde�eon, and .
who conuacu Cor sixd projects wi�h a conuactor(s) liansed pursuant to �he Convactoc's
License Law.
f'� i am u f�i,tdndu Sec . B& P C tor this mawo
;r Date 11 C _ . -
W RKER'S COMPFI�SATION DECLARATION
I �rm under penalry ot pe�jury one of ttx following declarations:
❑[ hsoe and will maintain a Certifiwte of Consent to self-insurc for Workc�s Compen-
sation, as provided for by Secrion 3700 of the Labor Code, for the perfo�mance o( the
work [or which Nis permit is issucd.
❑ I have and will maintain Worker's Compcnsation Insunnce. as �equired by Scction ,
3700 0( the Labor Code, Cw the per[ormance of the work for which �his permie is istued•
My Worke�s Compensadon Insurance carrier and Policy numbcr azc:
Cartier. Policy No.:
CERTfF7CATE OF EXEMPT[ON FROM WORKERS' ,
COMPENSATlON INSURANCE
(This section necd not be complcted it the pcm�it is (or onc hundrcd dotlacs (5100) ,
or Icss.)
I ceniCy thxt in the
become subject to �e Worker's Compensatian provisions of �c Labor Codc, you must
, O forthwith comply wi�h such provisions or this pecmi� shall bc dccmcd revokcd.
z �-' CONSTRUCTION LENDING AGENCY
H � I hemby atrrtn ihat there is a construction Icnding agency for the performance uf '
p(, � ihc wurk fur which Utis permit is iuucd (Scc. 3097, Civ. CJ .
W Q Lendcr's Namc
� z L,ender's Address
1 cenify U�at I havc rcad this application and staic tha� thc above infocmatiun is
� O cortcct. I agree to tomply with all city and county onlinances and sta�e laws relaung w
O U building conswction, and hemby authori�e representatives of this city to enler upnn Nc
abovc-mcntloncd properly for inspccuon purposes.
�'' a (Wc) agrce to save, indcmni(y and kecp hartnleu the Ciry of Cupcnino against
H � liabilities, judgmcn�s, costs and expenses which may in any way accnie againsl said �ty � /
U z ia consequence oC thc ���g ar m�s ����. Date �(/" �[�
►�
l:• /<< �C 7 Re-roofs ,��/
Signazure of ApplicanUConuactor �� T of R oof
HAZARDOUS MATER[ALS DISCLOSURE YP
Will �hc applicant or futurc building occupant storc or haadlc haiacdous matcrial
'efincd by thc Cupenino Municipal Codc. Chaptcr 9.I2. and thc Hcal�h and Safely
�, SecGon 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Y� N O '
Will ihc applicant or Cuturc building occupant usc equipmcnt or dcriccs wbich
If a roof is installed without first obtaining an inspection, agree to remove
emii hnrardaus air conuminan�c as dcfincd by thc Bay Area Air Quality Managcment all new rr aterials for inspeccion.
Disvict?
0 Ycs �-�
1 havc rcad the haiard<ws ma�crials rcquircmcn�s undcrChaptcr6.95 of �c Califor-
nia Hcalth & Saf Scctions 25505, 2 534. f undcrstand thaz if �hc buildin6
does not ntly have 'tenan4 �� � my respons' lity to notify the occupant of Ne 11 Date
rcyu' mcn�s which st Ec � W issu Ccnificatc of Occu ry. Signature of Applicant
t' �'� �'�� ��/� � All roof coverings to be Class "B or better
pu�Int^ryi agcnt
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